EBP

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Nurse Education Today

journal homepage: www.elsevier.com/locate/nedt

Review

The impact of nurse residency programs in the United States on improving retention and satisfaction of new nurse hires: An evidence-based literature review☆

Caitlin M. Eckerson1

10 Fowlerhouse RD Wappinger Falls, NY 12590, United States of America

A R T I C L E I N F O

Keywords: BSN residency program Traditional orientation Retention Satisfaction New nurse

A B S T R A C T

Entry into practice for newly graduated nurses can be a demanding and overwhelming experience. These stressful work conditions have contributed to decreased retention and satisfaction amongst new nurse hires. The aim of this literature review is to answer the following question: in newly hired BSN graduates, how would the use of a one-year nurse residency program compared to a traditional orientation affect turnover rates and re- ported satisfaction of the new nurse hires over a one-year period? Peer-reviewed research and systematic reviews between the years of 2012–2017 found on the Medline, Nursing & Allied health, and CINHAL were used. Inclusion criteria were peer-reviewed literature that addressed the impact of one-year NRPs on nurse retention or nurse satisfaction. Exclusion criteria were articles that addressed NRPs without discussing retention or sa- tisfaction. The JHEBP Appraisal Tools were used to extract and appraise evidence. Use of NRPs showed increased satisfaction and retention of new nurse graduates over a one-year period, leading to the conceptualization that this is a more effective method than traditional orientations for new nurse hires.

1. The Impact of Nurse Residency Programs on Satisfaction and Retention of New Nurse Hires

Transitioning from the student nurse role to the practicing nurse role has been identified as a stressful and challenging time for new nurses as they try to adjust to caring for multiple patients with chronic, complex health conditions (Van Camp and Chappy, 2017). The chal- lenging evolution can last as long as 12months and has been shown to be a contributing factor for a high turn-over rate amongst new nurses during their first year of hire (Olsen-Sitki et al., 2012). Research studying the impact of hospital work environments on retention of new nurse hires found that new nurses experience less anxiety and stress in environments that foster a safe learning environment and effective communication and support (Cochran, 2017).

This is a relevant issue to nursing education because, as educators, it is vital to assess the needs of new graduates and develop effective transitional programs that will empower new nurses to practice with confidence in a safe and proficient manner, which may lead to in- creased satisfaction and retention during their first year of hire.

In 2010, the Institute of Medicine (IOM) offered recommendations on how to improve the nursing profession to better care for the

increasingly complex patient population. One of the recommendations was to implement nurse residency programs (Al-Dossary et al., 2013; Lin et al., 2014). This recommendation was identified in response to evidence reporting retention issues and decreased satisfaction of new nurse graduates due to stressful work environments, increased patient acuity, and lack of confidence in skill and critical judgment (Al-Dossary et al., 2013). Further studies also found that as many as 90% of hospital nurse leaders felt that new graduate nurses are ill-equipped to safely and proficiently practice as a registered nurse (Al-Dossary et al., 2013). Transitioning from the student role to the fully practicing nurse role can be stressful and overwhelming, leading to 35–60% of nurses leaving their first place of employment within one year (Van Camp and Chappy, 2017). These high turnover rates can have detrimental financial im- plications, costing approximately $88,000 per nurse due to lost revenue spent on training and having to replace the nurse (Van Camp and Chappy, 2017).

A consistent finding amongst current evidence-based literature has found that nurse residency programs should be at least 10–15months in order to successfully prepare the new nurse for independent practice (Cochran, 2017). The aim of these programs is to provide continued support to new nurses during their first year of hire in order to foster

https://doi.org/10.1016/j.nedt.2018.09.003 Received 12 January 2018; Received in revised form 1 August 2018; Accepted 5 September 2018

☆ This research was not supported by any grants or financial funding.

1 This author did not have any institutional affiliations at the time of this review. E-mail address: [email protected].

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essential skills such as: critical thinking, prioritization, delegation, communication, leadership, and conflict resolution (Kramer et al., 2012). Common elements found in these programs consist of mentor- ship with a preceptor over the course of the program, and combination of didactic education, simulation, case studies, peer reflection and de- briefing, and evidence-based practice projects (Cochran, 2017; Goode et al., 2013; Kramer et al., 2012).

