Trinity Mother Frances decreased first-year nurse turnover from 28 percent to 18 percent within 18 months of implementing the Vizient/AACN Nurse Residency Program™.

Member Profile

Trinity Mother Frances is East Texas’ preferred health care provider, with a tradition of over 75 years of dedicated service. A national leader in patient satisfaction, advanced technology, and quality initiatives, the health system is a faith-based, not-for-profit organization dedicated to creating healthy communities. The system includes Mother Frances Hospital-Tyler, Mother Frances Hospital-Jacksonville, Mother Frances Hospital-Winnsboro, Louis & Peaches Owen Heart Hospital, Trinity Mother Frances Rehabilitation Hospital, Tyler ContinueCARE Hospital and Trinity Clinic.


In 2010, Trinity Mother Frances Hospitals and Clinics faced significant nursing turnover. The system had a critical need to increase the number of staff with a bachelor of science in nursing (BSN) and ensure a pipeline of committed nurses. Although many hospitals across the country had good retention rates due to the national economic downturn, the Texas economy was still relatively strong, and nursing vacancies continued to plague the health system. Nursing turnover also affected other priorities, including support for the journey to Magnet designation and the Pathway to Excellence designation. 


Robert Rose, RN, MS, NEA-BC, senior vice president and chief nursing officer, was new to Trinity Mother Frances and felt that a residency experience for new graduate nurses would benefit the system. With his support, Trinity Mother Frances implemented the Vizient/AACN Nurse Residency Program™ in October 2010. The one-year program is designed to ease the transition to practice for new graduate nurses.


The impact of the residency program on new nurse retention was immediately apparent. “In the first 18 months, we saw a significant drop in turnover, from 28 percent to 18 percent,” says Rose. “We are hiring less and hoping for even better results as we become more selective in our hiring.” Rose feels that nurse residents are coming out of the Vizient/AACN Nurse Residency Program with lots of information. “They are very capable of making change based on evidence,” says Rose. “The promise of the program is being delivered: better teamwork, more professionalism.”

Encouraging a stronger commitment to the health system through a better nursing culture

Key goals at Trinity Mother Frances include elevated nursing practice, a focus on evidence-based nursing, and a collaborative nursing culture. Champions of the residency program feel that these goals encourage nurses to remain committed to the organization. “We wanted to take on the challenge of hiring high-performing nurses and then having them stay and be committed to our hospitals and system,” says Carol LeClair, RN, MSN, ONC, director of professional excellence. “We are working to hardwire the program into our system and be more selective about the nurses that we hire. It has changed our intake practices.” The Vizient/AACN Nurse Residency Program has already increased focus on the bachelor of science (BSN) degree, and the system now expects nurses with associate degrees to move forward and complete the BSN program. Trinity Mother Frances works more closely with schools as part of the residency program, tightening the relationship between hospital preceptors and students.

Making improvements through evidence-based projects

A key component of the residency curriculum is the completion of evidence-based projects. Tamra Anderson, RN, BSN, nurse residency coordinator, feels that these projects have made real contributions to the health system. “Several of the projects are already influencing changes in policies and practice,” says Anderson. “For example, our oncology unit is making changes for neutropenic patients and neutropenic diets that are now supported with evidence in the literature. Other changes are being implemented in the emergency department because of a project that dealt with violence in that area.”

Enhancing the experience for both leaders and new graduates

Nurse managers and other leaders have noticed the program’s effect on nursing at Trinity Mother Frances. “We were excited to see the positive response of the directors in viewing the poster presentations on evidence-based projects at the residency graduation,” says Anderson. In fact, one nurse manager told Anderson that the program has caused him to have higher expectations as a manager. Feedback from nurse residents is also very positive. Rose, LeClair and Anderson agree that the program allows the residents to be heard and make an impact on nursing. After completing the one-year program, nurse resident Brandon Means told Anderson, “During the first six months, I wondered if this was a waste of my time. But after the sixth month, I started to realize and appreciate that this was a great opportunity.” In addition to becoming double board certified and a leader in his unit, Means has continued to support the nurse residency program, including speaking at the residents’ graduations and helping to facilitate the “Changing Patient Condition” residency module. After gaining new insights at a conference, he made a presentation to the ICU Dietary Committee on evidence-based practices to improve the way patients receive nutrition. He continues to assist Anderson with various residency modules and encourages others to do the same.

In the first 18 months, we saw a significant drop in turnover, from 28 percent to 18 percent. We are hiring less and hoping for even better results as we become more selective in our hiring.
Robert RoseRN, MS, NEA-BC Senior Vice President and Chief Nursing Officer Trinity Mother Frances Hospitals and Clinics