Poor retention is a critical issue among healthcare workers throughout the country. Decreased job satisfaction directly impacts nursing retention rates, particularly among new nurses transitioning from school to clinical practice. This MSN project introduces an enhancement to the current nurse residency program that includes clinical rotations in its educational foundation to solve job satisfaction issues among new graduate nurses. Evidence-based research indicates that clinical rotations benefit nurses early in their careers. These benefits include increased involvement in work, acquired additional skills, and enhanced job satisfaction in the workplace. This MSN project provides a clear path for implementing this unique type of residency program in nursing to be piloted at the University of Utah Hospital system in Salt Lake City. The new residency program format will be eight months and be implemented in a twenty-week timeline. The project implementation includes a project proposal, a PowerPoint presentation for staff and administration, and a lesson and assignment plan for educators in the program. Additionally, the project will provide pre- and post-surveys to test the understanding and success of project implementation and allow for future improvements and changes based on trends. The project also identifies ways to disseminate significant results and learned information to the university's stakeholders and other organizations nationwide. Providing clinical rotations to train and support new nurses can significantly impact the long-standing nurse retention crisis.

New graduate nurses encounter "transition shock" when they enter the workplace, especially in acute care settings such as hospitals. New graduate nurses have a difficult time transitioning into the work environment because they are unprepared by their academic training for the realities they will face and they often don't have the proper support in place to guide them through the transition. This leads to a high attrition rate of up to 30% within the first 18 months of employment which costs hospitals and health care facilities. High nurse turnover of new graduate nurses who aren't prepared for the complexities of clinical practice affect the quality of care provided. Patient outcomes are negatively affected because it often leaves hospitals dealing with a shortage of experienced nurses, which they compensate for by having high patient to nurse ratios. New graduate nurses must develop the necessary critical thinking skills to handle higher acuity patients and difficult situations, develop confidence in their clinical skills, and adapt to peer relationships. One solution to the "transition shock" that new graduate nurses face is the implementation of nurse residency programs. Nurse residency programs are shown to help new graduates have a better transition into the workplace and increase nurse retention. This paper discusses the problem of new graduate nurse turnover, the benefits of nurse residency programs, and the numerous research studies which have been done showing the success of nurse residency programs on new nurse graduate retention and job satisfaction. It also discusses how to implement a nurse residency program and monitor and evaluate its success.

The profession of nursing is facing a huge crisis. The number of experienced nurses is shrinking and the supply of new graduate nurses is becoming abundant in number. Consequently, the new graduate nurses are the largest source for hiring. However, the new graduates are so psychologically challenged to their particular roles that almost half of them change their employer in less than 12 months of their first job and manyL quit the profession altogether according to several researched studies. As a result, there is high turnover rate, low retention rate, low confidence and competency skills, poor job satisfaction, and poor patient outcome. Hospitals and acute care facilities are struggling to find a solution to these issues. Studies have shown that new graduate residency program is the solution to these problems. Nurse residency program will be implemented with appropriate planning and measurable goals. The length of the program will be one year. Reports will be run for preprogram statistics. The program will be interactive with didactic classroom sessions and clinical component that will increase the opportunity for mastering competency skills. Preceptors will provide appropriate feedback to the graduates. Evaluation of the program will be continuous. Post program numbers will be run for statistics and comparative analysis. Once the success has been ascertained by positive results and consistency after several times, the data will be disseminated to the greater nursing community which may include national and global nursing communities. Various media resources, such as but not limited to published journals and articles, will be used to disseminate information.

New graduate nurses are faced with stressful and challenging work environments as they transition from student nurse to practicing professional nurse. Some of the stress related factors are not having adequate skills resulting in a lack of confidence, uncomfortable working with an interdisciplinary medical staff, short staffing, poor leadership, and support. As a result, many new graduates leave the acute care setting within the first year from poor job satisfaction. This exacerbates short staffing problems, is costly for the acute care hospitals, and affects patient care. Most new graduate nurse's training programs are inadequate to prepare promising new nurses for the complexity of today's patient population and challenging work environments. Evidence based practice research supports the concept of institutionalizing a residency and mentorship program lasting at minimum one year with a designated mentor for up to one-year post preceptor ship to answer ongoing questions and concerns. Research evidence shows that acute care hospitals that have implemented this program have higher retention rates and significant increases in job satisfaction of newly graduated nurses. This proposal will include an implementation plan for acute care hospitals to put into practice a residency and mentorship program for new graduate nurses.

Health care facilities across the United States have implemented innovative approaches such as nurse residency programs to facilitate a successful transition to practice for new nurses. Many nurse residency programs evaluate their effectiveness by assessing critical thinking abilities, retention, return on investment, and job satisfaction. Evaluations are conducted using surveys and focus groups. However, there is a void in the literature that examines the effectiveness of a new nurse residency program from the participants' perspective; particularly asking the resident how the nurse residency program has advanced them to become a more competent professional. The theoretical model framing this investigation is Patricia Benner's novice to expert theory. The purpose of this qualitative case study is to understand participants' perceptions of a nurse residency program, specifically looking at how the program transitioned them from advanced beginner to competent nurse professional. The study sample included eight participants employed in a health care facility located in the southeastern United States. Open-ended research questions were designed to elicit the new nurses' perceptions of the effectiveness of a nurse residency program. Data collection was conducted using interviews and audio recordings. Emerging themes indicated that pre-experiences and expectations, leadership and professional development, stress and coping, supportive cohort, program improvements, and reflection on confidence and competency were fundamental elements for an effective nurse residency program. One recommendation from this study was for pre-residency assessment tools to be given to residents for customization to better facilitate the transition of new nurses to a competent professional.

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.

As the U.S. population ages, healthcare is shifting from acute care environments to post-acute and community settings. New nurses in particular lack the specialized knowledge required for chronic care and gerontological care and are often unprepared to transition into post-acute settings. Developing a Residency in Post-Acute Care offers practical curricula based on an innovative and successful nurse residency model that positions staff educators and preceptors to support new nurses as they enter post-acute settings. This indispensable book also provides tools and resources for nurse educators to use in developing and training new and existing staff, including: Lesson plans, objectives, and outlines, Activities geared toward adult learners, Strategies for presenting material, Detailed case studies, Participant evaluation methods, References and additional resources, The application model provided in Developing a Residency in Post-Acute Care is fully adaptable for multiple post-acute settings. This resource enables instructors to enhance competence and confidence in new nurses-not simply re-teach materials learned in school. In the end, better onboarding can lead to significant improvements in cost, quality of care, and nurse retention rates. Book jacket.