Nurse Residency Program: A Concept Analysis

Over one million new nurses will be needed to fill job vacancies by 2026 (Bureau, 2016). Further complicating this, newly licensed registered nurse turnover is between 17%-33% in the first two years of practice (Kovner, Brewer, Fatehi & Jun, 2014). The reasons for nurses leaving their job in the first year is not fully understood, but researchers have found the time between academia and the first year of practice to be highly stressful (Chappell, 2014) and described as the "continental divide" (Joint Commission, 2002). The evidence suggests that this divide leaves NLRN feeling a lack of support (Suzuki, Kanoya, Katsuki, Sato, 2006, Beecroft., Santner, Lacy, Kunzman, & Dorey, 2008, Bowles & Candela, 2005), belonging (Hayes, O'Brien-Pallas, Duffield, Shamian, Buchanan, Hughes, Laschinger, North & Stone, 2006) and experiencing difficulties with communication (Flicek, 2012) all resulting in an enhanced "reality shock" (Kramer, 1974). In addition to the practice academia gap, the demands of health care are ever increasing resulting in the need for highly complex decision making and critical thinking upon entering the profession.

Organizations such as The Joint Commission (TJC), Institute of Medicine (IOM) and Carnegie Study of Nursing Education have issued calls to action for an enhanced transition to practice for the profession of nursing (Joint Commission, 2002, IOM, 2011 & Benner, Sutphen, Leonard, & Day, 2010). Over the last 15 years, an effort to minimize the "continental divide" (Joint Commission, 2003), enhance the transition to practice (IOM, 2010) and prepare for the "tsunami" of vacancies of nurses has resulted in the emergence of the Nurse Residency Program (NRP). Research is supporting the impact that the NRP has on retention, satisfaction, and financial benefits are creating interest in health care organizations nationwide (Spector et al., 2015, AACN, 2018, Kovner et al., 2014). The literature is proving that there is very little consistency when it comes to the defining attributes of NRPs.

Through the use of the evolutionary concept analysis, the concept of nurse residency program is presented through supporting literature in the following stages: defining surrogate terms, antecedents, attributes, examples, and consequences. Based on these stages the definition evolved as a set of foundational and cohesive attributes for all NRP. A NRP is described as a post-graduate, accredited, transition to practice program that is theoretically driven and evidence-based. The program, established through an academic/practice partnership, is one in which a NLRN works with expert nurses in mentoring, precepting, and educational capacities as they enculturate into the profession of nursing. The fundamental goals of the one-year program are role socialization, enhanced competence, clinical reasoning, and critical thinking through didactic, simulation and interprofessional learning environments. This transition to practice environment affords a supportive, cohesive environment with the ultimate goal of an autonomous and safe nurse upon residency completion.

Currently, NRPs lack a cohesive set of attributes to fully explicate program outcomes or even begin to fully understand the implications on patient outcomes. With the academic/practice "continental divide" widening and the impending nursing shortage "tsunami warning" looming, there is no greater time to unify the concept of NRPs in the United States. Currently, there are a plethora of programs functioning as NRP, but the lack of continuity is apparent in the literature. To gain momentum to continue to minimize the academia practice transition gap and fully support and sustain the nursing workforce in the first two years of practice, a cohesive definition of NRP is necessary. Additionally, continuity is essential in implementation, theoretical models and evaluation to fully support advancements in research and policy. A cohesive definition of NRP allows for the profession of nursing to unify in its approach to the calls to action set forth by organizations like The Joint Commission, Carnegie Foundation and The Future of Nursing Report to enhance the transition to practice for all nurses.