June 22, 2017

[Nurse Resident Name]

[Address]

[Address]

RE: Nurse Residency Program

Dear [Name]:

Congratulations on your acceptance into the Nurse Residency Program (the “Program”) at Cheyenne Regional Medical Center (“CRMC”). You were chosen from many qualified applicants to be a participant, and now serve as an integral part of a growing and successful facility.

CRMC is committed to your success during your transition into nursing practice. The Program has been developed to help new graduate nurses with less than one (1) year of experience transition into their new role. The enclosed Cheyenne Regional Medical Center Nurse Residency Program Repayment Agreement sets forth our expectations and your obligations for your participation in the Nurse Residency Program.

I look forward to partnering with you in providing quality care to our patients from Cheyenne and our surrounding communities.

Sincerely,

Tess Taylor BSN, RN

Nurse Residency Program Director

Cheyenne Regional Medical Center

307-996-4743

Cheyenne Regional Medical Center Nurse Residency

Program RepaymentAgreement

In consideration for my participation in the Nurse Residency Program (“Program”) at Memorial Hospital of Laramie County d/b/a Cheyenne Regional Medical Center (“CRMC”), I ______(printed name), agree to work at CRMC, in a full-time position, for two (2) full years (twenty-four (24) calendar months) after hire into the Program. I understand that if I qualify for a Leave of Absence at any time during the two (2) year period, that Leave of Absence time will not be counted toward the two-year contract period.

I understand and agree that if I cease employment with CRMC prior to completing the one (1) year residency program and the one (1) year post-residency period outlined below, I will reimburse CRMC within sixty (60) days based on the guidelines below.

If nursing leadership and/or the Nurse Residency Advisory Board decides that a change of status or a transfer to a different clinical department is appropriate, I understand that this contract shall be transferred with my personnel file and shall continue to be in effect for the duration of this commitment.

Residency Program Period:

March 8, 2017 - March 8, 2018 (Day 1 of NEE to 1 year anniversary)

If I resign from employment with Cheyenne Regional Medical Center during the residency program period, I will be required to repay the cost of training based on total hours worked for CRMC, as outlined below. ______(Initials)

Post-Residency Program Period:

March 9, 2018 - March 8, 2019 (1 year anniversary to 2 year anniversary)

If I resign from employment with Cheyenne Regional Medical Center during the post-residency program period, I will be required to repay the cost of training based on total hours worked for CRMC, as outlined below. ______(Initials)

  1. Repayment Fee Schedule

Hours Worked / Amount of Repayment
0-1,872 Hours / $7,500.00
1,873-2,808 Hours / $5,000.00
2,809-3,744 Hours / $2,500.00

I understand that it is my responsibility to arrange repayment through the CRMC Finance Department prior to my departure from the facility, if for any reason the balance due has not been satisfied at the time of termination of my employment.

  • I acknowledge that my obligation to repay the amount corresponding to the repayment fee schedule will apply regardless of how my employment with CRMC ends; that is, whether my employment is terminated by CRMC or I choose to leave employment. This obligation to repay will also be triggered if I change status to part-time or PRN. I hereby authorize CRMC to withhold the amount corresponding to the repayment schedule from my final paycheck (including any amount of accrued Paid Time Off (“PTO”) that might otherwise be payable to me), to the full extent permitted by law and after all deductions required by law. If there remains a balance due, I hereby agree to make installment payments to CRMC at a minimum rate of one hundred dollars ($100.00) per month, with an annual percentage rate of eighteen percent (18%), and will sign a promissory note in the form attached hereto as Exhibit A.
  • Termination of employment as a result of layoff, disability separation, or other good cause as determined by the Human Resources Director will not require repayment of the lump sum.
  • If it becomes necessary for CRMC to institute legal proceedings to enforce repayment, I agree to pay all reasonable costs and attorneys’ fees incurred by CRMC.

______(Initials)

II.Nurse Residency Program Expectations:

  1. I understand that I need to attend 100% of all Nurse Residency Program classes and activities for the duration of the one (1) year program.
  2. Absences will be reviewed in partnership by the Nurse Residency Program Director and the Clinical Manager/Director. Unapproved absences may result in dismissal from the Program and my release from employment at CRMC.
  3. I am responsible for checking my CRMC e-mail account at least weekly.
  4. To aid in program development, I will complete all online surveys as instructed by my Nurse Residency Program Director starting at the beginning of the program, at six (6) months, and twelve (12) months.
  5. I will complete one evidence based project relevant to my current work.
  6. I will remain in good standing throughout the duration of the Program.
  7. CRMC defines good standing as sustaining no formalized disciplinary action and/or performance improvement plan. If I should sustain a formal type of disciplinary action and/or be placed in a performance improvement plan, I understand this will result in a review from the Nurse Residency Advisory Board (the “Board”). The Board will serve as my advocate and attempt to help me be successful. If an agreed upon plan cannot be reached, I understand this could result in dismissal from the Program and termination of my employment with CRMC.
  8. I understand that I need to remain in a full-time status for the duration of the one year Program and the one-year post-residency program.
  9. I commit to appeal to the Board if requesting an interdepartmental transfer during my residency.
  10. BSN status:

□ Holds a current BSN degree.

□ Holds a current ADN degree.

______(Initials)

  1. I shall enroll in an accredited BSN program within one (1) year of my hire date (by March 8, 2018) as a Registered Nurse at CRMC. ______(Initials)
  2. I shall submit proof of acceptance in an accredited BSN program to the CRMC Nurse Residency Program Director within one (1) year of my hire date (by March 8, 2018) as a Registered Nurse at CRMC ______(Initials)
  3. I shall complete my BSN program within four (4) years from my hire date (by March 8, 2021). ______(Initials)

By signing below, I acknowledge I have read and agree to the above identified requirements and objectives. I understand the commitment and investment made in me by Cheyenne Regional Medical Center and agree to fulfill the requirements.

Employee Printed Name: ______
Employee Signature: ______
Date: ______
Department Manager/ Director: ______
Date: ______
Nurse Residency Program Director: ______
Date: ______
Human Resource Representative: ______
Date: ______

EXHIBIT A

PROMISSORY NOTE

$Date:

I, , ("Maker"), for value received, promise to pay to the order of Cheyenne Regional Medical Center ("Payee") the sum of Dollars ($ ), representing the loan amount borrowed from Payee by Maker pursuant to Cheyenne Regional Medical Center Nurse Residency Repayment Agreement (the “Agreement") dated , between Payee and Maker.

IT IS AGREED that the principal shall draw interest at a rate of eighteen percent (18%) per annum and failure to make a monthly payment in the amount of One Hundred Dollars ($100.00) when due or any default under this Note shall cause the whole note to become due at once at the option of the holder of the Note. If this Note is not paid when due, or suit is brought, Maker agrees to pay all reasonable costs of collection, including reasonable attorney's fees.

Maker