Effect of Nurse Residency Programs on Retention of New Graduate Nurses

1. Effect of Nurse Residency Programs on Retention of New Graduate Nurses Leanne Lemon University of Central Florida College of Nursing

2. PICO Question • In new graduate nurses, what is the effect of nurse residency programs on retention?

3. Background & Significance • Transition from role of nursing student to professional is exciting and stressful. • Graduate nurses lack confidence, are frustrated with the work environment and work relationships, lack organizational and priority-setting abilities, and experience high levels of stress for the first year after being hired. Casey et al, 2004. • New graduate turnover ranges from 35%-60% within the first year of employment. Halfer & Graf, 2006.

4. Background & Significance • The Future of Nursing report recommends nurse residency programs for new graduate nurses or those going into new practice areas. Institute of Medicine, 2010. • New graduate nurses make up 10% of the nursing staff in acute care organizations, and this will likely grow as a result of an aging RN workforce and baby boomers planning retirement. Berkow et al, 2008. • By 2025, there is projected to be shortage of about 260,000 RNs in the United States. Beuerhaus et al, 2009.

5. Background & Significance • Turnover costs of one nurse are estimated to be anywhere from $82,000 to $88,000, and for every 1% increase in turnover, health care organizations spend an estimated $300,000 a year. Jones, 2008. • A survey by the Nurse Executive Center of more than 5700 nurse leaders found 90% of nursing school leaders considered new graduate nurses competent to provide safe, effective care to patients, compared with only 10% of hospital nurse leaders. This survey addressed six major skill categories: clinical knowledge, technical skills, critical thinking, communication, professionalism, and management of responsibilities.

6. Methods • Databases searched include the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Database of Systematic reviews, and Medline. • Keywords: • Graduate nurse • Residency program • Retention • Turnover

7. Methods • Exclusion Criteria • Programs prior to graduation from nursing school • Programs of less than one year duration. • Inclusion Criteria • Peer reviewed articles • English language • Programs in the United States

8. Methods • Results: 20 articles for review. • Reference lists were manually searched to identify additional relevant studies. • 10 articles met inclusion criteria. • Total sample size: >8,938 new graduate nurses • Level of Evidence: • Three studies are level III, well designed controlled trials without randomization • Three studies are level IV, evidence from cohort studies • Four studies are level VI, single descriptive and qualitative studies. Melnyk & Fineout-Overholt, 2011.

9. Findings: Increased Retention • All but one study reported an increased retention rate as a result of the nurse residency program with one exception. Based on the information provided in that study, it was inconclusive if as to whether or not the program resulted in increased retention (Kowalski & Cross, 2010).

10. Findings: Increase Self-Confidence • Five of the included studies reported an increase in self-confidence among the new graduates nurses upon completion of the nurse residency program.