Monday, September 19, 2022

By: Nicole Weathers, MSN, RN, NPD-BC (IONRP Manager)

Some people I talk to think that nurse residency is a magic bullet that will miraculously fix all the issues in their organization that cause new nurse turnover. While there is plenty of research to show that nurse residency improves retention rates, they are not magic. If used as a band-aid fix for something that needs more attention, it may cause more harm than good.

Picture this: you go into the ED with a cut on your hand. If the doctor just threw a band-aid on it, would it help? Sure, it would help, but what would the healing process and outcome look like at the end of the day? It would take quite a long time to heal or even scab over only to break back open a few days later, in which the process would start over again with a band-aid thrown over the top. In the end, the scar itself would be ugly, and there is always the potential for mobility problems, making things even worse.

Now I want you to picture that same situation, but instead of just a band-aid, the physician carefully assesses and cleans the wound using the latest evidence-based techniques to eliminate debris. They bring the edges of the tissue together using appropriate sutures to ensure the tissue can begin healing correctly. The wound then is tended to and kept clean and dry, returning to the doctor 7-10 days later to have the sutures removed and checked for complications and proper healing. In this case, recovery would have been quicker with a better outcome.

Support for new graduates is no different. If thrown on as a band-aid, it might still help but could do more harm than good. It is essential to take the time to assess, clean out debris, and bring things together properly to heal and recover. How do you do this? A SOAR analysis is a great tool that may help.

Why a SOAR analysis? New hires often feel overwhelmed at the amount they must do upon hire. New graduate nurses especially can feel overburdened by the 'to-do list' when enrolled in a year-long nurse residency program. Completing a SOAR analysis helps you take a 500-foot view of your current processes, from hiring and onboarding to orientation, preceptor and mentor programs, and mandatory education to ensure residency adds value and doesn't overburden these new nurses even more. Start by describing the current state of each in terms of communication, delivery methods, resources needed, and length of time it takes to complete. Then you are ready to SOAR.

What does this look like? And how do you do a SOAR Analysis?


While looking at each component new graduate nurses will complete throughout their first year, first recognize your strengths. What are you doing well? What positive feedback have you received around this process?


Next up, opportunities. What is not working well? Where are you simply checking a box with insignificant impact for the new employee? What constructive feedback have you received around each process?


This is my favorite part because this is where you get to dream and innovate. What do you wish existed in each step of the process? Thinking ahead 1, 3, or 5 years, what are your dreams for this process? You want to get something in place right now, but a year from now, perhaps that something will evolve into a little more. Your initial focus might need to be onboarding and orientation. Then, a year from now, you bring on a residency program, and three years after that, you build specialty-specific fellowships to train and keep your staff competent in those specialty areas.


This is where my SOAR analysis differs from many versions, but this might be one of the most critical steps. Looking at each piece of the process, what can be removed? What is unnecessary to complete within the first year of practice? You read that right…I want you to remove things from this process. What steps, activities, or training could be removed, condensed, or revised to simplify the process?

So many organizations I work with want to move quickly to get residency programs up and going, and I get the need and desire to do that. But, if the program is just being thrown on as another band-aid, you won't get the outcomes you want. I challenge our nurse educators and nurse leaders reading this to examine what it looks like to be a new graduate in your facility. What is working, what is not, and what can you simply remove before you get ready to add anything more?

Nicole Weathers, MSN, RN, NPD-BC

IONRP Manager,