In an effort to evaluate the impact of NRPs on new nurse hires the following question utilizing the PSCOT format (population, education, strategy, comparison, outcome, and time) was developed: In newly hired BSN graduates, how would the use of a one-year nurse residency program compared to a traditional orientation affect turnover rates and reported satisfaction of the new nurse hires over a one-year period? The aim of this review is to answer this question by analyzing current lit- erature to determine the effects of NRPs compared to traditional or- ientations on retention and satisfaction of new nurses during their first year of hire.

2. Method

2.1. Search Protocol

2.1.1. Search Engines and Databases Used Electronic search engines used to perform the search were: Medline,

Nursing & Allied Health Database, and CINHAL. All databases used yielded a wealth of results and information to review regarding the topic of NRPs.

2.1.2. Search Terms A wide variety of terms were used to search for literature for this

review. The keywords used during the search were: (a) nurse residency program, (b) BSN residency program, (c) baccalaureate nurse, (d) new nurse, (e) traditional orientation, (f) transition, (g) retention, (h) turn- over, and (i) satisfaction.

2.1.3. Boolean Phrases Keywords were imputed into the advance search tabs with use of the

Boolean phrase “and” or “or” to connect each keyword and narrow the results. Boolean phrases included in the literature search included: (a) nurse residency program AND satisfaction OR retention, (b) BSN re- sidency program AND retention, (c) BSN residency program AND sa- tisfaction and (d) new nurse AND nurse residency program.

2.1.4. Age of Literature Articles produced within the past five years (2012–2017) were

considered for the review to ensure that the most recent evidence is being used. A search for historical, relevant data was also considered for inclusion.

2.1.5. Inclusion Criteria Articles produced from the search were assessed for inclusion.

Inclusion criteria were: published in English, peer-reviewed, addressed nurse retention rates, addressed nurse satisfaction, preceptor-based with nurse residency program participation, one-year long nurse re- sidency program.

2.1.6. Exclusion Criteria Elements that lead to exclusion from this review were: languages

other than English, non-peer reviewed articles, programs that focused on preceptor-only orientations, addressed NRP without discussion of satisfaction or staff turnover rates, articles that discussed factors of NRPs that affected job satisfaction, nurse practitioner residency pro- grams, and research conducted in hospitals outside the United States.

2.1.7. Articles Selected for Inclusion There were 299 articles located with 18 articles that were selected

to be appraised for use in the literature review. Of the 18 articles, 12 met the inclusion criteria to be included in the review. The John Hopkins Evidence Based (JHEBP) Appraisal Tools were utilized in performing a critical appraisal of the abstracts and articles to help identify the articles to be used.

2.2. Evidence Matrix

The 12 articles that met the inclusion criteria were analyzed for strength and quality of using the John Hopkins Evidence-Based Practice (JHEBP) Appraisal Tool. In order to organize the findings, information pertaining to the: setting, findings, observable measures, limitations, and quality rating were then recorded utilizing the JHEBP Individual Evidence Summary Tool. Please refer to the Appendix for this in- formation.

2.3. Evidence Synthesis

Based upon the literature review it was discovered that the use of the NRP has had a generally positive impact on satisfaction and re- tention of new nurse hires. The evidence included a wide diversity of evidence levels and quality. Common themes present amongst the findings will be further discussed in this section.

2.3.1. Synthesis of the Population All 12 articles included in this study evaluated nursing graduates

with less than one year of experience (Cline et al., 2017; Edwards et al., 2015; Fiedler et al., 2014; Goode et al., 2013; Lin et al., 2014; Medas et al., 2015; Olsen-Sitki et al., 2012; Rosenfeld et al., 2015; Salmond et al., 2017; Smith et al., 2016; Trepanier et al., 2012; Van Camp and Chappy, 2017). It was discovered that there were limited articles that described the impact of the NRP on just baccalaureate prepared (BSN) nurses. Out of the 12 articles, three evaluated only BSN nurses (Goode et al., 2013; Fiedler et al., 2014; Rosenfeld et al., 2015). The other nine articles evaluated both BSN and associated-prepared nurses (ASN); (Cline et al., 2017; Edwards et al., 2015; Lin et al., 2014; Medas et al., 2015; Olsen-Sitki et al., 2012; Salmond et al., 2017; Smith et al., 2016; Trepanier et al., 2012; Van Camp and Chappy, 2017).

2.3.2. Synthesis of the Strategy All articles included in this review dealt with NRPs. Six of the ar-

ticles focused on NRPs initiated throughout a facility, or corporation (Fiedler et al., 2014; Goode et al., 2013; Medas et al., 2015; Olsen-Sitki et al., 2012; Rosenfeld et al., 2015; Trepanier et al., 2012). Three of the articles focused on specific specialties: one focused on pediatric NRPs, one on oncology NRPs, and one investigated NRPs in long-term care facilities (Cline et al., 2017; Salmond et al., 2017; Smith et al., 2016).

