Bridging the gulf from school to the life-and-death reality of a hospital can be a jarring experience for many new nurses.

It's often sink or swim.

One panicked day can follow another until a nurse masters a job that has become more specialized and where the pressure to avoid mistakes is intense.

The stress forces a large number of nurses to leave their jobs after the first year, adding to growing concerns nationwide over medical errors and an anticipated nurse shortage.

Yasmine Ramadhan knows the feeling.

"Things are completely different from a textbook," said the University at Buffalo graduate who recently started work at Buffalo General Hospital.

Hospitals confront a problem: How do they retain more new nurses -- the average turnover rate of first-year nurses is 27 percent nationally and even higher in Buffalo -- and ensure they're prepared for the hectic pace of hospital work?

One answer is nurse residency.

Just as young doctors go through supervised on-the-job training in residencies, hospitals are turning to somewhat similar programs to help novice graduate nurses like Ramadhan gain confidence and competence at work.

She is among the 76 participants in the first nurse residency program in Buffalo, a collaboration that will begin later this month among Kaleida Health, Erie County Medical Center, Veterans Affairs Medical Center and Roswell Park Cancer Institute.

"You're on top of the world when you get out of school, and you think you know a lot," said Ramadhan, who works in Buffalo General's surgical unit. "You find out pretty quickly that you have tons more to learn."

The nurse residents will train with an experienced nurse and be paired with a mentor to offer support. They also will meet together in the classroom once a month over the year to sharpen skills -- everything from simulation training with computerized life-size dolls to role-playing with medical students to improve teamwork.

"For us, it's not just a way to retain nurses. We also see this as a recruitment tool," said Connie R. Vari, executive vice president and chief operating officer of Kaleida Health.

In the past, new nurses waited several months after graduation before they were licensed by the state to practice. During this time, novice nurses typically worked under the direct supervision of an experienced nurse.

Today, with cutbacks in hospitals and computer-based testing for nurse licenses, new graduates are approved to work faster than ever, yet hospitals are less able to afford lengthy orientations, Vari said.

To make matters more difficult, the learning curve for nurses grew steeper over the years as hospitals focused on the sickest patients and the complexity of care increased, she said.

Hospitals across the country have tried nurse residencies in the past, but only in recent years have formal programs sprouted that appear to have more staying power. For instance, the University Health System Consortium, an alliance of more than 100 academic medical centers, and the American Association of Colleges of Nursing in 2002 created a widely copied residency program primarily for hospitals affiliated with universities.

Today, 62 sites in 28 states participate in that yearlong program. The average turnover rate for the more than 16,000 first-year nurses who have done the residency is just 4.4 percent compared with the 27.1 percent national average, according to the association.

"Nursing organizations and deans of nursing schools came to the realization that new nurses were often not ready to hit the ground running," said Kathy McGuinn, the association's director of special projects. "It's not about the job schools and hospitals are doing preparing graduates. It has to do with the complexity of health care."

Calls for more supervision and on-the-job learning have led the National Council of State Boards of Nursing to consider a standardized transition program for new graduates.

The Buffalo program got started in 2009 with a $335,720 grant from the John R. Oishei Foundation to Kaleida Health to develop a regional nurse graduate program. The residency is modeled after a different program than the one created by the association but is similar in many ways.

The program includes all the major hospitals in Buffalo except those in the Catholic Health System, as well as academic partners D'Youville College, Erie Community College, Niagara County Community College and UB. The 76 voluntary participants represent about 13 percent of 600 new nurses in Buffalo this year, and the program can take up to 96 individuals, Vari said.

Catholic Health hospitals have not yet been invited to participate but would welcome an opportunity to consider it in the future, said Chuck Hayes, a spokesman.

The recession has eased the nursing shortage, as unemployed individuals turn to nursing for work.

For instance, the nurse vacancy rate at Kaleida Health, which employs about 3,000 nurses, is down to 2 percent compared with nearly 10 percent a few years ago, Vari said.

That's expected to change.

In a 2009 Health Affairs article, nurse work force expert Peter Buerhaus of Vanderbilt University and co-authors found that despite the current easing in vacancy rates, the U.S. nursing shortage is projected to grow to 260,000 registered nurses by 2025. The major reason is the rapidly aging work force.

Nursing schools are churning out more nurses. But they also are turning away thousands of qualified applicants because of a lack of instructors and classroom space that limits the growth in graduates.

The decision to start a nurse residency is not an easy one for hospitals because the programs are expensive, including the cost of filling in for the experienced nurses who must take time out to supervise and train the new graduates. Unlike physician residency programs, nurse residencies do not receive regular financial support from the federal government. One reason is that the Centers for Medicare and Medicaid Services considers nurse residency programs continuing education and not a requirement for employment.

But Vari and other nurse residency advocates say there is a good business case for hospitals to embrace nurse residency because the programs can reduce costs from high turnover rates. On average, the cost associated with training a new nurse to fill the spot of one vacated in a first-year turnover is about $88,000, the American Association of Colleges of Nursing reports.

The Buffalo program offers the new nurses classroom instruction, on-the-job supervision and a mentor they can call any time for support.

That's appealing to Ramadhan.

"I'm lucky to be on a great floor where all the nurses are helpful," she said. "But having one person I know I can call is a great idea. She understands what it's like to be a new nurse."

hdavis@buffnews.comnull