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491The Journal of Continuing Education in Nursing Vol 43, No 11,
2012
Transition Within a Graduate Nurse Residency ProgramKendra D.
Varner, BSN, MSN, RN-BC, and Ruth A. Leeds, BSN, MS, RN-BC
Graduate nurses are a vulnerable population and they desperately
need a supportive organizational culture during their transition to
professional practice as well as leadership willing to invest in
their future (Duchscher, 2009). Hospitals remain the primary
em-ployer of recently graduated nurses (83%); however, more than
half of the nurses surveyed indicated that they had changed
positions or planned to leave their current job within 3 years
(U.S. Department of Health and Hu-man Services, 2010). As the
evidence of their effective-ness grows and national agencies such
as the Institute of Medicine (2010) and the National Council of
State Boards of Nursing (NCSBN) (Spector & Echternacht, 2010)
call attention to the needs of graduate nurses, edu-
Ms. Varner is Assistant Professor of Nursing, Kettering College;
and Ms. Leeds is Education Coordinator, Center for Nursing
Excellence, Kettering Medical Center, Dayton, Ohio.
The authors disclose that they have no significant financial
interests in any product or class of products discussed directly or
indirectly in this activity, including research support.
The authors thank Dr. Brenda Kuhn, Belinda Mallett, Tish
Guz-man-Edwards, and Dr. Judy Boychuk Duchscher for their support
and contributions.
Address correspondence to Kendra D. Varner, BSN, MSN, RN-BC,
Assistant Professor of Nursing, Kettering College, 3737 Southern
Blvd., Kettering, OH 45429. E-mail:
[email protected].
Received: May 21, 2012; Accepted: September 5, 2012; Posted:
Oc-tober 8, 2012.
doi:10.3928/00220124-20121001-28
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Objectives: After studying the article, Transition Within a
Graduate Nurse Residency Program, in this issue, the participant
will:
1. Explain how nursing role transition theory was incorporated
into the nurse residency program (NRP) design.
2. Discuss elements essential for a positive transition to
practice experi-ence within an NRP.
3. Describe positive outcomes associated with a successful
NRP.
4. Discuss challenges associated with NRP evaluation.
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abstractAs evidence of the effectiveness of these programs
grows, nurse leaders feel the pressure to establish
high-quality, yet cost-effective graduate nurse transition
pro-grams. In 2009, the authors developed an innovative pro-gram by
incorporating transition theory, research results, stakeholder
involvement, and the recommendations of the National Council of
State Boards of Nursing. The graduate nurse residency program
yielded positive outcomes, in-cluding stakeholder satisfaction and
high retention rates.J Contin Educ Nurs 2012;43(11):491-499.
2.3 Contact Hourscne ArtiCle
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cators and administrators alike feel a heightened sense of
urgency to establish high-quality, yet cost-effective transition
support programs within their organizations (Hansen, 2011). This
article describes the development, implementation, and outcomes of
an innovative graduate nurse residency program (NRP).
BACKGROuND Situated in southwestern Ohio, Grandview Medi-
cal Center (GVMC) is a 411-bed facility with an urban
population; its sister hospital, Southview Medical Center (SVMC)
has 123 beds and serves a suburban population. In 1999, these
osteopathic medicine teaching hospitals became affiliated with the
faith-based Kettering Health Network (2011). GVMC and SVMC
experienced over-whelming nurse vacancy rates in 2005. The
graduate
nurse turnover rate was 50% in the first year, matching national
figures (Bowles & Candela, 2005). Graduate nurses who left the
organization cited a poor work en-vironment due to staffing,
leadership issues, and a per-ceived lack of support.
Visionary leadership partnered with the Studer Group and began
the Baldridge excellence journey in an effort to change the
organizations culture. Starting in 2005 and lasting for 2 years,
GVMC and SVMC served as Ver-sant RN Residency beta testing sites.
The 12-month turnover rate decreased to approximately 20%; however,
the program costs significantly increased and the recom-mended
structure did not meet the organizations needs. As a result,
nursing leadership, in collaboration with the human resources and
finance departments, decided to de-velop an organization-based
program.
Figure 1. Stages of transition theory. [Reprinted with
permission from Duchscher, J. B. (2008). A process of becoming: The
stages of new nursing graduate professional role transition. The
Journal of Continuing Education in Nursing, 39(10), 441-450.]