2.3.3. Synthesis of the Comparison Most of the articles compared the results of their studies regarding

retention and satisfaction to national statistics (Cline et al., 2017; Fiedler et al., 2014; Goode et al., 2013; Medas et al., 2015; Rosenfeld et al., 2015; Salmond et al., 2017; Smith et al., 2016). One article compared the study results to retention rates at the hospital prior to the initiation of the NRP (Trepanier et al., 2012). There were no articles found that met the inclusion criteria that studied nurse turnover and satisfaction for those included in a NRP compared to a control group that participated in a traditional orientation.

2.3.4. Synthesis of the Outcome and Time Based upon the literature review it was discovered that the use of

the NRP has had a generally positive impact on satisfaction and re- tention of new nurse hires. Satisfaction rates of the programs im- plemented in these studies were analyzed using various measurements. Four studies used the Casey-Fink Survey (Cline et al., 2017; Goode et al., 2013; Olsen-Sitki et al., 2012; Salmond et al., 2017). The

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McCloskey/Mueller Satisfaction Scale (MMSS) was another measure- ment tool used in three studies (Fiedler et al., 2014; Goode et al., 2013; Medas et al., 2015). The Gerber's Control Over Nursing Practice Tool, The Nurse Job Satisfaction Scale, and The Cummings and Estabrooks' quality rating tool were used in two studies (Goode et al., 2013; Lin et al., 2014).

2.3.5. Nurse Retention Nurse retention rates have shown a dramatic increase with the use

of NRPs with most studies showing a retention rate of over 90% after the first year of hire (Goode et al., 2013; Medas et al., 2015; Trepanier et al., 2012). Two studies showed a lower retention rate (Rosenfeld et al., 2015; Salmond et al., 2017). One study had a retention rate of 85% one year post hire during the first year of the program being im- plemented; however, the study showed that the retention rates in- creased with subsequent NRPs, with a peak retention rate of 97.2% for the NRP implemented in 2010 (Rosenfeld et al., 2015). The other study of a long-term care NRP had a retention rate of 86% after the first year; however, the authors still considered this to be a considerable im- provement compared to the state-wide average of 64% retention rate for new nurse hires in long-term care facilities (Salmond et al., 2017). Yet, Rosenfeld et al. (2015) found that 78.4% of participants in the NRP were still working at the same facility three years after his or her date of hire.

Financial savings were also noted in some studies as a direct cor- relation to increased nurse retention. Trepanier et al. (2012) reported a net gain of $15,228,000 across the 15 hospitals studied due to increased nurse retention rates. Another study found that the increased retention saved a facility $13,057,200 over a three-year period (Fiedler et al., 2014).

2.3.6. Nurse Satisfaction Nine of the articles explored new nurse satisfaction as a result of the

NRP (Cline et al., 2017; Edwards et al., 2015; Fiedler et al., 2014; Goode et al., 2013; Lin et al., 2014; Medas et al., 2015; Olsen-Sitki et al., 2012; Salmond et al., 2017; Van Camp and Chappy, 2017).

Two studies reported a high level of perceived job satisfaction at the start of the NRP that remained steady at six and 12months (Fiedler et al., 2014; Olsen-Sitki et al., 2012). Perceived contributors to high level of satisfaction were peer support and positive interactions with staff and patients (Fiedler et al., 2014; Medas et al., 2015).

One study showed a gradual decrease in overall satisfaction de- monstrated in a decrease in overall satisfaction from the start of the NRP (Salmond et al., 2017). The other studies showed a decline from perceived satisfaction at six months, however, the level of satisfaction was found to be back up to baseline at 12months (Cline et al., 2017; Edwards et al., 2015; Goode et al., 2013; Lin et al., 2014; Medas et al., 2015; Van Camp and Chappy, 2017). Contributing factors identified to the decrease in satisfaction were: stress related to the work environ- ment, staffing, and difficulty acquiring a day shift position (Lin et al., 2014; Medas et al., 2015). The rebound in satisfaction noted could be related to an increase in confidence and management of workload by the end of the NRP (Lin et al., 2014).

