In Julia Paronish-Ludwig’s first job following her graduation from nursing school, she worked in an orthopedic-monitoring unit at Conemaugh Hospital with another new nurse on a holiday weekend, with lots of patients injured in accidents.

She felt ill-prepared and underconfident, reduced to hoping that the skills she learned in school would hold up — which, fortunately, they did.

Van Zandt VA Medical Center now offers a pair of yearlong residency programs for recently graduated registered nurses and nurse practitioners, designed to transition them from uncertain novices to confident, well-rounded professionals, while eliminating the kind of worries that bedeviled Paronish-Ludwig in her first job.

Eighteen percent of new RNs leave the field after their first year, largely because they’re forced to deal with issues beyond their competence too early in hospital units to which they’re exclusively assigned, due to short-staffing that prevents experienced fellow nurses from properly overseeing their work and tutoring them, according to Laura Litzinger, who directs the RN residency program.

By contrast, both of the Van Zandt residency programs provide “100-percent protected time,” during which new nurses and nurse practitioners work under gradually decreasing supervision, without the full weight of responsibility for potential mistakes that tends to make many new RNs flee too early, according to Litzinger and Paronish-Ludwig, speaking at the hospital Monday.

Eighty percent of new registered nurses’ time is spent in clinical rotations in various departments, always under guidance of “preceptors,” while 20% is spent in “didactic” — strictly educational — mode, according to Litzinger.

The new RNs’ training includes time spent in six core hospital units, consultations that lead to sending patients to non-VA community care, as well as time in the pharmacy and the respiratory, physical and occupational therapy departments, according to Litzinger.

The training for new nurse practitioners is heavy on primary care, but also includes cardiology, renal care, dermatology, orthopedics, mental health care, pain clinic work, urgent care and nursing home care, coupled with one day a week in didactic mode — which includes military-related education — along with a final project for which students design improvements to a hospital program or policy, under guidance from Saint Francis University, an affiliate for the programs, according to an email from Paronish-Ludwig.

The programs aim to provide the kind of transitional help that Paronish-Ludwig herself received when she was a new NP at Windber Hospital under guidance from Dr. Michael Comas, she said.

Comas would confer with Paronish-Ludwig on patients, including one who came to the emergency department with swollen legs caused by heart failure and who could have gone either to a medical-surgical floor or the intensive care unit.

By leading questions, Comas guided her through “a decision tree” that took into consideration the patient’s current condition, her lab results and her prior history — “every aspect,” Paronish-Ludwig said.

There was no definitive correct decision, but with Comas’ approval, she decided to send the patient to the ICU.

“Better to be safe,” she said.

After the consultation with Comas, she could make that decision with full confidence, due to the moral and intellectual backstop the doctor provided — the kind of support that helps any new practitioner become confident to work independently, according to Paronish-Ludwig.

Each of the Van Zandt programs are designed to send a group of recent graduates through as a “cohort.”

The VA’s Office On Academic Affairs (OAA) pays their salaries.

Both programs are currently or soon will be in recruitment mode.

Information on them is available on the Van Zandt website.

Despite the benefits of the measured transition from school to professional life that the programs are designed to provide, it’s hard to compete with civilian hospitals offering big signing bonuses to recently graduated nurses, according to Litzinger.

One of the goals of the program is to provide Van Zandt — and the VA system as a whole — “highly educated and clinically competent” professionals, according to information provided to the Mirror.

All the first-year participants of the programs, which began in 2023, were hired by Van Zandt.

There is, however, no requirement for participants to join the VA workforce after completing either program, according to Litzinger and Paronish-Ludwig.

The rules that govern how nurse practitioners function vary among states, according to Dr. Anthony Good, director of Saint Francis’ nurse practitioner program.

In Pennsylvania, nurse practitioners operate as independent providers, although each must have a collaborative agreement with a physician, according to Good.

They’re exempt from that state requirement at Van Zandt, but nevertheless subject to a facility requirement for such a collaborative agreement, Good said.

Nurse practitioners can make medical diagnoses, devise plans of care, order tests and prescribe medications, according to Good.