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Perceptions of a Nurse Residency Program. Nancy Fink, MSN, BSN, RN, CCRC Karen Lutter, MSN, BSN, RN, NE-BC. Objectives. Describe the purpose of the nurse residency pilot program at IH-DM. Identify historical background behind typical nursing orientation.

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Perceptions of a nurse residency program

Perceptions of a Nurse Residency Program

Nancy Fink, MSN, BSN, RN, CCRC

Karen Lutter, MSN, BSN, RN, NE-BC


  • Describe the purpose of the nurse residency pilot program at IH-DM.

  • Identify historical background behind typical nursing orientation.

  • Review the next steps for developing a nurse residency program.

  • Describe the outcomes from building a nurse residency program and the implications for retention.


  • Survival of the hospital RN

  • Decreased supply of RNs and increased burnout

  • Dissatisfaction with job leads to early departure

  • National Turnover and Vacancy Rates in Acute Care Hospitals

    • 21.3% average turnover rates

    • 8.9% to 16.4% average vacancy rates


  • Stress among new RNs in new position

  • Transition issues

    • 30%-60% of new RNs leave within one year

  • Cost of orientation

    • 100% of annual salary


  • Inconsistent at Iowa Health Des Moines

    • Hospital orientation

    • Preceptor training

    • Length of unit orientation

    • Gap between academics and frontline nurse

  • Turnover and Vacancy at Iowa Health Des Moines

    • 11.36% Turnover (2008); 8.33% (2010)

    • 2.31% Vacancy (2009); 1.74% (2010)

    • Historically RNs left within 1-5 years of their employment; current trend in 2010 within 5-24 months


  • Issues to retain newly licensed nurses

    • Provide job satisfaction

    • Consistent orientation plan with enhanced preceptor development

    • Increased confidence and competence


  • Find the perceptions expressed by newly hired graduates regarding their confidence and competence after six months of attending a residency program and examining their transition into the acute care setting.

Legal and ethical
Legal and Ethical

  • IRB approval obtained at Iowa Health Des Moines and Clarkson College.

  • Data analyst sent the SurveyMonkey link to the participants at midpoint.

  • New RNs accessed the survey through their protected electronic email system.

  • Confidentiality maintained by the data collection system

  • Implied consent was given if participant answered the survey.

Literature review
Literature Review

  • Not another lecture (Poynton, Madden, Bowers, Keefe & Peery, 2007)

    • New RNs do not want to sit in a classroom

    • Need to direct more hands on learning

    • Material to be more relevant to their nursing specialty or interest

  • Develop Curriculum (Bonnel, 2009).

    • Built to enhance the academic curriculum

  • Residency Support (Altier & Krsek, 2006)

    • Enriched learning experience of newly licensed nurses

    • Includes didactic and clinical orientation

    • Successful transition into nursing practice

Literature review1
Literature Review

  • Nursing Executive Center (NEC, 2008)

    • Identified need for preparing RN for new role after graduation

    • Nurse leaders identified that new RNs need to go beyond academic preparation to retain and build confidence of new RN

    • Used a dual-survey method for academic and frontline nursing leaders

    • Purpose of survey to isolate specific nursing competencies

      • Thirty-six competencies isolated that drive nursing preparation-practice gap

  • University HealthSystem Consortium (UHC) and American Association of Colleges of Nursing (AACN)

    • Curriculum for residency program and guidelines to enhance the confidence and competence of the new RN (Poynton, Madden, Bowers, Keefe & Peery, 2007)

Theoretical framework
Theoretical Framework

  • Utilization of Patricia Benner’s Theory (1984)

    • Novice to Expert

    • Development of extended orientation with newly licensed nurses

    • Growth with extended orientation from novice to advanced beginner

    • Curriculum constructed with foundation of academic degree


  • Nurse manager assisted in identifying newly licensed nurses to participate in residency program.

  • Once the managers agreed for the newly licensed nurse (RN) to participate in the residency program, the new RNs were approached.

  • Final selection was determined by the research investigators.