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493The Journal of Continuing Education in Nursing Vol 43, No 11,
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The graduate NRP task force, comprising nurse exec-utives, unit
managers, and staff educators, analyzed the existing program and
considered graduate nurse and pre-ceptor feedback. Stakeholder
involvement resulted in ef-fectively addressing cost, retention,
patient care, and ori-entation issues. Additional benefits included
increased support for the program throughout the organization. The
task force established a flexible 20-week graduate nurse internship
with didactic and clinical components, but satisfaction with the
program remained low. The graduate nurses noted that they felt
dropped off at the end of the program, and the annual turnover rate
rose to 30%. At the end of 2008, nursing leadership agreed to
overhaul the existing program again.
In February 2009, the organization employed a full-time,
masters-prepared nurse educator situated within staff development
to complete the program redesign with input from the task force.
The NRP leader coor-dinated the graduate nurse orientation
experience by collaborating with established division- and
unit-based staff educators and participating in clinical rounds.
She facilitated didactic instruction and recruited subject matter
experts. The NRP leader was the chairperson for the curriculum and
debriefing task force subcommit-tees; she participated in the
facilitys preceptor and clini-cal practice committees. As the
graduate nurse advocate, the NRP leader was available at all times
by pager to provide psychosocial and transition support. This
mul-tifaceted role involved ongoing program development,
implementation, and evaluation, along with networking with local
nursing schools and selection of residency candidates.
PROGRAM DEVELOPMENT On review of transition theories and current
pro-
gram structures, commonalities emerged. Theoretical input from
nursing (Duchscher, 2008) (Fig. 1), along with occupational
psychology (Williams, 1999) (Fig. 2) and transition management
(Bridges, 2009), provided a greater understanding for the program
redesign. A suc-cessful program would need to provide support
tailored to the unique learning needs of the graduate nurse role
transition stages: doing, being, and knowing (Duchscher, 2008). The
authors considered the strengths and limita-tions of various
existing programs and educational strat-egies (Altier & Krsek,
2006; Herdrich & Lindsay, 2006; Keller, Meekins, & Summers,
2006; NCSBN, 2009; Salt, Cummings, & Profetto-McGrath, 2008;
Shermont & Krepcio, 2006) and determined that a comprehensive
transition program needed precepted clinical experience, role
socialization, and didactic sessions. Nurse leaders decided to
proactively adopt the NCSBN-recommend-ed structure (NCSBN, 2008),
which involved an extend-ed orientation with yearlong
organizational support.
The curriculum was based on the developing a cur-riculum (DACUM)
validation from the Versant experi-ence, Quality and Safety
Education for Nurses (QSEN) recommendations (Cronenwett et al.,
2007), analysis of
Figure 2. Phases and features of the transition cycle for
individuals. (Reproduced with permission from Eos Career Services,
www.eoslifework.co.uk/transprac.htm.)
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the hospitals patient population data, and input from the task
force. Residency content presentation would occur throughout the
year; class structure involved limited di-dactic content followed
by application exercises, such as case studies and group
discussions. Transition education was a curricular thread with a
goal of normalizing the experience (Duchscher, 2008; Keller et al.,
2006).
ANTICIPATED PROGRAM OuTCOMEs The aim of the phased NRP was to
ensure excellent
nursing care, based on the networks sacred mission to improve
the quality of life in the communities it serves (Kettering Health
Network, 2011). The purpose of the phased program was to recruit
and retain the nursing work force while promoting lifelong learning
and com-mitment to both professional nursing and the organiza-tion.
Anticipated program outcomes included successful transition to the
professional role, socialization to the health care team, and safe
delivery of care. Another goal was the development of clinical
leadership skills (Nurs-ing Executive Center, 2005).
Based on theory, research results, education best practices, and
stakeholder input, a four-phase program structure emerged that was
designed to address inherent
transition and professional development needs (Fig. 3). The NRP
leader focused on program implementation, including orientation and
retention of graduate nurses. With executive sponsorship,
leadership support, a cadre of trained preceptors, and a nurturing
organizational culture, the phased program launched in April
2009.
PROGRAM IMPLEMENTATION To qualify for the program, a candidate
had to be a
graduate registered nurse from an accredited nursing school with
less than 6 months of acute care experience. Candidates interviewed
with a nurse leader panel that included nurse managers with unit
vacancies, the nurs-ing school liaison, and the NRP leader. A peer
interview process followed for top candidates. During the
selec-tion process, individual characteristics, such as academic
performance, clinical experience, references, and area of interest,
were strong considerations (Beecroft, Dorey, & Wenten, 2008).
