RN New Graduate Transitional Residency Program


Support the New Graduate's transition from novice to competent, professional nurse.

Improve their confidence and competence.

Ease transition from classroom to bedside.

* Improve RN Recruitment *

* Decrease Turnover *

* Decrease Overtime & Bonus Pay *

* Decrease Dependency on Contract  Labor *

Why a Residency?


Prepare the New Graduate to:

  • Demonstrate effective clinical decision-making skills
  • Function as an equal partner with professional colleagues in the patient care team
  • Incorporate research-based evidence into practice
  • Provide clinical leadership in improving patient care
  • Formulate an individual plan for continued learning and professional development


  1. Clinical Competence
  2. Clinical Skill Validation with      Bedside Skill Sign-Off 
  3. Workplace Culture Toolbox
  4. Culture Competency Validation
  5. Clinical Leadership / Quality Improvement Project

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Course Content

Clinical Competence

Patient and Employee Safety 

Medication Administration 


General Patient Care 

Genitourinary System 

Gastrointestinal System 

Ortho System 

Neuro System 

Endocrine System 

Integumentary System 

Cardio-Vascular System 

Respiratory System 

Lymph & Immune System 

Behavioral Health

Clinical Skill Validation

Key skills, identified from the Clinical Competence Course and from hospital and unit needs, are used to create Clinical Skill Validations.

Checking off competencies may occur anywhere there is an internet including at the bedside and simulation lab with the COS Bedside Skill Sign-Off.  

Competency progress may be viewed at any time on the Competency Dashboard by the New Graduate, Preceptor or Mentor, Manager, Onsite Coordinator, Nurse Leadership, and COS Faculty. 

Using the Competency Dashboard supports early intervention for problem solving and opportunities to praise and encourage wins.

Workplace Culture Toolbox

Integrity & Ethics

Health Policy & Regulatory Frameworks

Healthcare Business & Finance

Role Transition & Self Care

Workplace Acclimation & Organization

Systems Theory, Thinking & Design 

Change Management


Research & Critical Thinking

Patient Care & Education 

Case and Care Management 

Quality & Culture of Safety 

Teamwork & Leadership Skills    

Career Pathway Development 

Culture Competency Validation

Key Competencies for Workplace Culture Toolbox & Hospital-Specific Competencies. 

Culture Competency Validation begins with a self-assessment at the beginning of the Program and is completed as one of the last activities at the end of the 12 months.

Competency progress may be viewed at any time on the  Culture Competency Dashboard by the New Graduate, Preceptor or Mentor, Manager, Onsite Coordinator, Nurse Leadership, and COS Faculty. 

Using the  Culture Competency Dashboard  supports early intervention for problem solving and opportunities to praise and encourage wins.

Clinical Leadership / Quality Improvement Project

The Clinical Leadership / Quality Improvement Project supports development of critical thinking and clinical reasoning skills. 

It provides a framework for exploration and continuous, lifelong learning. 

The excitement of finding and sharing an improvement for patient care or for the quality of life for colleagues on your own unit can be the impetus for a life of contribution in nursing. 

? Why ?

Why an RN New Graduate Residency Program?

Driven by the danger of trying to provide patient care with too few nurses and weary from calling all day to fill vacancies on the schedule despite paying overtime and bonuses and using contract labor, Chief Nurses, Chief Financial Officers and Chief Executive Officers nationwide are searching for ways to recruit and retain nurses.

Unfortunately, many hospitals are also struggling with a shortage of staff who can support the education and transition of the new graduate. 

These problems are exacerbated in many rural mid-sized and smaller hospitals where recruitment and retention can be particularly challenging and their older, experienced staff are retiring.

Key to filling RN vacancies is the successful recruitment and retention of  the New Graduate.

For the New Graduate nurse, the job market is often wide-open. 

Research indicates that the young nurse is looking for a job that supports: 

  • a flexible life style, 
  • respect as a member of a professional care team, and 
  • career growth opportunities. 

They are not prepared for the hospital culture that awaits them upon graduation. 

Courting new graduates with sign-on bonuses no longer meets these nurses’ needs. 

They are leaving at the alarming rate of 30% during their first year.

While new graduate residency programs are the focus of much activity around the country, most are not structured to meet the complex demands of transitioning the new graduate. These programs are not achieving the desired outcomes. 

The COS New Graduate Transitional Residency Program is based on recommendations and evidence gathered over 10 years by the Institute of Medicine (now the Health and Medicine Division); the Joint Commission; National Council of State Boards of Nursing; and the Robert Wood Johnson Foundation. Those findings were complemented with many years of experience by the COS leadership developing and implementing successful recruitment and retention programs including educational programs for new hires and new graduates. 

The COS New Graduate Transitional Residency Program was developed to meet your needs.

Potential Benefits

1. Improved Recruitment 

A branded, structured, evidence-based program that meets the needs for transitioning into your hospital and its culture is appealing to the new graduate nurse who is aware of options and challenges in the workplace.

