Effectiveness of transition programs on new graduate nurses' clinical competence, job satisfaction and perceptions of support: A mixed-methods study.

AIM: To assess the effectiveness of two graduate nurse programs on new graduate nurses' overall competence at 3, 6, 9 and 12 months. Secondary aims were to assess new nurses' job satisfaction at 12 months and explore their experiences of support. BACKGROUND: Most clinical settings have implemented transition programs to help new nurses to adapt to their new environments and expand their competences. To this day, very few studies have assessed the effectiveness of these programs. DESIGN: Longitudinal mixed-methods study. METHODS: The study was conducted at two teaching hospitals in Australia. New nurses were recruited during orientation. Data were collected at baseline (T0; n = 88), 3 (T1; n = 29), 6 (T2; n = 15), 9 (T3; n = 11) and 12 months (T4; n = 9). At each time point, the questionnaire included demographic and the Nurse Competence Scale. At T4, the questionnaire also included the Nurse Satisfaction Scale. Semi-structured interviews were conducted from T1 to T4. This study conforms to the STROBE guidelines. RESULTS: Competence increased significantly at T1, with participants stating that they learned by "getting out" of student mode. At T2, despite no significant difference in competence, participants expressed they were more confident and in control, because they felt supported. Again, at T3, there was no significant increase in competence. Finally, at T4, competence increased significantly, with participants acknowledging that they still had a lot to learn. CONCLUSION: This study supports that 12-month transition programs are necessary for NGNs to expand their competence. One major factor influencing NGNs during their first year was how well they felt supported and encouraged to seek help when they needed it. RELEVANCE: There is a need to understand how new NGNs enrolled in transition programs expand their competences. Their professional development depends on a supportive environment where NGNs feel confident in asking questions or for help.

Leveraging the Librarian in a Nurse Residency Program.

Hospitals are increasingly implementing Nurse Residency Programs (NRPs), but medical librarians are often left out of their institution's respective programs. Librarians possess a unique, knowledge-based skill set that is a natural fit for the content and goals of a NRP and should be more frequently considered and used by such programs. This article identifies and explores several roles for librarians in NRPs and discusses the impact and results of including librarians.

A description of U.S. post-graduation nurse residency programs.

BACKGROUND: Concern regarding newly licensed registered nurses' abilities to cope with the increasing complexity of care has led to the development of a variety of nurse residency program (NRP) initiatives. The unknowns are the extent to which and how various program elements are implemented across NRPs. Without understanding the extent to which NRPs deliver the same program, determination of their impact on care is limited. The purpose of this study was to describe U.S. NRPs and thereby identify the extent of treatment fidelity across programs. METHODS: Program attributes were measured using a 24-item survey based on the outcomes production conceptual framework. The survey was sent to known NRP directors or chief nursing officers at the 1,011 U.S. hospitals having 250 or more inpatient beds; 203 surveys (a 20% response rate) were returned. RESULTS: Almost half (48%) of hospitals reported operating an NRP. NRP models included University HealthSystems Consortium (22%), facility based (54%), and "other" (24%). Significant (p < .01) differences were noted among and within program model types in terms of career planning, project requirements and types, and mentoring. CONCLUSIONS: The extent of differences within and across program types indicates a lack of treatment fidelity needed to detect objectively the impact of the NRP as a discrete intervention on patient outcomes. NRP expansion may be limited by the number of hospitals of a size most likely able to support such programs.

Nursing students' work readiness and its influencing factors before participating in a nurse residency program: a multicenter cross-sectional study.

Background: Studies have shown that work readiness is closely related to nurses' role adaptation, career development, and patient safety. However, we know little about the nursing students' work readiness and its influencing factors before participating in a nurse residency program, and whether factors have changed from before. Aim: (1) To investigate the work readiness of nursing students ready to engage in a nurse residency program; (2) to identify the factors affecting the nursing students' work readiness and the associations between emotional intelligence and work readiness; and (3) to discuss the changes of factors affecting nursing students' work readiness. Design: An online, multicenter cross-sectional study. Methods: 878 nursing students from eight tertiary hospitals in Chongqing, China were recruited. The online investigation used the General Information Questionnaire, the Nursing Students' Work Readiness Scale, and the Emotional Intelligence scale. The data were analyzed using IBM SPSS V23.0. Results: 768 valid questionnaires were included in this study. The nurses obtained a work readiness score of 277.08 ± 44.39 and an emotional intelligence score of 89.57 ± 13.89. Univariate analysis revealed that the following factors affected work readiness: age, sex, family support for becoming a nurse, voluntary choice of nursing major, previous experience as a student cadre, scholarship recipient status, willingness to engage in nursing work during the COVID-19 pandemic and confidence in clinical nursing practice. Frequent incidents of violence, poor salary for nurses for the nurse residency program, and low social acceptance were the top three reasons for decreased confidence in clinical nursing among nursing students. Furthermore, multiple linear regression analysis indicated that age, voluntary choice of nursing major, student leadership experience, confidence in clinical nursing work, self-emotion, and emotional application significantly influenced nurses' work readiness. Conclusion: Clinical instructors and administrators should dynamically assess nurses' work readiness, prioritize individuals aged ≤23, who have chosen the nursing profession involuntarily, lack prior experience as student cadres, and exhibit low confidence in clinical nursing work. This focus will enhance their emotional self-management skills and ability to apply emotions effectively, improving their work readiness and training efficacy.

