By Vicki Moran, PhD, MSN/MPH, CNE, RN, APHN-BC, CDE
Recently, I was in a meeting with a nursing administrator who was asking how schools of nursing are preparing student nurses for their transition to practice. For most nurse educators, this can be a very loaded question. I answered by validating the courses taught in nursing school, but left the discussion wondering why this question was asked. Then it dawned on me! The administrator was attempting to develop a program that would assist in transitioning newly licensed nurses into the practice of nursing.
It has been postulated that 90% of nursing faculty believe that nursing students are prepared for practice, while only 10% of hospital and health care systems leaders agree (Berkow, Virkstis, Stewart, & Conway, 2008). In 2010, the Institute of Medicine recommended that nurse residency programs (NRPs) be developed as a way to reduce attrition rates and assist the demand of registered nurses (RNs).
A recent executive summary by the American Academy of Nursing on policy provided evidence supporting a nurse residency program (NRP) for newly licensed registered nurses as part of an employment contract (Goode, Glassman, Ponte, Krugman, & Peterman, 2018). The authors state that hospitals are eligible for reimbursement from the Center for Medicare and Medicaid Services (CMS), similar to other residency programs for pharmacy, medicine, and chaplain programs (Goode et al., 2018). The summary supports policy recommendations focusing on the NRP accreditation to assure standardization of education, clinical standards, and accurate evaluation metrics (Good et al., 2018).
Other supporting bodies of nursing and nursing education have also advocated for the development of NRP programs. In 2014, the National Council of State Boards of Nursing (NCSBN) developed, implemented, and evaluated a transition to practice program (TPP) via online learning modules. Facilities across three states randomly assigned new graduate RNs access to the online modules as part of the onboarding process (NCSBN, 2014). Graduates in the traditional and online learning modules self-reported less errors, fewer negative safety practices, and higher overall competence ratings. The new graduates in the “established” programs had better outcomes (NCSBN, 2014).
The American Nurses Credentialing Center (ANCC) has been the certification center for Magnet Hospital and also supports the development of NRPs. There is even an accreditation for NRPs or fellowship programs through the ANCC Practice Transition Accreditation Program (PTAP)™ (ANCC, 2018).
Transitioning new graduates to the practice setting has been well-documented in literature. Current NRP initiatives which have been studied include the TPP by NCSBN (Spector et al., 2015), Vizient formally called AACN/UHC (Goode et al., 2013), Versant (Ulrich et al., 2010), and the Veterans Health Administration (Anderson, Hair, & Todero, 2012). Additionally, Maryland has implemented a statewide NRP (Warren, Perkins, & Greene, 2018).
Most NRPs have similar curricular concepts such as: leadership, teamwork, collaboration, communication, research-based practice, patient safety, critical thinking, nursing skills, delegation, time management, and professional development (Anderson et al, 2012). Programs do vary widely for educational intervention, curricular content, program duration, teaching learning strategies, and outcome measures for examining effectiveness (Anderson et al., 2012). However, the most important outcome of NRPs is focused on the retention of the new graduates (Silvestre, Ulrich, Johnson, Spector, & Blegen 2017).
NRPs should be at least 10-15 months in order to support independent practice by the newly-licensed RN (Cochran, 2017). It’s imperative that RNs be provided with adequate time for self-evaluation and feedback. In addition to key curricular concepts, the professional development of the RN will depend on their NRP preceptors and institutional support from the facilities and staff.
Subsequent integrative and systematic reviews of NRPs identify that there is a great need for the development of these programs to reduce costs and turnover, while improving the self-efficacy and confidence of the new graduate.
American Nurses Credentialing Center (ANCC). 2018. htts://www.nursingworld.org/organizational-programs/accreditation/ptap/
Anderson, G., Hair, C., & Todero, C. (2012). Nurse residency programs: An evidence-based review of theory, process, and outcomes. Journal of Professional Nursing, 28 (4), 203-212.
Berkow, S., Virkstis, K., Stewart, J. & Conway, L. (2009). Assessing new graduate nurse performance. Nurse Educator, (34) 1: 17-22. doi: 10.1097/01.NNE.0000343405.90362.15
Cochran, C. (2017). Effectiveness and best practice of nurse residency programs: A literature review. Medsurg Nursing, 26(1), 53-63.
Goode, C.J., Glassman, K.S., Ponte, P.R., Krugman, M., & Peterman, T. (2018). Requiring a nurse residency for newly licensed registered nurses. Nursing Outlook, 66, 329-332.
Institute of Medicine (IOM). (2010). The future of nursing: Leading change, advancing health: Report recommendations. Retrieved from http://nationalacademies.org/hmd/~/media/Files/Report%20Files/2010/The-Future-of-Nursing/Future%20of%20Nursing%202010%20Recommendations.pdf
NCSBN. (2014). NCSBN’s transition to practice study: Implications for boards of nursing. Retrieved from https://www.ncsbn.org/TTP_ImplicationsPaper_Dec2014.pdf
Silvestre, J.H., Ulrich, B.T., Johnson, T., Spector, N., & Blegen, M.A. (2017). A multisite study on a new graduate registered nurse transition to practice program: Return on investment. Nursing Economics, 35(3), 110-118.
Spector, N., Blegen, M.A., Silvestre, J., Barnsteiner, J., Lynn, M.R., Ulrich, B., Fogg, L., & Alexandar, M. (2015). Transition to practice study in hospital settings. Journal of Nursing Regulation, 5(4), 24-38.
Ulrich, B., Krozek, K., Early, S., Ashlock, C.H., Africa, I.M., & Carman, M.L. (2010). Improving retention, confidence, and competence of new graduate nurses: Results from a 10-year longitudinal database. Nursing Economics, 28(6), 363-375.
Warren, J.I., Perkins, S., & Greene, M.A. (2018). Advancing new nurse graduate education through implementation of statewide, standardized nurse residency programs. Journal of Nursing Regulation, 8(4), 14-21.