Nurse residency programs (NRPs) have been identified as a means to promote transitioning of new nurses into the professional nursing role. Questions have arisen related to which elements within those programs are most meaningful to the development of new nurses. As the nursing shortage drives the need for quick transition and development of nurses to meet workforce needs, nursing must identify what is meaningful to nurses in their transition to practice. The purpose of this multi-site study was to explicate meaning from the experiences of newly licensed registered nurses (NLRNs) who have just completed NRPs. The research question was "What factors have meaning for NLRNs who have experienced transition to practice in nurse residency programs in acute care settings?" Semi-structured interviews were used to collect data from six NLRNs from three different NRPs after completion of their programs. Using interpretative phenomenological analysis, themes and variations within those themes were derived from the descriptive narratives provided from participant interviews. Overarching themes identified were Relationships, Reflection, Active Learning, Resources and Organizational Systems. Findings have implications for practice and education as the nursing profession strives to find ways to transform nurses in an effective and efficient manner.

New nurses report feeling unprepared, incompetent, and highly stressed, contributing to first-year turnover rates of 25% in some healthcare organizations. Turnover, combined with a preparation-practice gap, has alerted advocacy organizations and researchers to recommend the development of nurse residency programs. Nurse residency programs are a post-graduate training period where new nurses receive enhanced clinical education in the healthcare setting. While highly variable in structure and attributes, programs usually include educational sessions, clinical immersion, and role socialization opportunities. Evidence supports that new nurses participating in nurse residency programs experience positive outcomes, including increased confidence, competence, and decreased turnover rates. Despite this, only half of the hospitals nationwide have implemented a program with most designed around a single health system mission. This dissertation study aimed to identify the attributes of nurse residency programs influencing the newly licensed registered nurse. An integrative review of the literature and evolutionary concept analysis was completed to examine the state of the science of nurse residency programs. Findings revealed a lack of conceptual and theoretical design and variability among program structures, creating a gap in the literature about the attributes of programs that are most influencing new nurses. Based on the literature's noted gaps, a qualitative description study was conducted. Purposive sampling strategies were used to recruit nurses who recently completed varied program models across the United States. New nurses reported the attributes of programs and described how those positively and negatively influenced the transition to practice experience. The overarching themes revealed that new nurses need a cadre of highly supportive individuals across the clinical and educational continuum who espouse astute interpersonal and communication skills. New nurses desire engaging activities with intra and interprofessional team members for clinical skill application, knowledge advancement, and role socialization. New nurses need the structure of meetings at times and in a sequence conducive to learning; and for preceptorship experiences to be facilitated by trained preceptors, on a unit, and of a length that supports confidence for autonomous practice. Future research will include the development and testing of an evaluation tool based on the findings from this study.

The Future of Nursing explores how nurses' roles, responsibilities, and education should change significantly to meet the increased demand for care that will be created by health care reform and to advance improvements in America's increasingly complex health system. At more than 3 million in number, nurses make up the single largest segment of the health care work force. They also spend the greatest amount of time in delivering patient care as a profession. Nurses therefore have valuable insights and unique abilities to contribute as partners with other health care professionals in improving the quality and safety of care as envisioned in the Affordable Care Act (ACA) enacted this year. Nurses should be fully engaged with other health professionals and assume leadership roles in redesigning care in the United States. To ensure its members are well-prepared, the profession should institute residency training for nurses, increase the percentage of nurses who attain a bachelor's degree to 80 percent by 2020, and double the number who pursue doctorates. Furthermore, regulatory and institutional obstacles-including limits on nurses' scope of practice-should be removed so that the health system can reap the full benefit of nurses' training, skills, and knowledge in patient care. In this book, the Institute of Medicine makes recommendations for an action-oriented blueprint for the future of nursing.

Purpose: The purpose of this review is to compare current research on nurse residency programs and determine to what degree they assist the positive transition of new graduate nurses during the first year of practice. Design: An integrative literature review was conducted of research studies on nurse residency programs in acute care settings. Kramer's Reality Shock Theory guided this review. Methods: Research published in the U.S. between 2007-2013, was obtained from electronic data searches using the key works "new graduate nurses", "novice nurse", "reality shock", and "nurse residency programs." Outcomes were compared and synthesized into major themes. Findings: Major themes include an increase in competency, satisfaction, peer support, confidence, commitment to the profession, and retention of nurses who completed yearlong residency programs. Organizational cost savings was also found. Conclusions/Relevance: The findings support previous research recommendations that the ideal length of nurse residency programs is one year; and the essential program components include preceptors or mentors and didactic education. This study findings show advance evidence of the important effects that nurse residency programs have on new graduate nurses' transition into practice, including a reduction in reality shock.

Nurse residency programs are evidenced based structures and processes that support newly licensed nurses' successful transition from student to professional nurse during the first year of practice. Nurse residency programs are endorsed by the American Association of Colleges of Nursing (AACN), the National League for Nursing (NLN), and the Institute of Medicine (IOM). The purpose of this literature review is to identify the essential components of successful nurse residency programs and associated nurse outcomes post completion. The review identified the five essential program components that lead to positive outcomes of increased retention, competency, and job satisfaction. The five essentials are a nurturing learning environment, supportive leadership, having a mentor or preceptor, peer support systems, and an increase in clinical time for skill mastery. Implications for nursing education and recommendation re presented.

The aging population in the United States and greater access to healthcare due to recent legislative reforms will result in an increased demand for registered nurses. However, meeting this demand will challenge healthcare organizations due to an aging nursing workforce that will be retiring, a lack of new nurses entering the profession due to lack of employment opportunities related to the current macro-economic environment, and the lack of capacity to produce nursing graduates. Furthermore, reported turnover rates of newly graduated registered nurses range from 18 to 60% during the first year of employment. Healthcare organizations implementing structured nurse residency programs have reported success in stemming the tide of new graduate turnover. However, there is a lack of empirical evidence in the nurse residency literature regarding variables that have been shown to decrease turnover of registered nurses. The purpose of this study was to examine the outcome variables of job satisfaction, organizational commitment, and turnover among newly graduated nurse residents in Magnet, Magnet Aspiring, and Non-Magnet Hospital work environments across the US. A descriptive correlational retrospective secondary analysis was completed examining the outcome variables in a sample of 628 newly graduated nurses completing a structured nurse residency program between January 1, 2007 and December 31st, 2009 in general acute care hospitals. The findings from this study demonstrated the difference between job satisfaction at two months, six months, and 12 months among nurse residents in the different work environments. Furthermore, the influence of the residency program on organizational commitment in the context of differing work environments is reported. Moreover, turnover rates following the completion of the nurse residency were found to be lower than the national average for newly graduated nurses. Finally, the relationships between the outcome variables are explicated. The findings of this study will assist in informing healthcare executive's decision making when considering interventions to decrease turnover of newly graduated nurses.