The first year is pushing new nurses to the edge
Article | May 1, 2026
Reading time: 6 mins
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
1. Normalize uncertainty and build identity through it
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.
2. Train for complexity, not just tasks
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.
3. Build emotional infrastructure—not just clinical capability
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.
4. Extend support beyond orientation and year one
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.
5. Design for connection, belonging, and growth
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 strategic bottom line
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.
- Redesign the transition, not just the training: Prepare nurses for decision-making, prioritization, and real-world complexity from day one.
- Build emotional infrastructure: Create space for reflection, peer support, and psychological safety.
- Train for adaptability, not routine: Equip nurses to navigate different settings, patient needs, and care environments.
- Create early pathways for contribution: Invite new nurses to participate in improvement work early in their careers.
- Extend support beyond 12 months: Recognize the first two years as a critical window for growth, confidence, and retention.
- Implement a nurse residency program: The Vizient/AACN Nurse Residency Program—one of the first of its kind—helps transition newly licensed nurses from academic to practice. Developed by Vizient and the American Association of Colleges of Nursing (AACN), the nurse residency program includes an evidence-based curriculum and interactive exercises. The nurse residency program is designed to help decrease the nurse turnover rate, improve decision-making skills, enhance clinical nursing leadership practices, and promote the incorporation of evidence into practice. Participants benefit from access to benchmarking data, an up-to-date curriculum, and the opportunity to network with peers.