The effectiveness of nurse residency programs on new graduate nurses' retention: Systematic review.

Background: The World Health Organization estimated a need for around 6 million nurses by 2030 to meet the healthcare demand. The International Council of Nurses reported that, the impact of COVID-19 pandemic, the aging nursing workforce, and the high turnover of nurses were some of the factors that contributed to the anticipated 13 million nursing deficit. Globally, there is a worry about the high turnover with no doubt. The cost of turnover and recruitment incurred by healthcare organizations are huge which requires developing measures and interventions to address the problem. Nurse Residency Programs is a promising educational intervention for improving nurses' retention rates and reducing the impact of the shortage. PICO question: What effect does successful completion of Nurse Residency Program have on new nurses' retention rates compared with new nurses who missed the Nurse Residency Program? Inclusion criteria: The review included articles; published in English, between 2016 and 2023 that addressed nurse retention rates, associated with Nurse Residency Program participation. Methods: The systematic review followed the PRISMA protocol. An extensive search on the Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE, Academic Search Complete, and PubMed for studies published between January 2016 and March 2023 in English language. The key words, 'graduate nurses', 'new graduate nurses', 'residency', 'internships and residency', 'NRP', 'retention and retention rates'. Utilizing the JBI Sumari, two reviewers screened the citations, reviewed the eligibility criteria, conducted the critical appraisal, and assessed the risk of bias and extracted data from the included studies. Cochrane Risk of Bias in Non - randomized studies of intervention (ROBINS-I) tool was used to assess risk for bias. Results: Out of 189 studies, 48 studies removed as duplicate, remaining with 141 article. After screening titles and abstracts, only 48 papers retrieved for full-text evaluation. Out of 48 research only 5 publications were included in the review. The researchers identified the methodological heterogeneity is a major factor to stop the metanalysis and keep the systematic review. Conclusions: Nurse Residency Programs showed promise as an educational intervention to cultivate well-supported, competent, and confident new nurses. These programs have the potential to improve retention rates during the initial 12 months of employment. To gain a deeper understanding of retention beyond the first year, additional randomized control trials are essential. Furthermore, there is a need to integrate standardized Nurse Residency Programs into organizational policies and clinical practice settings in the UAE.

Impacts of the COVID-19 Pandemic on Newly Licensed Critical Care Nurses.

Newly licensed registered nurses (NLRNs) were significantly impacted by the COVID-19 pandemic. NLRNs experienced interruptions or significant alterations across, academia, clinical rotations, precepted experiences, and transition to practice programs. All NLRNs were impacted, especially those in critical care who cared for the most acutely ill patients. This article represents a program evaluation of NLRNs in the critical care area during the COVID-19 pandemic and a comprehensive review of the literature related to COVID-19s impact on NLRNs.

Respiratory Residency: Establishing Excellence for the Newly Licensed Respiratory Therapist.

BACKGROUND: Workforce issues have highlighted the fact that newly graduated respiratory therapists (RTs) need more support during their transition to practice; however, there are few data on best practices for RT residency programs. METHODS: The aim of this project was to evaluate the feasibility and effectiveness of a residency program for licensed RTs with < 1 y of experience post graduation. The approach to improve new graduate transition to practice included a streamlined clinical-based orientation, didactic learning, evidence-based practice plan, and incorporated simulation. Data were collected in a secure electronic database at a multi-campus health care system utilizing anonymous questionnaires. The participants responded to questions about demographic information, overall confidence, clinical skills, and knowledge base topic confidence. RESULTS: Participant responses reported an increase in their overall factor score measures for role confidence, clinical skills, and knowledge-based topics. CONCLUSIONS: The collected responses showed an increase in a wide range of clinical skills and other soft skills. These results indicate that a respiratory care residency program adds value to the training, overall well-being, and retention of the newly graduated RT.

Associations Between the COVID-19 Pandemic and New Nurses' Transition to Practice Outcomes: A Multi-site, Longitudinal Study.

