Nurse Residency Programs: A Transition

into Practice Deidre Dennison RN

NUR 444 – Nursing LeadershipSUNYIT

Purpose: To investigate the efficacy of nurse residency programs (NRPs) on new graduate nurse retention in general by performing literature reviews as well as comparing the overall trends to the outcomes of Albany Medical Center’s NRP

Audience: New graduate registered nurses (RNs & GNs) employed at AMC & other institutions nationwide

Introduction

I worked with a staff member at the Center for Learning & Development at Albany Medical Center – a separate off-site center dedicated to continued education and extensive orientation/course offerings

My experience included multiple NRP sessions, hospital critical care nursing leadership meetings, education & resuscitation committee meetings, follow-up with NRP ‘cohort group’(ICU & cardiovascular)

Preceptor Role/Information

According to Rhodes et. al. (2013), newly licensed registered nurses (NLRNs) make up approximately 10% of the clinical staff in hospitals

Turnover rates of NLRNs within the first year averages from 35% to 61%

Contributes to increased hospital costs, staffing shortages, and quality of care

Significance to Nursing

Factors that have been shown to add to new graduate nurse turnover include:◦ Stress◦ Ineffective orientation◦ Working ‘short’◦ Scare resources◦ Group cohesion/support◦ Feelings of being unprepared for the multiple

roles associated with nursing

Why the High Turnover?

Focus of NRPs include clinical skills, but the focus is more on professional skills: ◦ Critical thinking◦ Time management/organization◦ Prioritization◦ Appropriate delegation◦ Professional/Interdisciplinary communication◦ Effective patient teaching/health literacy◦ Dealing with difficult patients and families◦ Stress management

Characteristics of NRPs

Provides a ‘cohort group’ to new registered nurses which meets socialization needs & which the new grad can express their successes & frustrations

Promotes leadership skills Reduces newly graduated registered nurse

turnover from the 30% range into the single digits in some cases (Trepanier, Early, Ulrich, & Cherry 2012)

Reduces hospital costs - for every nurse that leaves a position, it costs the hospital between $40,000 - $64,000 (Baggot, et. al. 2013)

Benefits of NRPs

Based on the changes of practice as nurses progress in their field, gain more experience, and develop more effective clinical/professional skills

Evolves in five stages throughout the nurse’s career

“Movement from reliance on abstract principles to use of past concrete examples as paradigms” (Hood, 2010, p.13)

Benner’s Novice-to Expert Theory

Stages of Benner’s Theory

Stages Continued

The organization has been using NRPs for almost three years as mandatory orientation for new graduate registered nurses

12 month program Requires research Power Point presentation to

nursing leadership at the end of the program by smaller groups based on specialty

Improved new grad retention rates beginning the first year and beyond

My agreement with Albany Med prohibits me from releasing specific figures as the findings are being prepared for publication in the future

Experience With NRPs at Albany Medical Center

NRPs can be an effective way to reduce new graduate registered nurse turnover along with the associated expenses & other negative results of turnover

Cost analysis shows that although NRPs require financial and time investments, they are still less costly than high turnover expenses

Provides a more level playing field in regards to practice by nurses with various levels of education/preparation

Summary

Hood, L. J. (2010). Leddy & pepper's conceptual bases of professional nursing. Philadelphia, PA: Wolters Kluwer Health.

Theisen, J. L., & Sandau, K. E. (2013). Competency of New Graduate Nurses: A Review of Their Weaknesses and Strategies for Success. Journal Of Continuing Education In Nursing, 44(9), 406-414.

Trepanier, S., Early, S., Ulrich, B., & Cherry, B. (2012). New Graduate Nurse Residency Program: A Cost-Benefit Analysis Based On Turnover and Contract Labor Usage. Nursing Economic$, 30(4), 207-214.

Rhodes, C., Radziewicz, R., Amato, S., Bowden, V., Hazel, C., McClendon, S., & ... McNett, M. (2013). Registered Nurse Perceptions After Implementation of a Nurse Residency Program. Journal Of Nursing Administration, 43(10), 524-529.

References