2. Decreased Turnover

New Graduate turnover is 30% in the first year of practice (Lippincott, 2017). While some turnover is expected among New Graduates, decreased turnover has been reported when support is provided through structured residency programs. 

3. Labor Cost Savings

  •  $22,000 to $64,000 - cost of replacing one RN (RWJF, 2018).
  • Overtime to cover vacant shifts
  • Bonus to cover vacant shifts
  • Contract Labor

4. Improved Reimbursement

Decreased patient transfers due to 

lack of staffing.

5. Improved Staff Satisfaction

Improved New Graduate Satisfaction.

Improved resiliency with adequate staffing.

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Uniquely designed Transition-To-Practice

Innovative Program Structure

COS New Graduate Transitional Residency Program is a structured, guided, 12 month offering. Its evidence-based curriculum is designed to support the new nurse’s transition from novice to competent, professional nurse. To be most respectful of the New Graduate’s time, a new Program begins each week.

While the amount of time the individual New Graduate needs to complete the Program will vary, general expectations are:

During the first 6 weeks, the New Graduate completes 12 hours per week of Program activities including Cohort Web Conferences every 2 weeks. Work on assigned competencies begins. The remainder of work time is spent on the unit with the Preceptor learning about patients, colleagues and the work of the unit. Cross Departmental Experiences may begin during this time and will continue throughout the Program.

During weeks 7 - 12, the New Graduate completes 4 hours per week of Program activities including Cohort Web Conferences every 2 weeks. The remainder of work time is spent on the unit with the Preceptor, caring for patients, completing Clinical Competency Validation and beginning work on Bridge Competency Validation.

For the remaining 9 months, the New Graduate completes 2 hours per week of Program activities including Cohort Web Conferences every 4 weeks. The remainder of work time is spent in patient care. The Clinical Leadership / Quality Improvement Project is completed. 

The New Graduate continues to be shepherded through the culture transition by COS Faculty and onsite support staff.

Activities Throughout the Program

  • Learning Module Completion 
  • Cross Departmental Experience
  • Virtual Simulation   
  • Competency Validation with Bedside Competency Sign-Off
  • Journaling  
  • Cohort Web Conferences 
  • Virtual Office Hours
  • Coaching/Emailing 
  • Clinical Leadership / Quality Improvement Project 

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COS RN New Graduate Transitional Residency is a Blended Learning experience with both onsite and online education and support. 

COS provides structure, curriculum, learning modules, competencies to be completed, and continuous interaction with New Graduate, Unit Manager, Preceptor, Mentor, Onsite Coordinator and other key onsite players. 

Our strategy is to surround the New Graduate with supporters and encouragers. COS Faculty coach continually by regularly responding to email and by Virtual Office Hours each week and as needed. Support is available throughout the 24 hour day, weekdays and weekends.

Onsite, the New Graduate is supported by the Unit Manager; a Preceptor who functions as role model, educator, facilitator, and evaluator; and a Mentor. The Preceptor and Mentor complete COS Development Courses and are supported throughout their experience by COS Faculty. Monthly Preceptor Cohort and Mentor Cohort Web Conferences are hosted by COS Faculty for continued development and debriefing. 

Key to Program success is the Onsite Coordinator, a nurse leader, often a nurse educator, who is the hospital’s COS liaison.  COS leadership is available to the Onsite Coordinator to discuss any aspect of the program.


COS innovative Cloud-Based Platform allows us to provide programs that are cost-effective and easily client-customized. This makes Blended Learning easy, flexible and smart.

Maximum flexibility and mobility enables the New Graduate to complete learning assignments in their own time, at their own pace, and anywhere the web is available. 

Our platform supports all mobile devices and enjoys industry-leading up-time. It is accessible regardless of time of day or day of week.

The New Graduate’s progress can be viewed at any time by the New Graduate and all persons involved in the learning experience. 

All COS Learners may create a Professional Portfolio to document COS coursework, other educational achievements, certifications, personal committee work, research involvement, professional organization involvement, and volunteer work.  The cloud-based document is available indefinitely.

This full support for Competency-Based Learning coupled with actionable learning analytics, supports maximum productivity for the New Graduate and all persons supporting the nurse learner.


Designed to support Competency-Based Learning, New Graduate Program Dashboards are available online for review at any time.

New Graduate progress and outcomes available for review include:

  • Confidence
  • Competence
  • Mastery of the Job
  • Ability to Organize and Prioritize
  • Satisfaction
  • Engagement
  • Bedside Leadership
  • Course Progress
  • Competency Completion

COS works with hospital to provide data to trend program impact:

1.     Organization Data

  • Recruitment
  • Turnover
  • Overtime
  • Bonus Pay
  • Contract Labor

2.     Clinical outcomes


Learn about Cloud-Based Professional Portfolio