Structured Onboarding and Residency Programs for Oncology Nurse Retention

By Kate B. Hubbard, MSN, RN, OCN®, NPD-BC, Elaine S. DeMeyer, RN, MSN, AOCN®, BMTCN® - Last Updated: September 1, 2022

Healthcare is experiencing “the great resignation,” a period of alarming turnover since 2020, accelerated by the COVID-19 pandemic. One in 4 health care workers (25.9%) resigned in the past year, with nursing resignations higher than the national average at 27.1%. Although the root causes of this resignation are multifactorial and complex, education is one of the top reasons nurses are resigning.

Oncology nurses provide highly specialized patient care (eg, chemotherapy administration, symptom management), making it more challenging for organizations to recruit an experienced replacement.

Although there is no single approach to fix the staffing crisis, focusing on education is one way cancer programs can shift nursing resignation into nursing retention.

The Cost of Nursing Turnover

Turnover is costly for health care organizations. The average cost for staff nurse turnover is $46,100, and the average hospital lost $7.1 million in 2021 due to turnover. More than one-third (36.3%) of all new hires left within a year, and one-half (54.4%) left within 2 years. These data are for all nurses; these rates are typically higher in specialty areas. For instance, consider the additional cost of chemotherapy certification or stem cell transplant education.

These staggering numbers emphasize how costly, yet important, nurses’ first 2 years are to ensure their future success. In oncology care, onboarding helps the oncology nurse learn about cancer care but also influences the quality of care for patients with cancer and their loved ones.

Standardize Onboarding and Orientation

All nurses benefit from a robust and well-structured orientation plan, especially specialty nurses like those in the oncology field. Oncology curricula (eg, e-learning modules, classes, competencies) can provide a standardized learning experience. Self-paced online, on-demand learning modules are becoming a cornerstone of onboarding. They allow newly hired nurses to control their own learning pace at their convenience. Online, on-demand modules ensure that all learners have the same baseline knowledge.

Oncology nurse educators and preceptors can focus on applying that knowledge to practice. They can use interaction time to build critical thinking skills through classroom discussions, case studies, and competency validation. A flipped classroom approach transitions the educator’s time from developing and teaching content to discussing content. The Oncology Nursing Society and beyond Oncology are organizations that provide virtual evidence-based oncology education.

Oncology Nurse Residency Programs

Because of the high number of oncology nurses leaving within the first 1-2 years, many organizations are developing nurse residency programs. There are many definitions of a nurse residency program. Some are more like a 2-week internship than a 6- to 24-month residency program. HCA Healthcare is one of many organizations with a robust new graduate nurse residency program. Theirs aims to enhance the clinical orientation of new graduate nurses and assist their transition to professional clinical practice. They offer many programs and services, including state-of-the-art simulation training, case study discussions, and ongoing educational seminars. In addition, they provide emotional support by pairing the nurse with a designated mentor for the first year. Through a special project, the new nurse gains research and presentation skills for professional development. Each nurse creates a clear career growth pathway for continuous professional growth.

Nurse residencies aim to produce clinically competent nurses who will continue to flourish in nursing for years to come. Lyndsey Conway, MN, RN, BMTCN®, of Seattle Cancer Alliance, shared at the 2022 ONS Congress that the outcomes of their nurse residency program were 98% retention at 1 year, 93% at 2 years, and 87% retention at 5 years for nurse residency program participants.

Cancer programs need to redirect resources toward a more individualized support for new nurse hires. Standardized, repeatable web-based education for onboarding and oncology-specific new graduate nurse residency programs can improve nurses’ satisfaction. With more confident, competent oncology nurses, retention rates are likely to climb.



2022 NSI National Health Care Retention & RN Staffing Report

Oncology Nursing Society

The Flipped Classroom: A Critical Appraisal

beyond Oncology

Nurse Residency Program

Mission Possible: Enhancing Oncology Nurse Recruitment and Retention