A case study in centralizing retention, advancement, and pipeline strategy under one nursing leader
Most health systems divide nursing workforce work among HR, education, and recruitment, with nobody accountable for the whole. Vanderbilt Health took the other route: on Oct. 12, 2026, Dominique Jarman, MSN, RN, became its first Director of Nursing Workforce Development, reporting to the interim system chief nursing officer. She entered the system 15 years ago through its nurse residency program. Per the announcement, the role owns entry, onboarding, advancement, and retention as one portfolio. The question for other systems is scope and reporting line: how much authority to hand one leader, and which metrics must move.
A Director of Nursing Workforce Development is one leader accountable for the full arc of a nurse's time in a health system: entry, onboarding, advancement, retention, and return. Vanderbilt Health formalized that idea in October 2026, naming Dominique Jarman, MSN, RN, to the newly created post effective Oct. 12. She reports to Pat Givens, DHA, RN, NEA-BC, Interim System Chief Nursing Officer, which places the work inside nursing leadership rather than under HR or education alone.
The title could read as a recruiting job. It isn't. Jarman's mandate, as described by Vanderbilt, spans defining the vision and future growth paths for the nursing workforce; finding data-driven ways to expand advancement and improve retention; overseeing existing and emerging community partnerships; developing integrative onboarding strategies; implementing advanced practice placement opportunities across the system; and building feedback systems that feed employee input back into workforce decisions.
Read that list as an operating portfolio, not a press release. It starts before hire (student placement, community pipeline), continues through the first year (onboarding, residency), extends into career mobility (advancement pathways, advanced practice placement), and loops back through listening (feedback that shapes the next decision).
When you weigh whether a responsibility belongs in this role, ask one question: does it affect whether nurses join, stay, advance, or re-enter? Student clinical placement, residency completion, internal transfer pathways, alumni re-recruitment, and the data that tracks them all qualify. Requisition handling, background checks, and offer letters stay with HR.
The reusable lesson is packaging: six related responsibilities under one accountable leader with a seat at the nursing executive table, rather than scattered across departments that rarely share a metric.
The debate has moved from whether nursing workforce development needs an owner to which owner can actually move supply.
At Vanderbilt Health, the answer is now a nursing leader. Dominique Jarman, MSN, RN, became Director of Nursing Workforce Development on Oct. 12, reporting to Interim System Chief Nursing Officer Pat Givens, DHA, RN, NEA-BC.
In most systems, supply work is split among HR, talent acquisition, nursing education, and unit preceptors. Each group owns a slice, but no one owns the handoff. Recruitment fills a vacancy; onboarding absorbs it; retention inherits the consequences. A single accountable executive closes that gap because the same person is measured on pipeline, transition, and staying power.
Reporting to the CNO adds three things an HR-only owner rarely has: clinical credibility with unit leaders, budget influence over education and residency, and a seat at staffing and capacity decisions.
The constraint is structural. AACN's October 2025 survey found 1,588 full-time faculty vacancies across 863 responding schools, a 7.2% vacancy rate1, with 80.9% of those openings requiring or preferring a doctoral degree.2 AACN also reports 92,672 qualified applications turned away in 20252; its 2024 count was 80,1623, citing faculty, clinical sites, preceptors, and space. Those are applications, not unique applicants, and some students enrolled elsewhere.
A dedicated role is not free. Smaller systems may do better assigning the scope to an existing CNO direct report with clear authority and metrics.
The test question is simple: does anyone in your organization wake up each morning accountable for nurse supply and advancement across the whole system?
A dedicated workforce development role only works if the plan underneath it is concrete. Vanderbilt Health's new director position bundles six functions that are often scattered across HR, education, and recruiting. Treating them as one portfolio gives a nursing leader clear ownership and a measurable indicator for each.