Background: The transition between nursing school and nursing practice has been well studied and recognized as a turbulent time for new nurses. Existing literature suggests that transition to practice (TTP) programs can successfully support new nurses through this challenging period. However, TTP program outcomes have not been studied related to the COVID-19 pandemic, which altered TTP experiences for many new nurses by limiting their access to clinical sites for hands-on patient care experience and shifting delivery of nursing education and TTP programs from in-person to virtual environments. Purpose: The purpose of this study was to analyze the associations between TTP outcomes and the COVID-19 pandemic. Methods: This was a retrospective correlational, longitudinal study using secondary analysis of Vizient /AACN Nurse Residency Program survey data from the Casey-Fink Graduate Nurse Experience Survey and the Nurse Resident Progression Survey. Self-reported data from new nurses in Southeast Texas who participated in a standardized TTP program before the COVID-19 pandemic (2017-2019) were compared with self-reported data from nurses who participated in the TTP program during the pandemic (2020 and 2021). Results: A total of 2,673 nurses participated in this study. When adjusting for demographic composition of the cohorts, statistically significant differences (p < .05) were identified in the advocacy, patient safety, and commitment outcomes with a decline in change scores from baseline to 12 months in the COVID-19 pandemic cohort compared to the pre-COVID-19 pandemic cohort. Conclusion: Our findings provide new information on the impact of the COVID-19 pandemic on new nurses' participating in a standardized TTP program. The results indicate that patient safety and commitment to staying employed in the organization and the nursing profession should be priority improvement areas for employers and TTP program staff as they work to support new nurses' TTP in a pandemic.

Developing a Perioperative Nurse Residency Program to Address Planned Nurse Retirements.

Many perioperative nurses are nearing retirement age, which requires hospital and other surgical facility leaders either to compete for experienced perioperative nurses or to find educational solutions to prepare qualified nurses for the perioperative nurse role. Facing the upcoming retirement of several perioperative nurses, leaders at the Sacramento Veterans Affairs Medical Center needed to be proactive. This article describes the leaders' exploration of possible solutions to the shortage, the development of attainable goals, and the steps to provide a successful perioperative nurse residency program. It discusses the required human and material resources, the candidate screening process, and information related to classroom and clinical experiences. The first nine-month perioperative nurse residency program concluded with three graduates who are now working full-time as RN circulators and scrub persons. This facility's administrative leaders immediately approved a second cohort that ran from February 2019 to November 2019.

Transition experiences of nurses as students and new graduate nurses in a collaborative nurse residency program.

BACKGROUND: A small Midwestern college of nursing and an affiliate hospital partnered to design a nurse residency program where students are extended pre-hire job offers in a practice area of their choice and are then partnered with a preceptor who they will work with in a clinical immersion experience during the last semester of their nursing program and in their orientation period as new nurses. PURPOSE: The purpose of this qualitative, phenomenological study was to explore the lived experiences of a cohort of nurses as students and new graduate nurses during transition in this collaborative nurse residency program. METHOD: A transcendental phenomenological qualitative approach using Meleis' Transition Experience Theory as a theoretical framework is used for this study. RESULTS: Themes of feeling overwhelmed, supported, and confident were identified. A finding unique to the literature and this nurse residency program model is a theme of overwhelming support. CONCLUSIONS: This information can be used to improve the nurse residency program and its outcomes and also further the advancement of nursing knowledge of the transition experience of new nurses.

Determining the Effect of Two Different Approaches to Orientation on Self-Efficacy in Inexperienced Nurses.

Self-efficacy is an extensively studied, yet underutilized, indicator of the effectiveness of current education, the measurement of which could contribute to planning the direction of future education. An efficacy expectation is the conviction that one can successfully execute the behavior required to produce the outcomes (Bandura, 1977). This article presents the results of a study that compared the self-reported self-efficacy of newly hired nurses before and after a nurse residency program.

Psychometric Evaluation of a Tool for Assessment of Clinical Development in Newly Licensed Registered Nurses.

BACKGROUND AND PURPOSE: For effective evaluation of clinical development, established psychometric properties of reliability and validity are essential. The Clinical Development Assessment (CDA) tool was developed within a 12-month pediatric nurse residency program. Benner's novice-to-expert model framed the development of the CDA. METHODS: Data from 129 nurse residents and their preceptors were used to evaluate internal consistency reliability and face, content, and construct validity. Nine elements were assigned a six-point Likert scale scored as (a) unsafe, (b) novice, (c) advanced beginner, (d) competent, (e) proficient, and (f) expert. RESULTS: Moderately strong reliability was found. Using exploratory factor analysis, a single factor accounted for 68% of the variance in clinical development. Face and content validity were confirmed. CONCLUSIONS: This study identified a brief, valid, and reliable tool to evaluate clinical development in newly licensed registered nurses.

A telling transition: new graduate nursing in the oncology and bone marrow transplantation setting.

The University of Colorado Hospital's Post-Baccalaureate Nurse Residency Program is a Commission on Collegiate Nursing Education-accredited program structured to provide critical elements important for a successful transition into professional nursing practice. As part of the program, graduate nurse residents receive a year of education that includes 12-24 weeks of precepted orientation on the clinical unit, paid specialty courses, and monthly seminars that provide additional curriculum and mentoring support. At the completion of the program, the residents complete an evidence-based practice project and a clinical narrative summarizing their residency experience. The following is an example of one resident's exemplar.