  • Invited newly licensed RNs within last six months and graduated from an accredited nursing program.

  • Participants reviewed the class schedule and the class objectives and given the opportunity to ask questions.

  • It was explained to the participants that at any point they can withdraw from the class and the research.

  • Six participants currently enrolled in the residency program.

Curriculum foci
Curriculum Foci

  • Leadership skills/Evidence Based Practice

  • Critical Thinking

  • Delegation & Resource Management

  • Prioritization & Healthcare Delivery

  • Communication (Physician, peers)

  • Review Core Measures (CNS & Quality)

  • Model of PDSA

  • Ethics, Advance Care Planning

  • Diversity in Healthcare/Customer Service

  • Role Change (Shadow another healthcare role during this week)

  • Conflict Resolution/Change Theory

  • Career Development/Celebration

Average score from survey questions 1 5 graph 1 of 2
Average Score from Survey Questions 1-5Graph 1 of 2

Average score from survey questions 6 10 graph 2 of 2
Average Score from Survey Questions 6-10Graph 2 of 2

Projected expenses
Projected Expenses

  • Residency program will be developed and implemented by the Clinical Professional Development staff at no additional cost to the organization

  • Extended education time for the graduate nurse

    • 12 sessions; 4 hours in length; 48 hours

    • Graduate nurse starting wage $20.77/hr

    • Additional cost $996.96/nurse

    • Six graduate nurses in pilot

    • Total cost $5,981.76


  • Need for a strong preceptor program

    • Challenges in orientation module tool

    • Challenges in prioritization in patient assignments

  • Resources for faculty and finances

    • Educator needs at least 7 hours prep work for one hour of class time (Beecroft, Kunzman, & Krozek; 2001)

    • Resource considered as in-kind support as responsibility of clinical professional development department within IHDM

  • Benchmarking

    • Difficult at this point as residency program pilots for RNs is new

  • Program for IHDM

    • Number of participants small

    • Survey tool not tested for validity


  • Continue the RN Residency program augmenting the existing nursing orientation at Iowa Health Des Moines (IHDM) in 2011 and 2012.

    • Start within six months of licensure

    • Enhance preceptor program

    • Add simulation to the course material to increase hands on skills

    • Develop tool kit for nurse leaders

    • Collaborate with Human Resources with application process


  • Institute of Medicine (IOM, 2010)

    • The Institute of Medicine and Robert Wood Johnson Foundation included implementing a residency program as a targeted recommendation at the local, state, and national level.

  • Time Line for Implementation

    • First pilot, 6 residents participated, April 2010 – September 2010

    • Second pilot, goal for 20 residents to participate, August 2011 - February 2012

    • Third pilot, goal for 20 residents to participate, February 2012 - August 2012

    • Full implementation August 2012


  • Altier, M.E. & Kresek, C.A. (2006). Effects of a 1-year residency program on job satisfaction and retention of new graduate nurses. Journal for Nurses in Staff Development, 22(2), 70-77.

  • Beecroft, P.G., Kunzman, L., & Krozek, C. (2001). RN internship: Outcomes of a one-year pilot program. JONA, 31(12), 575-582.

  • Benner, P. (1984). Novice to Expert: Excellence and Power in Clinical Nursing Practice. Menlo Park, CA: Addison-Wesley.

  • Bonnel, W. (2009). Clinical performance evaluation. In D.M. Billings & J.A. Halstead (Ed.) Teaching in Nursing: A Guide for Faculty (3rd Ed.) (pp. 449-458); St. Louis, MO: Saunders Elsevier.


  • Nursing Executive Center. (2008). Bridging the preparation-practice gap: Volume I: Quantifying new graduate nurse improvement needs. The Advisory Board , ix-71.

  • Poynton, M.R., Madden, C., Bowers, R., Keefe, M., & Peery, L.H., (2007). Nurse residency program implementation: The Utah experience. Journal of Healthcare Management, 52(6), 385-397.

  • Reinsvold, S. (2008). Nursing Residency: Reversing the cycle of new graduate RN turnover. Nurse Leader, 46-49.