3. Limitations

There were three common themes amongst the twelve articles re- lated to limitations and risk of bias: (a) economic hardships, (b) poor response rate, (c) and voluntary participation. Economic hardship re- lated to the economic decline in the United States in 2008 was noted as a potential limitation in two studies. The researchers felt that the poor economic conditions could have influenced increased nurse retention (Olsen-Sitki et al., 2012; Trepanier et al., 2012).

Low response rates were reported as a limitation in five of the ar- ticles. (Fiedler et al., 2014; Goode et al., 2013; Medas et al., 2015; Olsen-Sitki et al., 2012; Smith et al., 2015). One article had a response

rate of less than 25% which negatively impacted the quality of the study (Medas et al., 2015).

A risk for selection bias was identified as a limiting factor in two studies (Fiedler et al., 2014; Lin et al., 2014). The authors reported that since participants were aware that they were participating in a survey and that participation was voluntary, there was an identified risk for participants reporting “superficially increased changes in satisfaction” (Lin et al., 2014, p. 448).

Another limitation to this study was the lack of evidence studying just BSN nurse hires, as the majority of the studies included both ASN and BSN graduates. Only three out of the twelve studies included just BSN nurse graduates in their program (Goode et al., 2013; Fiedler et al., 2014; Rosenfeld et al., 2015). This could be considered a confounding variable as one's level of education may impact how he or she handles stressful work environments and increased patient acuity. Additionally, confidence in skill and critical judgment may be different amongst ASN and BSN graduates. Based upon differences in level of education, ASN graduates and BSN graduates may require different elements to be in- cluded in the NRP in order to successfully complete the program (Cochran, 2017).

Furthermore, there were no studies found during the literature re- view that compared traditional orientation programs to NRPs during the same time period. This may decrease the reliability of the findings as retention and satisfaction during different time periods may vary due to factors such as job availability and economic conditions.

4. Discussion

4.1. Review of Evidence

Review of evidence analyzed in this review yielded two important findings. Based upon the literature reviewed there is a strong correla- tion between the use of a NRP and increased nurse retention of new nurses in their first year of hire (Cline et al., 2017; Edwards et al., 2015; Fiedler et al., 2014; Goode et al., 2013; Medas et al., 2015; Van Camp and Chappy, 2017). The improved retention rates were also shown to have positive financial implications, saving some facilities up to $15,228,000 (Trepanier et al., 2012). This is vital information that is beneficial for nurse educators in the hospital setting as well as nurse graduates looking for their first job. Through the use of the NRP, it can be assumed based upon the literature, that more new nurses will remain in their role within the first year of hire, which will also have positive financial outcomes for the facility compared to facilities offering only traditional orientation programs (Trepanier et al., 2012). Furthermore, newly graduated nurses may be more prone to apply to a hospital of- fering a NRP due to the positive outcomes of NRPs present in current literature.

There is moderate evidence to support an increase in satisfaction with the use of a nurse residency program. Although literature showed a decrease in satisfaction in new nurse hires after six months of em- ployment, satisfaction rates stabilized and were still considered to be high based upon the McCloskey Mueller Satisfaction Scale (Goode et al., 2013; Fiedler et al., 2014; Lin et al., 2014).

4.2. Implication for Practice

These findings reinforce the need for medical institutions to develop NRPs in place of traditional orientations for new nurse hires. The cor- relation between NRPs and improved satisfaction and retention amongst new nurses is promising in terms of encouraging new nurses to remain in their role and continue to develop and grow professionally. This will have a positive implication for the facility in terms of financial savings and increased experience and satisfaction amongst staff mem- bers.

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5. Conclusion

NRPs have been identified as a successful method, in comparison to traditional orientation, in easing new nurses into the role as a profes- sional nurse (Van Camp and Chappy, 2017). Increased retention and satisfaction of new nurse hires have been proven outcomes of NRPs,

positively impacting nurse turnover rates and finances in healthcare institutions. Further research is needed in the following areas in order to strengthen research supporting the implementation of NRPs: com- paring traditional orientations with NRPs during the same time period, studying the effect of NRPs on just BSN graduates, and implementing methods to increase participation in the studies being conducted.

Appendix A. Evidence Matrix Table

Article name Author and date

Evidence type Sample size, setting

Findings that help answer the EBP question

Observable measures

Limitations Evidence level, quality

Longitudinal outcomes of an institutionally developed nurse residency program

Cline, D., La Frentz, K., & Fellman, B. (2017)

Longitudinal Retrospective analysis

Purpose: To present a 10-year retrospective review of outcomes from an internally developed nurse residency program

Sample: 1118 nurse residents who completed the NRP between the summer of 2005 until November of 2014

Setting: A Comprehensive cancer center. Students were assigned to the hematologic, surgical, medical oncology, intensive care, and emergency center units.

