Nurse residency programs (NRPs) have been identified as a means to promote transitioning of new nurses into the professional nursing role. Questions have arisen related to which elements within those programs are most meaningful to the development of new nurses. As the nursing shortage drives the need for quick transition and development of nurses to meet workforce needs (Buerhaus, Auerbach, Staiger & Muench, 2013), nursing must identify what factors are meaningful to nurses in their transition to practice. The Future of Nursing Report called for measurement of nurse retention, nurse competency, and patient outcomes to determine outcomes related to the nursing workforce (IOM, 2011). Hospitals using established programs for nurse transition had higher retention rates, fewer reported patient care errors, and fewer negative safety practices (Spector et al., 2015). An NCSBN-sponsored study recently concluded that many elements exist in transition to practice, but identification of specific elements or combinations of elements is needed to further the development of transition programs in the United States (Spector et al., 2015).
The purpose of this multi-site study is to explicate meaning from the experiences of newly licensed registered nurses (NLRNs) who have just completed NRPs in acute care settings. What factors within their new practice environment contributed to their growth and satisfaction in the workplace? The research question was “What factors have meaning for NLRNs who have experienced transition to practice in nurse residency programs in acute care settings?”
Semi-structured interviews were used to collect data from six NLRNs from three different NRPs after completion of their nurse residency programs. Using interpretative phenomenological analysis, themes and variations within those themes, were derived from the descriptive narratives provided from participant interviews. Overarching themes identified from the narratives were Relationships, Reflection, Desire for Active Learning, Resources and Organizational Infrastructure. Within the theme of Relationships, the subthemes of “Connectedness” and “Support” emerged from the data. Another noted subtheme occurred within the discussion of Resources—“Access to Seasoned Nurses.”
Relationships were noted to be significant among the participants as they described the interactions with preceptors, mentors and other staff within their workplace settings. Participants also described important relationships among the peer groups within the NRPs. The NLRNs derived a sense of connectedness that enabled them to assimilate their new roles and become a part of the profession. The NLRNs also described a sense of support that empowered them to gain competence and confidence in the new experiences. In situations which lacked the presence of connectedness and support, the NLRNs described less positive experiences. Other studies have also demonstrated the importance of the preceptor or mentor relationships (Spiva et al., 2013; Craig, Moscato & Moyce, 2012; Olson-Sitki, Wendler & Forbes, 2012).
Reflection was another factor deemed important to the NRP process by participants in the study. The NLRNs described struggles that they encountered in each of their settings and how they were able to take these experiences back to the NRP classroom, sharing their feelings and reflecting on the experiences that they had encountered in practice. Individualized reflection within their practice setting helped NLRNs to work through the emotions and the problem-solving aspect of the situations that they experienced. Exploration of experiences with opportunities to debrief and reflect on practice contribute to the development of nurses (Sherwood & Horton-Deutsch, 2012; Trepanier et al., 2012).
Participants in this study expressed a desire for active learning in the workplace and in the educational setting, as well. The NLRNs described some of their best learning opportunities as those activities that occurred in simulated bedside scenarios, interactive case studies, and guided practice at bedside with the preceptor. Many described similar active learning strategies within their nursing programs which they attributed to their formation as a nurse. The opportunity to practice within a safe and non-judgmental environment contributed to the efficacy of these nurses as they entered practice settings. In the NCSBN study, similar conclusions were noted about the importance of active learning (Spector et al., 2015).
The NLRNs also ascribed meaning to the quick access to resources. At times this was noted in the need for physical resources, such as blood products or personal protective equipment. But more frequently the resources that they wanted were of an instructional nature—ready access to policies and procedures or information about patient care. The most common discussion was that of access to seasoned nurses, who could provide guidance and information quickly and decisively. Some of the nurses described situations in which the preceptor had limited experience and was unable to provide the information needed. Some participants relayed stories of several new nurses on a unit with one preceptor with less than one year of experience. Hospitals must ensure that nurses have adequate resources available to promote optimal care for patients and adequate support for new nurses (Bratt, 2013).
A key theme that developed from the narratives of the participants was the need for organizational structure that supported the NRP. As noted by Bratt (2013), the importance of top-down support for the NRP is non-negotiable. Administrative support within the hospital system is elemental. Follow-up to ensure that roles within the NRP structure are fully developed and communicated is essential to the success of the programs (Spiva et al., 2013). Ensuring that adequate staffing is in place to support the learning that must occur in the workplace begins with nurse administrators (Blegan et al., 2015).
Findings of this study have implications for practice and education as the nursing profession strives to find ways to transform nurses in an effective and efficient manner. Nurses within practice and academia must work collaboratively to further define the meaningful factors that contribute to growth of NLRNs. Professional nursing must be proactive in developing the next generation of nurses to continue safe and effective practice.