After achieving licensure, the graduate nurses attended the monthly
orientation designated for program participants.
In late January 2009, 17 residents who were hired un-der the
previous model later became the phased program pilot group; all
subsequent graduate nurses entered the
Figure 3. Phased graduate nurse residency program.
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495The Journal of Continuing Education in Nursing Vol 43, No 11,
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phased structure. Approximately 60% of the new hires had an
initial associates degree preparation, matching national averages
(U.S. Department of Health and Hu-man Services, 2010); the majority
of residents had been traditional nursing students. Although many
residents had previous health care experience, almost 35% had none;
thus, the orientation phase provided essential edu-cation and
support.
All newly hired graduate nurses enrolled in the tran-sition
program and followed a specialty preparation track based on the
division of hire. Residents were hired predominantly for critical
care units (48%), followed by medical-surgical units (38%).
Perioperative resi-dents also participated in the Association of
periOpera-tive Registered Nurses (AORN) specialty preparation
course, Periop 101. All emergency department residents had
completed their school preceptorship in an emer-gency department or
critical care unit before hire. Ma-ternity residents had worked as
obstetrical technicians on that unit.
PHAsED APPROACH TO GRADuATE ROLE TRANsITION Phase 1:
Orientation
At GVMC and SVMC, experienced nurses attended a brief network
patient care services overview, followed by a unit-based
orientation that lasted approximately 4 to 6 weeks. A
competency-based orientation evaluation substantiated clinical
readiness for practice (Lenburg, 1999). Nurses completed online
learning and specialty-specific classes throughout the first year.
The NRP ex-tended orientation was a mandatory addendum for all
contracted graduate nurses. Residents received a badge pin
indicating their program affiliation and graduate nurse status;
attending class sessions facilitated group bonding and fostered
organizational belonging be-yond a unit- or division-based identity
(Shermont & Krepcio, 2006).
During this role transition stage, the graduate nurse focuses on
doing, or behaviorally adapting to the nursing role. At this stage,
the primary interest is receiv-ing the skills and knowledge to be
successful at the most visible aspects of their practice, which is
often misper-ceived as task orientation (Duchscher, 2008; Williams,
1999). Nursing orientation involved six division tracks (Fig. 3).
The weekly graduate NRP class sessions provid-ed clinically focused
didactic content, such as respiratory management, central line
care, care of dialysis patients, and laboratory practice with
limited exposure skills, such as chest tubes, tracheostomy care,
and blood administra-tion. A couple of facilitated debriefing
sessions helped to mitigate the initial transition shock
(Duchscher, 2009).
Precepted time on the home unit provided the gradu-ate nurses
with experiential learning opportunities to in-crease their
clinical reasoning, allowed socialization to the role and unit, and
improved professional and clini-cal skills. Nurse managers selected
the unit preceptors and ensured that they attended a 1-day training
course through staff development. Preceptors usually had 2 or more
years of experience, provided quality nursing care, and adhered to
the organizations standards of behavior.
Alternate unit experiences provided the residents with precepted
exposure to affiliated unit workflow variations, enabled empathy
for the patients experience, and fostered collaboration between
units. One resident indicated that this learning opportunity in the
emer-gency department was very important because it is not always
understood how the flow works and why it is so important to get the
patient admitted ASAP. Another resident who was going from an
intensive care unit to a step-down unit noted, It was nice to get a
feel [for the unit] prior to being floated there one day.
The length of the orientation phase varied based on individual
needs, shift, and division track, but generally included 350
precepted hours during 12 to 20 weeks. The resident completed
weekly reflections and received written evaluations from the
preceptor; the NRP leader and nurse manager provided feedback as
well. The nurse manager, NRP leader, preceptor, unit educator, and
graduate nurse collectively determined practice readi-ness during
an end-date huddle that served as a mark-er event to usher in the
next role development phase (Bridges, 2009; Hansen, 2011), as well
as a summative evaluation opportunity. After the graduate nurses
com-pleted the orientation phase and entered staffing, they were
switched to the home unit cost center.