| Component | What It Covers | Accountable Owner | Primary Indicator |
|---|---|---|---|
| Strategic workforce vision | Defining the long term growth path for the nursing workforce and setting systemwide direction for sustainability | Director of Nursing Workforce Development, reporting to the system chief nursing officer | Vacancy rate by unit and by role, tracked against the growth target |
| Data driven advancement pathways | Identifying analytics informed solutions that open internal promotion routes and improve retention | Director of Nursing Workforce Development with nursing education and analytics partners | Internal promotion or transfer rate and turnover among staff who advanced |
| Onboarding integration | Building one coherent strategy for new and existing employee onboarding across the system | Director of Nursing Workforce Development with HR and unit leadership | First year retention of newly hired nurses |
| Academic and community partnerships | Overseeing existing and emerging relationships with schools of nursing and community partners to build recruitment and onboarding pipelines | Director of Nursing Workforce Development with education partnership staff | Number of active partnerships and hires sourced through them |
| Advanced practice placement | Implementing expanded placement opportunities for advanced practice roles throughout the health system | Director of Nursing Workforce Development with advanced practice leadership | Advanced practice placement volume and fill rate for those roles |
| Employee feedback systems | Prioritizing system development that collects and applies employee feedback to guide workforce and growth decisions | Director of Nursing Workforce Development with HR and shared governance | Response rate on feedback channels and share of feedback themes acted on |
Dominique Jarman's career is the clearest proof of concept for internal growth pathways. She entered Vanderbilt Health through its Nurse Residency Program, practiced pediatric nursing, advanced to Lead Nursing Education Specialist, and in October 2026 became the system's Director of Nursing Workforce Development. That is roughly 15 years from residency to a system-level leadership seat, and every rung was inside the same organization.
Each step does a specific job. The residency stabilizes the new graduate through the first year, when turnover risk is highest. The preceptor role adds clinical teaching credibility. The education specialist role builds curriculum design, academic partnerships, and onboarding skill. Manager and director roles turn that operational knowledge into system strategy. Without the upper rungs, residency graduates leave for advancement elsewhere, and the organization pays to develop talent it does not keep.
Vizient/AACN program materials have cited 87.2% first-year retention for nurse residency participants against 67.2% nationally1, while an earlier outcomes report put resident retention at 84.8%. Those numbers reflect different cohorts and reporting periods, so treat them as a directional range for your own cohort review, not a single fixed benchmark. NSI's 2026 report lists 22.7% first-year turnover for newly hired RNs3, a broader measure that includes experienced hires. The pattern is what matters: structured residency outperforms the national new-graduate picture, and the advantage disappears if nurses cannot see a next step.
Publish the ladder. Post a residency to preceptor to education specialist to manager to director pathway with the credentials, certifications, and minimum time-in-role expected at each step. Make eligibility visible to every nurse at hire, and review progress at least annually. A ladder that exists only in a leader's head is not a retention strategy; a published one gives nurses a reason to stay and gives your system a measurable internal mobility metric.
At the University of Maryland School of Nursing's Dedicated Education Units, students get 10 to 18 percent more hands-on clinical exposure than in traditional rotations, and 43 percent of prior DEU students were hired as new graduates.1
A DEU turns selected units into recurring education sites: staff nurses precept, faculty keep academic oversight, and students join the care team instead of rotating through loose placements.2 Reported benefits include shorter orientation and stronger candidate attraction.1 Adjunct-faculty arrangements are the lighter-weight version, and they are how Dominique Jarman built her network before the director role: she taught at local schools of nursing while growing education partnerships into recruitment and onboarding strategies.
The pipeline leaks at graduation when the person negotiating student placements is not the person who owns conversion into residents. Jarman's specialist-era template pairs the two: partnership agreements are negotiated with hiring intent, and onboarding is designed alongside them. AACN and AONE describe the strongest partnerships as joint enterprises rather than placement contracts, with the majority of clinical placement at the partner facility and shared outcome tracking.3
Community colleges, workforce boards, and regional pipeline programs widen the applicant pool rather than reordering it. But the binding constraint is rarely student interest. It is clinical placement slots and faculty availability. Any partnership plan should state up front how many slots the system can supervise and how preceptors will be developed and recognized.
These 2025 national wage benchmarks from the U.S. Bureau of Labor Statistics set the pay range a retention strategy must compete against, plus the management premium that makes advancement credible. For registered nurses, the 25th percentile is $80,330 and the 75th percentile is $112,350, a $32,020 spread where internal equity complaints and external offer risk both live; medical and health services managers post a $123,860 median, the comparison point for advancement promises. Pay is not the whole story: AMN's 2025 survey of 12,171 RNs found 56 percent valued real-time self-scheduling and, for nurses considering retirement, the six highest retention factors after financial incentives were all flexibility-related, while 2022 National Sample Survey data analyzed in Health Affairs Scholar found 28.7 percent frontline turnover, with job dissatisfaction the strongest predictor.
| Occupation | Total employment (2025) | Mean annual wage (2025) | 25th percentile wage (2025) | Median annual wage (2025) | 75th percentile wage (2025) |
|---|---|---|---|---|---|
| Registered Nurses | 3,379,720 | $101,420 | $80,330 | $97,550 | $112,350 |
| Medical and Health Services Managers | 597,080 | $140,970 | $94,700 | $123,860 | $166,100 |
For nurse leaders, the business case lives or dies on one number: what a single departure costs, not what the program costs.
