Nurses Monica Negaard and Linda Hackenbruch can be found together on Alaska Regional Hospital's critical care unit much of the time these days, their Dansko clogs clopping on the floor in unison as they visit patients.
Normally a new nursing school graduate like Negaard wouldn't start her career by caring for some of the hospital's most acutely ill patients. But Negaard has been paired with Hackenbruch, who has been a nurse for 30 years and in the critical care unit for 15, as part of Alaska Regional Hospital's first registered nurse residency.
Long a part of educating physicians, structured residency programs that bridge the gap from classroom to hospital are an increasingly important way for Anchorage hospitals to hire and retain nurses.
The hospitals hope graduates will stay on, helping to replace a generation of retiring baby boomer nurses and combating high turnover rates that force them to hire expensive, temporary fill-in staff.
It's not that Anchorage doesn't have enough nurses, says Barbara Berner, the head of University of Alaska Anchorage's nursing school.
UAA graduates 200 new RNs each year.
But entry-level nurses often leave the state to get the experience they need to get hired here for specialized units like critical care and labor and delivery.
"When we graduate new nurses they come out as generalists," Berner said. "They can't really function in some of these specialty areas."
When they leave the state they don't always come back.
It can be hard to recruit the experienced nurses hospitals need to staff specialized units, said Linda Doughty, Alaska Regional's head of nursing.
"When you say, we'd like for you to come to Alaska, they say, 'Thank you, but no thank you.' "
Turnover is another problem.
Alaska Regional's 2012 turnover rate was 20 percent for all nurses, said hospital spokeswoman Kjerstin Lastufka.
Providence's rate was about 18 percent for first-year nurses, said Carrie Doyle, the hospital's head of clinical practice research and staff development.
Often, Doughty said, hospitals turn to "travelers" -- contract nurses who sign on to work a stint of 13 weeks or more -- to fill gaps.
They pay a high cost to do it. With agency fees, housing and transportation costs included, the hourly rate to employ a traveling nurse is about 26 percent higher than for a staff nurse, Doyle said.
Hospitals want local, dedicated full-time nurses on staff because it's safer and less expensive than hiring temporary replacements or fill-ins, said Doughty. Residency programs can produce those nurses.
They may become even more important in the future, Berner said. While the number of RNs has grown by nearly 25 percent in the last decade, according to a 2013 U.S. Department of Health and Human Services nursing survey, a new nationwide shortage is expected as baby boomers begin to retire.
"(Hospitals) are trying to get ahead of the situation," she said.
The idea of extending medical residencies to nurses isn't new. Many hospitals across the country offer some form of residency, Doughty said.
But the program at Alaska Regional goes beyond those by including classroom instruction, three levels of nurse-to-nurse mentoring, close monitoring, daily debriefing and frequent testing and evaluation, she said. By the end of the 18-week program, nurses are expected to be working with the "competence and confidence" of a nurse with 18 months experience.
"This is a million-dollar project," Doughty said. "But when you look at what you spend in relocation fees and sign-on bonuses, you could easily have $30,000 to $40,000 invested in a nurse before they even get up here. So when you compare the costs it's kind of a moot point."
The hospital is investing up-front in training and retaining nurses rather than patching holes with fill-in nurses and staffers from Outside who might leave within the year, she said.
Alaska Regional's residency uses a curriculum developed by a California-based company called Versant. Nine nurses are in the first class but the hospital hopes to train up to 30 a year in the future, program manager Rebecca Unwin said.
Providence offers what they call "ships" programs: internships, externships and fellowships for new nurses.
The hospital is revamping its current programs to standardize them, Doyle said.
"Our eventual hope is that we bring a pipeline of nurses into general and special areas and we can cut down on the use of travelers," she said.
With Hackenbruch standing beside her, Negaard set up a pressure line to monitor the fluids of a cardiac patient. The two had already practiced the maneuver in an empty room, with Negaard narrating each step to her mentor.
For Negaard, a Montana native who has long been set on critical care nursing, the opportunity to be hired straight into the unit with some welcome hand-holding made Alaska Regional her first-choice employer.
And it has made the transition into caring for her own patients much less stressful.
"I don't think I'd be able to handle walking into a critical care unit without a guide," she said.
Reach Michelle Theriault Boots at firstname.lastname@example.org or 257-4344.