Phase 2: Transition For the first time, the graduate nurse is
being the
nurse, trying to cognitively adapt to role expectations
(Duchscher, 2008; Williams, 1999). Between the fourth and the ninth
month of hire, the graduate nurse exists in a crisis state that
often results in physical, emotional, and spiritual exhaustion as
the nurse attempts to determine whether to stay or go. At
approximately the sixth month, the graduate nurse often experiences
a crisis of confidence or defining moment (Fig. 2). The authors
of-ten observed this event as a two-sided coin. For example, a
residents first patient code might be the crisis. On re-flection,
these experiences can transform into role-defin-ing moments as
graduate nurses realize that they know what to do and whom to
call.
Each month, the transition phase residents attended a required
class encompassing a facilitated debriefing
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session and didactic content. Topics included transition
management, communication, delegation, and time man-agement.
Facility-specific training on materials distribu-tion, pharmacy
updates, and case management contin-ued to provide more of the big
picture. Each resident identified a staff nurse mentor for informal
monthly meetings during this stage.
Nursing leadership agreed on a protected status for these
residents. Nurse managers and house supervisors ensured that the
residents would not float for at least 3 months after orientation.
Overtime was strongly dis-couraged; for stress reduction,
leadership expected the residents to take a vacation approximately
6 months af-ter hire. Preferably, residents were not to precept new
hires or to be in charge during the first year. Transition
education for nurse leaders facilitated their ability to
an-ticipate, recognize, and effectively support the critical
turning point. The second phase ended on completion of the
transition sessions at approximately the ninth month of hire.
Phase 3: TransformationIn the knowing phase, the graduate nurse
usually
begins to recover, experiencing renewed energy, enthu-siasm, and
comfort in the role (Duchscher, 2008; Wil-liams, 1999). One
resident wrote, Knowing that Im part of a team, and theyre there
for me no matter what, gives me the courage to face any situation
at hand. The transformation monthly classes included a debriefing,
additional role development, and leadership-oriented didactic
content. Nurse leaders presented expectations for organizational
and unit-level involvement, intro-duced the clinical ladder, and
emphasized the impor-tance of lifelong learning and professional
contribu-tions. The residents often began to seek out more recent
graduates to mentor, which enabled employee engage-ment and
leadership development opportunities. Com-pletion of the mandatory
phased program educational requirements in the first year opened
the door to the voluntary fourth phase.
Phase 4: Exploration During the second year of hire, the NRP
provided
quarterly meetings that included a debriefing and free
continuing education classes. Participation in facility events and
specialty-specific organizations encouraged employee engagement and
satisfaction. Regarding facil-ity committee involvement, a resident
stated, It helps you gain a more global view of what we do every
day [and] gets you out of your unit bubble. [It] helps things make
sense! Nurse leaders led by example and champi-oned these
expectations. Completion of the second year
signaled fulfillment of the contract requirements and
of-ficially marked the end of the residency experience.
PROGRAM EVALuATION Program outcomes for a successful transition
to profes-
sional practice, socialization to the role, and development of
leadership skills were measured through stakeholder satisfaction,
further evidenced by employee retention and engagement. Safe
delivery of care evaluation involved quality measures; however,
data were limited.
stakeholder satisfaction The programs stakeholders included the
residents,
patients, preceptors, and nurse leaders. During each phase,
residents received an anonymous online survey to allow them to
provide feedback on job and program satisfaction. Overall, resident
satisfaction remained high (> 94%) throughout implementation of
the program. The extended clinical orientation, specialty
education, and ongoing support were among the most highly rated
factors.
Survey comments and personal anecdotes about feel-ing supported,
understanding the nurse role, experienc-ing a heightened sense of
clinical confidence and compe-tence, and fitting in on the unit
supported achievement of the programs outcomes. Managers provided
qualita-tive evidence of the organizational effect of the program
through quality patient care experiences, increased unit committee
involvement, and selection for leadership roles, such as charge
nurse, preceptor, mentor, and unit educator. Within the 2009
cohort, continuing education contributed to an increase in
baccalaureate-prepared nurses from 30% to 50% by 2011.
Nurse leader rounds and patient satisfaction surveys showed that
residents frequently were described as pro-viding outstanding
patient care. Written comments included best nurse during my stay,
made me feel at home, and going above and beyond. During the second
implementation year, preceptors received an on-line survey to
determine their support for the program. Monthly nursing leadership
and clinical nurse manager meetings provided the NRP leader
opportunities to present program updates and receive feedback. Each
year, the nurse managers responded to a survey on the programs
effectiveness. Flexible structures, leadership support, and ongoing
feedback and collaboration for process improvement enabled the NRP
leader to make improvements to the program.