NSI's 2026 National Health Care Retention and RN Staffing Report puts average cost per bedside RN turnover at $60,090, describing 2025 conditions. For an average hospital, annual RN turnover losses run from $4.2 million to $6.2 million, averaging $5.19 million, and each one-point change in turnover moves financial impact by roughly $295,000. Multiply your own separation count by those figures before you price a single intervention.
Hiring a new-graduate RN averages $37,094. One published onboarding case study costed an eight-week orientation at $9,120.96, including $576 in preceptor pay, and broader education and training estimates range from $8,000 to $50,000. No national average exists for a full residency cohort, so build yours from cohort size, staffing model, duration, and which cost categories you include.
Ten residents through an eight-week orientation at that case-study rate is about $91,000. Newly hired RNs turn over at 22.7% in year one, and those hires account for 29.0% of all RN separations. If structured transition support prevents even two first-year departures at $60,090 each, that is $120,180 avoided against roughly $91,000 spent, and the program is net-positive before you count faster competency or lower vacancy.
Most programs get judged on satisfaction scores and completion rates, never on avoided replacement cost, which is exactly why workforce budgets are cut first. Pick one denominator, cost per retained nurse per year, and report every intervention against it so a residency cohort, a tuition benefit, and a career ladder can be compared on the same footing.
Turnover and vacancy benchmarks are most useful when they come from the same survey year and care setting. The 2026 acute-care figures below put RN turnover at 17.6% and vacancy at 8.6%, while Magnet hospitals reported 7.3% vacancy; regional variation runs higher, with Southeast hospitals at 18.7% turnover and West hospitals at 18.4%. A current national first-year completion rate for nurse residency programs is not reported by these sources, so that column is shown as not reported rather than estimated from turnover or vacancy.
| Setting | RN Turnover Rate | RN Vacancy Rate | Residency First-Year Completion |
|---|---|---|---|
| Acute-care hospitals | 17.6% | 8.6% | Not reported |
| Magnet hospitals | Not reported | 7.3% | Not reported |
Two dashboards, not one: an operational view that changes staffing decisions this week, and a strategic view that changes structure next year. Collapse them into a single monthly packet and you get a data dump no executive reads twice.
Assign one accountable owner to every line: RN vacancy (unfilled against budgeted FTEs, with a national reference of 8.6% in 2025)1, first-year turnover (goal under 10%)2, residency cohort completion, internal fill rate, agency and premium labor percentage, time to fill (experienced RNs averaged 78 days in 2025)1, and promotion or advancement counts. Vacancy, agency use, and cohort completion belong on the monthly operational cadence.5 Pipeline yield, internal fill rate trends, and cost per retained nurse belong quarterly or annually, where they inform structural decisions rather than next week's deployment.
Jarman's scope includes applying employee feedback to workforce decisions. That only works if exit and stay-interview themes are reported beside the numbers, not buried in a separate annual survey deck.
Benchmark to published external figures, not last year's internal performance, or the dashboard quietly ratifies decline.4 National hospital RN turnover was 17.6% in 2025 by the headline measure1 and 14.6% counting only full- and part-time staff3, so state which definition you use.
Every indicator needs one named leader. The workforce development director should own the ones nobody else claims.
The question is not whether workforce development matters. It is whether one accountable leader should own it systemwide, or whether it keeps living in fragments across HR, education, and recruitment.
If you answer no on scale, constraint, or fragmentation, fix the process first and revisit next year.
Document what the role owns outright (residency, advancement pathways, academic partnerships, workforce data) and what it only influences (compensation, staffing ratios, unit scheduling). Ambiguity here is what sinks these roles in year two. Then fund the minimums leaders underestimate: a workforce analyst or guaranteed data access, a named partnership portfolio owner, and budget authority over education and residency spend.
The Vanderbilt Health lesson is not the title. It is that one leader is accountable for supply, retention, and advancement systemwide.
