Nurse residency program provides a sustainable solution to nurse turnover

Safety net hospitals cannot afford constant turnover

The impact of the nursing shortage has been palpable for hospitals that fill a safety net role in their communities, where persistent turnover threatens workforce stability and financial sustainability. While national efforts have focused on nurse supply, demand and the cost of replacement, the continued loss of nurses after they enter practice remains a significant and costly challenge. High turnover is a pervasive, costly barrier to care delivery and team culture, driving recruitment and onboarding costs, forcing hospitals into a cycle of constant replacement rather than long-term stability.

At NYC Health + Hospitals (NYC H+H), that reality came into focus when nurse turnover reached 46% in 2019. Leaders at New York City’s largest municipal health system, which serves more than 1.2 million New Yorkers a year, found this unacceptable. Leadership recognized that sustaining the workforce would require a fundamentally different approach, one that treated retention, professional development and long-term support as core operating priorities rather than downstream outcomes.

Residency programs build careers, not just onboard nurses

What followed was the NYC H+H Nurse Residency Program (NRP), designed to stabilize the workforce over time. The program, which has reached 50 cohorts over its five years, focuses on long-term engagement with support beyond orientation. Using the Vizient/AACN Nurse Residency Program™ curriculum as its foundation, the NYC H+H program deployed a strategy to address nurse retention, workforce stability, leadership development and innovation.

Systemwide standardization creates consistent excellence

Backed by funding from the New York City government and the New York Alliance for Careers in Healthcare, a public-private partnership to strengthen the city’s healthcare workforce, NYC H+H launched its NRP in 2019 as part of a citywide regional collaborative. Over time, the health system expanded, standardized and embedded the program across its hospitals, creating a consistent transition-to-practice experience and a retention pathway that supports nurses beyond their first year.

44 percentage points translates to $12.7M in annual cost avoidance

Turnover among NRP graduates has decreased substantially since the program was launched, reaching just 5% in 2025. This level of turnover is well below national benchmarks and reflects an approximately 44-percentage point reduction among participating nurses.

The financial implications of achieving a 5% turnover rate are substantial. According to the 2025 NSI National Health Care Retention and RN Staffing Report, one-percentage point change in registered nurse turnover saves the average hospital $289,000 annually. Applied to this improvement, the NYC H+H NRP is associated with an estimated annual cost avoidance of more than $12.7 million, underscoring its role not only in workforce stabilization but also in long-term financial sustainability.

The NRP is intentionally designed to surround new nurses with long-term support, said Natalia Cineas, the system’s chief nurse executive and senior vice president.

Nurses who contribute meaningfully stay longer

As part of the NRP, newly licensed nurses complete high-impact evidence-based practice projects and quality improvement projects aligned with organizational priorities and Magnet standards. The ability to contribute meaningfully to the organization and receive recognition helps create continuity and reinforces belonging for the NRP participants, sustaining, engaging and stabilizing the workforce.

“The projects significantly impact our community,” said Albert Belaro, senior director of professional practice and education at NYC H+H. Belaro points specifically to a project to prevent pressure injuries that could be replicated beyond the hospital walls.

Alumni become mentors, turning graduates into culture builders

The NRP functions as a gateway into a culture of mentorship and professional governance. Support extends well beyond graduation: alumni return as mentors, facilitators and leaders, creating continuity and reinforcing a sense of belonging.

“We really try to create that psychological safety, but also that lifelong mentorship as part of their professional development,” Cineas said.

This sustained engagement has helped stabilize the workforce, strengthen succession planning and transform organizational culture.

Retention is a strategic imperative, not just an HR metric

Looking forward, NYC H+H intends to stick with the NRP as a part of its strategy to keep its nurses in the long run.

“This program has been instrumental in our recruitment and, of course, retention strategy,” Cineas said. “Creating that culture of support and education to nurses has been really key.”