Organizational Retention Organizational evaluation involved
retention statis-
tics and quality outcomes. Significant variation in gradu-
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497The Journal of Continuing Education in Nursing Vol 43, No 11,
2012
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ate nurse program vernacular and outcome evaluation is found in
the literature (Spector & Echternacht, 2010). The NRP task
force defined retention as full- or part-time employment at either
facility for the length of the 2-year program contract.
Organizational policy did not allow transfers of new hires until 6
months of employ-ment; within the program, transfer was discouraged
dur-ing the first year. Rare exceptions occurred based on a
collaborative decision that another unit might be a better fit.
Within the phased program, the first-year turnover rate averaged
5%. The second-year cohort turnover rate varied from zero to 9%.
After completion of the 2-year contract, the facility turnover rate
increased to 24%, with almost half remaining in the network (Fig.
4). The residents who left the organization took positions in
non-acute care settings, such as hospice, extended care, and
outpatient dialysis. Each year, a graduate nurse de-parted during
the transition crisis window, despite sup-port and early
intervention.
Patient safety and Quality Work environment, academic
preparation, and nurs-
ing experience affect patient outcomes; positive out-comes
reflect excellent nursing care (Aiken, Clark, Sloane, Lake, &
Cheney, 2008). Because of the existing reporting system, direct
tracking and trending between specific resident practice and
quality measures, such as medication errors, pressure sores, and
failure to rescue, was not possible. Unit managers occasionally
notified the NRP leader of near-miss and incident reports
in-volving residents. Clinical rounding provided the great-est
opportunity to receive accounts from residents and preceptors
regarding medication errors, falls, and the use of rapid response
teams. Nursing leadership used these reports for program and
facility-specific quality improvements.
CONsIDERATIONs Pre-existing conditions greatly facilitated the
suc-
cessful implementation of the phased program. Nurs-ing
leadership was already in agreement. Approximately 30% of the
current preceptors emerged from previous residency designs. The
existing NRP budget covered ex-penses incurred through the extended
orientation as well as ongoing support. Collaboration among nurse
leaders, preceptors, and residents was an established expectation.
Professional and personal life experiences, combined with academic
preparation, enabled the NRP leader to contribute to the programs
success.
Regarding cost-effectiveness, replacing a nurse can cost up to
1.3 full-time equivalents (Jones, 2008). Lead-
ership calculated the program cost for each graduate nurse,
based on participant wages, instructor and pro-gram leader
salaries, materials, and other associated ex-penses. Preceptors
received no financial compensation and worked their regular
schedules. Because of the de-crease in graduate nurse turnover
costs and the notable positive outcomes for both the participants
and the orga-nization over the implementation period, leadership
de-termined that the program provided an excellent return on
expectations (Hansen, 2011). Efficiency was achieved by remaining
within the current orientation processes, using a designated
coordinator, and capitalizing on exist-ing resources.
The authors acknowledged that other factors, such as the program
contract, the economy, and limited job opportunities for graduate
nurses, may have contributed to high retention rates. However, high
post-contract retention rates suggested that the contract was not
the main factor. Although the economy and limited job
op-portunities are considerations, former and current resi-dents
actively recruited peers. Survey results identified the NRP, the
opportunity to pursue an area of interest, positive coworker
relationships, and a supportive work environment as primary
retaining factors, reflective of the findings of Beecroft et al.
(2008).
CHALLENGEs The recruitment and on-boarding process was
lengthy, occasionally resulting in the loss of outstand-ing
candidates who joined other organizations. Because all graduate
nurses were required to participate, the pro-gram contract served
as a deterrent for a small number of candidates. The human
resources department offered an employee referral bonus that
provided an additional
Figure 4. Phased nurse residency program retention. RN =
regis-tered nurse.
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recruitment incentive; however, some referred graduate nurses
were not desirable candidates.
Numerous logistical challenges were present. Month-ly candidate
enrollment resulted in continuous on-boarding. Phased class
offerings occurred in concurrent cycles for which regular session
facilitators occasionally were not available. Meeting the range of
professional development needs was difficult; associates-prepared
nurses often lacked background in didactic content that was
familiar to baccalaureate-prepared residents.
The NRP leader helped to coordinate the precepted clinical time
and arranged the alternate unit experiences, which was a
time-consuming process. Residents were hired for various shifts on
14 different units at the two facilities, making weekly clinical
rounds a challenge. Thus, the NRP leader relied heavily on the
preceptor and nurse manager to identify progress concerns. Be-cause
of budgetary limitations, socialization opportuni-ties occurred
through class discussions, on breaks, and informally outside of
work.
