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.

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.

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.

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 purpose of this evidence-based project was to compare one-year outcomes for newly licensed Registered Nurses (NLRNs) in three organizations within the same healthcare system. All three have lower than nationally reported turnover and strategies for NLRN retention. Only one is using a Nurse Residency Program (NRP). NRPs are recognized as an effective strategy to retain newly licensed registered nurses (NLRNs) in their first year of employment (Institute of Medicine [IOM], 2010; The Advisory Board, 2007; Spector, 2007). The Commission on Collegiate Nursing Education (CCNE) (2008) defines an NRP as a series of learning sessions and work experiences that occur continuously over a 12-month period designed to assist NLRNs as they transition into their first professional nursing role. This cross-sectional, descriptive study utilized the Casey-Fink Graduate Nurse Experience Survey and intent to stay questions to collect data on NLRNs at one year post hire. Results indicated no statistically significant differences between the three sites and the subscales of the survey. There was a trend of a more positive score for professional satisfaction with Site A. Turnover was also similar between sites and lower than the reported 10% average, with Site A at 2%, Site B at 5%, and Site C at 4%. There was a statistically significant difference between Site A and C in the intent to stay in their current position, with Site A longer than Site C. The study supports the literature and evidence that a NRP is an effective strategy to decrease first year turnover. Further study is needed related to the effectiveness of the components of the NRP, length of time for mentorship, and the impact of accumulation of cohorts.

In this comprehensive resource, nursing staff development expert Jim Hansen, MSN, RN-BC, provides instruction and tools to plan, justify, and structure a nurse residency program that develops and retains new nurses through their first year