Implementing a New Graduate Registered Nurse Residency Program for Home Health in California

Sutter Care at Home (SCAH), part of the not-for-profit Sutter Health integrated system, serves Northern California's Valley and Bay Areas through 14 licensed home health and nine hospice agencies, many of which reach rural communities. Like many home health organizations, SCAH has faced a persistent registered nurse (RN) shortage, challenging its ability to maintain care delivery standards. In response, executive leadership launched a 12-month Registered Nurse New Graduate Residency Program to recruit and support newly graduated RNs. This innovative program blends simulation and field-based learning to develop the clinical competence, confidence, and independence required for effective home health practice. The initiative addresses a critical regulatory challenge: California Department of Public Health requirements mandate 1 year of experience for home health nurses, historically limiting hiring to experienced RNs. Prior to the residency, administrators had to submit individual program flexibility requests for each new RN. This residency model demonstrates a sustainable and scalable solution to the home health nursing shortage. It allows organizations to safely integrate new graduates into the workforce while meeting state regulatory requirements. Other home health agencies facing similar workforce pressures may benefit from adopting structured residency programs and engaging with regulatory bodies to establish pathways for new graduate integration. By investing in new nurses early, organizations can build a more stable, prepared, and loyal home health workforce equipped to meet the growing demand for community-based care.