Article
How structured support, real-world experience, and early-career connection are helping new nurses find their footing and stay.
Health systems aren’t losing new nurses because they’re unprepared. The challenge is how well the system supports them once they arrive.
The first year of nursing practice has become one of the most consequential, and often preventable, points of strain in healthcare. Yet many organizations still approach it as a short-term transition rather than a long-term investment.
What emerged as key insights from a panel of early-career nurses at the recent Vizient Nurse Programs Conference—all participants in structured nurse residency programs—offers a more complete picture. Their experiences, reinforced by data, point to something important: The first year is where workforce strategy begins to take shape, for better or worse.
And when the right support is in place, it can also be where nurses begin to find their footing—and their future.
Here are their perspectives.
~24% of new nurses leave within their first year
16.4% average RN turnover nationally vs. 10% turnover for RNs who have gone through Vizient nurse residency programs
$3.9M–$5.7M average annual hospital loss from RN turnover
The first shift as a practicing nurse isn’t simply a continuation of training. For many, it feels like a sudden change—even a rupture.
In school, responsibility is shared. There’s a safety net—instructors, preceptors, structured checkpoints. Then, almost overnight, much of that structure drops ff, and expectations shift quickly. It can feel disorienting. But as several nurses on the panel described, it’s also where growth begins.
That early uncertainty isn’t a sign of failure; it’s part of how professional identity takes shape. The difference is whether new nurses are left to navigate it alone or are supported as they work through it.
Nurse residency programs play a critical role here. Not by removing the discomfort of the first year, but by helping nurses understand it—giving them language, context, and support as they build confidence in real time.
What new nurses expect the job to be and what it actually is don’t always line up.
Training often emphasizes discrete skills and checklists. And those fundamentals matter. But the reality of nursing quickly expands beyond them. It’s managing multiple patients with competing needs. Coordinating across teams. Making decisions in real time, often with incomplete information.
For many new nurses, this shift isn’t about lacking knowledge—it’s about adjusting to the complexity of the role.
This is where structured support can make a meaningful difference. By creating space to talk through real clinical scenarios, reflect on decisions, and build critical thinking skills, nurse residency programs help bridge the gap between knowing and doing.
Over time, that reassurance, especially through experiential learning, helps nurses move from task completion to clinical judgment—a transition that is essential for competence, confidence, and retention.
There’s a part of nursing that can’t be taught through protocols alone. It shows up in emotionally complex moments—when patients receive difficult news, when families are grieving, or when the weight of the work accumulates over time.
New nurses encounter these realities early. And without support, those experiences can be difficult to process.
What stood out in the panel discussion was how valuable it is when organizations make space for that processing—through peer dialogue, guided reflection, and shared experience. These aren’t just “nice to have” elements. They are part of how nurses sustain themselves in the role.
When emotional support is built into the structure of the first year, it helps transform those moments from sources of isolation into opportunities for connection and growth.
Most organizations invest heavily in orientation. It’s structured, visible, and well-supported. But over time, that scaffolding begins to fade.
At the same time, expectations increase—often just as nurses are still building confidence and judgment. This is where continuity matters.
The nurses on the panel emphasized how important it is when support doesn’t disappear after the initial transition period. Ongoing mentorship, access to leaders, and opportunities for feedback all contribute to a stronger sense of stability.
Many nurse residency models are beginning to reflect this—extending support beyond the first year of practice.
Because for many nurses, that first year isn’t the end of the transition. It’s just the beginning.
Unexpected workload is often cited as a primary driver of nurse turnover. But what these nurses described points to something deeper. They expect the work to be demanding. What makes the difference is whether they feel seen, supported, and able to grow. Small moments matter here. Being asked for input. Being trusted with responsibility. Being invited to contribute beyond assigned tasks.
These experiences signal belonging.
Nurse residency programs and supportive leadership structures can help create those moments more intentionally—ensuring that new nurses aren’t just integrated into the workforce but connected to it.
Over time, that sense of connection is what encourages nurses to stay, engage, and continue developing in their roles.
The economics are hard to ignore. Every nurse who leaves represents significant cost and added strain on an already stretched workforce.
But the deeper insight is this: The first year is where nurses begin to decide whether they see a future in the profession—and within a particular organization.
What the nurses in the panel made clear is that when the right structures are in place, that decision can shift. Support, mentorship, and thoughtful program design don’t eliminate the challenges of the first year, but they can make those challenges manageable and even meaningful.
Organizations that are making progress in retention aren’t just adding more content or extending timelines. They’re rethinking how the first year is experienced—treating it as the foundation of long-term workforce stability.
The first year isn’t just a transition. It’s an opportunity to shape how nurses grow, connect, and choose to stay.
Improving early-career nurse retention doesn’t just require incremental changes—it calls for a more intentional approach to how the first year is designed.
Senior Director, Nursing Programs
Kelly Gallagher is the senior director for Nursing Programs at Vizient working on the Nurse Residency Program team. Her role focuses on operations and thought leadership of the Vizient/AACN Nurse Residency Program™. Prior to this role, Gallagher was the Director of the Nurse Residency Program at Penn Medicine in Pennsylvania and New Jersey where she provided oversight and strategic leadership...
Vizient Lead Programmatic Advisor, Nurse Residency Program
As a lead programmatic advisor for the Vizient/AACN Nurse Residency Program, Meg Ingram supports organizations in transitioning new graduate nurses to the profession of nursing as well as overseeing the program’s curriculum. Prior to joining Vizient, she was a nurse residency program coordinator and is passionate about creating a supportive, collaborative program in which new graduates can learn and engage...