The phased program used team precepting; residents received both
a primary and a secondary preceptor for flexibility in scheduling.
Occasionally, newer nurses served as secondary preceptors.
Residents selected a mentor other than the preceptor to avoid
burnout. Be-cause it was an informal process, mentor-mentee
engage-ment varied. Participation in the second year of the NRP was
voluntary, and sessions were poorly attended.
Validated evaluation tools were not used during the initial
implementation of the phased program. Reflec-tions written by
residents and feedback from preceptors were manually reviewed by
the NRP leader. Program success was predominantly gauged by
retention and stakeholder satisfaction; quality reporting systems
were not conducive to isolating the effect of the resident
pro-gram. Access to graduate nurse retention and satisfaction data
before 2009 was limited, and variations in program structure made
comparative outcome analysis difficult.
CONCLusION Both GVMC and SVMC transformed into competi-
tive places of employment. The NRP, along with an op-portunity
to work within an area of interest, facilitated the recruitment and
retention of exceptional graduate nurses. Stakeholder involvement
increased support for the program across the organization. The
success of the phased program occurred because of a hospital
culture supportive of education, visionary leadership, and nurse
advocates committed to a positive transition to practice
experience.
REFERENCEs Aiken, L., Clarke, S., Sloane, D. M., Lake, E., &
Cheney, T. (2008). Ef-
fects of hospital care environment on patient mortality and
nurse outcomes. Journal of Nursing Administration, 38(5), 223-229.
doi:10.1097/01.NNA.0000312773.42352.d7
Altier, M. E., & Krsek, 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., Dorey, F., & Wenten, M. (2008). Turnover
intention in new graduate nurses: A multivariate analysis. Journal
of Advanced Nursing, 62(1), 41-52.
Bowles, C., & Candela, L. (2005). First job experiences of
recent RN graduates: Improving the work environment. Journal of
Nursing Administration, 35(3), 130-137.
Bridges, W. (2009). Managing transitions: Making the most of
change (3rd ed.). Philadelphia, PA: DaCapo Press.
Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J.,
Johnson, J., Mitchell, P., et al. (2007). Quality and safety
education for nurses. Nursing Outlook, 55, 122-131.
Duchscher, J. (2009). Transition shock: The initial stage of
role adap-tation for newly registered nurses. Journal of Advanced
Nursing, 65(5), 1103-1113. doi:10.1111/j.1365-2648.2008.04898.x
Duchscher, J. B. (2008). A process of becoming: The stages of
new nursing graduate professional role transition. The Journal of
Con-tinuing Education in Nursing, 39(10), 441-450.
Hansen, J. (2011). Nurse residency program builder: Tools for a
success-ful new graduate program. Danvers, MA: HCPro.
Herdrich, B., & Lindsay, A. (2006). Nurse residency
programs: Re-designing the transition into practice. Journal for
Nurses in Staff Development, 22(2), 55-62.
Institute of Medicine. (2010). The future of nursing: Leading
change, advancing health. Washington, DC: National Academies
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Jones, C. (2008). Revisiting nurse turnover costs, adjusting
inflation. Journal of Nursing Administration, 38, 11-18.
key pointsGraduate Nurse Residency ProgramVarner., K. D., Leeds,
R. A. (2012). Transition Within a Graduate Nurse Residency Program.
The Journal of Continuing Education in Nursing, 43(11),
491-499.
1 Graduate nurses desperately need a supportive organizational
culture during their transition to professional practice as well as
leadership willing to invest in their future.
2 As the evidence regarding these programs effectiveness grows,
nurse leaders feel the pressure to establish high-quality, yet
cost-effective, graduate nurse transition programs.
3 Residency programs should provide support tailored to the
unique needs of each of the role transition stages of the newly
graduated registered nurse.
4 Transition theory, research results, stakeholder input, and
nation-al agency recommendations are essential elements of graduate
nurse residency program design.
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499The Journal of Continuing Education in Nursing Vol 43, No 11,
2012
2.3 Contact Hourscne ArtiCle
Keller, J. L., Meekins, K., & Summers, B. L. (2006). Pearls
and pitfalls of a new graduate academic residency program. Journal
of Nursing Administration, 36(12), 589-598.
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