Impact of nurse residency programs on new graduate nurse retention outcomes: an integrative review

Abstract

Problem/Purpose: New graduate nurses are essential employees. Given the nationwide nursing shortage and the turmoil caused by the COVID-19 pandemic, there is a need to focus on new nurses' transition to practice. The transition from an academic setting into real-life practice is often stressful; therefore, nursing organizations have shifted their focus to emphasize new nurse satisfaction, support, and retention through the implementation of nurse residency programs. Nurse residency programs are hospital-implemented programs lasting about a year, and can vary in format, length, and structure. The programs aim to support new nurses' growth in essential skills like critical thinking, prioritization, and delegation. The purpose of this study was to conduct an integrative literature review to identify and evaluate the influence that nurse residency programs have on new graduate nurse attrition and retention outcomes. Procedure/Methods: Electronic database search of CINAHL, PubMed, and Web of Science discovered studies completed in the United States from 2017 to 2022. English-language articles were selected and reviewed for inclusion of registered nurses in an acute care setting that addressed new graduate nurses and intent to leave (attrition or retention) as a primary or secondary measure. Twelve articles met the inclusion criteria. The studies were evaluated for quality using Whittemore and Knafl's (2005) data analysis process. The application of Benner's Novice to Expert (1982) nursing theory provided the framework for the transitional experiences of new nurses. Results: Evidence supports new nurses participating in nurse residency programs experience positive outcomes, including increased confidence, social support, and decreased turnover rates. Workplace challenges and personal stressors were found to negatively impact turnover. Communication, recognition, rewards, and preceptor/mentor support positively influenced retention for at least a year, which provided hospitals with break-even to positive return on investment. Conclusions: New graduate nurses require time to grow and learn during the first year of practice. Three new phases of the novice nurse transition, supported by nurse residency programs, are proposed to enhance the expansion of Benner's theoretical model. The major thematic findings and improved retention rates demonstrate the need for resources and structured support encompassed within nurse residency programs.