Best practice components for nursing new graduate residency programs: an integrative review of the literature

Abstract

The need for an effective transition to practice program, such as nurse residency programs (NRPs), has been documented for over 80 years (Townsend, 1931 as cited in Spector et al., 2015). Anderson, Hair, and Todero (2012) stress how new graduate registered nurses (RNs) face high patient acuity and complex situations, nursing shortages, high turnover, burnout, excessive overtime demands, reduced new RN orientations, and heavy use of agency/traveling nurses to fill gaps (Joint Commission on Accreditation of Healthcare Organization, 2002; Jones & Gates, 2007 as cited by Anderson et al., 2012). Not only does this turnover negatively affect morale and job satisfaction, it's also very expensive with the estimated cost to replace these nurses ranging from $49,000 to $92,000 per nurse (Kram & Wilson, 2016). NRPs have been recommended to combat turnover and provide support during the transition into professional practice (Benner, Sutphen, Leonard, & Day, 2010; IOM 2011; The Joint Commission, 2002 as cited by Spector et al., 2015; Cochran, 2017). However, despite these recommendations, there continues to be a lack of comprehensive, evidence-based NRPs offered by employers (Spector, et al., 2015). The purpose of this integrative review of literature was to explore the best practice components of NRPs. This integrative review was performed by mining relevant literature from predetermined databases and all reference lists of the selected literature. A total of 13 publications met the predetermined inclusion criteria. After reviewing how different factors affect the transition of new graduates, it was concluded that an NRP that was based on a national model or developed internally in congruence with national models would provide best chance for a successful transition for new graduates. This model would include an adaptive, evidence-based curriculum that is customized to the patient populations and unit specifics, a program length of at least 12 months, and training and careful selection of preceptors and mentors. Additionally, it is recommended to that NRP staff have an awareness of differences in new graduate ADN and BSN preparedness and skill sets and adapt the NRP as needed to accommodate both cohorts.