- Greater than 90% retention rate after one year

- Moderate decline in satisfaction over the course of the residency program.

The Casey-Fink Graduate Nurse Experience Survey was used to measure data obtained

- Data collected over 10-year period had some variability in questions asked - Residency program curriculum changed over time to stay in line with the NCSBN guidelines, making it difficult to draw conclusions about how aspects of curriculum impacted survey scores

Responses were originally completed on paper for the first few years of study and then had to be manually inputted into electronic data collection spreadsheet

III A

A systematic review of the effectiveness of strategies and interventions to improve the transition from student to newly qualified nurse

Edwards, D., Hawker, C., Carrier, J., & Rees, C. (2015)

Systematic Review

Purpose: To determine the effectiveness of the strategies used to support newly qualified nurses during the transition into the clinical workplace

N/A - Studies showed a higher 12- month job satisfaction with use of NRP and retention rates were between 73 and 94% at one year

Evaluation of the impact of support strategies and programs on individual and organizational outcomes

- The search was restricted to the English language

II A

Long-term outcomes of a post baccalaureate nurse residency program

Fiedler, R., Read, E. S., & Lane, K. A. (2014).

Descriptive case study

Purpose: To determine what influence a nurse residency program (NRP)

Sample: 170 graduates who were still employed at the medical center

Setting: NPR employed at

- Only 5.6% of residents left during their first year of hire

Satisfaction remained high with the highest

The survey was released by SurveyMonkey analyzed using McClockey/ Mueller Satisfaction Scale

- Small sample size -Response rate of 30.2% - Participation was voluntary which increases rick of selection

III A

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has on long-term outcomes including turnover rates, career satisfaction, and leadership development

medical center between July 2008 and August 2010

rating for interaction with the coworkers

bias - Trying to locate nurse residents once they graduated from the yearlong program

Lessons learned from 10 years of research on a post- baccalaureate nurse residency program

Goode, C. J., Lynn, M. R., & McElroy, D. (2013).

Longitudinal survey

Purpose: To examine the outcomes from 10 years of research on a post- baccalaureate new graduate nurse residency program

10-years of data of 31,000 graduate nurses across 100 hospitals in the United States who participated in the AACN Nurse Residency Program

- High job satisfaction initially, with a significant decrease at 6months which then stabilized at 12months. - Pre-NRP retention 70.5%. - 1-year Post-NRP retention 94%

Data was measured by the Casey-Fink Graduate Nurse Experience Survey, the MMSS, Gerber's Control Over Nursing Practice Scale, and the Graduate Nurse Residency Program Evaluation

- Resident participation rate slowly declined over the length of the 10-year study to 48% by the end of the 10 years.

III B

Factors influencing job satisfaction of new graduate nurses participating in nurse residency programs: A systematic review

Lin, P. S., Viscardi, M. K., & McHugh, M. D. (2014).

Systematic Review Purpose: To explore the relationship between nurse residency program and new graduate nurse's job satisfaction

N/A Studies saw a decline in satisfaction at 6months with an increase in satisfaction by the completion of the nurse residency program

The Cummings and Estabrooks' quality rating tool was used to appraise the articles

Participants were made aware that they were participating in the survey

II B

Outcomes of a comprehen- sive nurse residency program

Medas, J. C., Amato, S., Grimm, D., Radziewicz, R., Rhodes, C., VanHorn, C., & McNett, M. (2015).

Prospective Cohort Study

Purpose: to study the effects of a one year long comprehensive nurse residency (CNRP) program over an 18-month period

Sample: 79 participants of the CNRP in 2010

Setting: Public Hospital in Northeast Ohio with Magnet recognition

- Satisfaction amongst the participants was the highest at hire, then decreased at 6months with a gradual increase by 18months with the mean satisfaction being a 3.789 (5 being the highest possible response using MMSS.) - Retention rates have been between 90 and 94%

The McClockey- Mueller Satisfaction Scale (MMSS) was used to measure satisfaction amongst the participants

- Response rate decreased from 37% at the beginning of the study to 35% at 6months, 15% at 12months and 11% at 18months post hire.

- Was a single-site study which may have impacted the generalizability of the results

II B

Evaluating the impact of a nurse residency program for newly graduated registered nurses

Olson-Sitki, K., Wendler, M. C., & Forbes, G. (2012).

Descriptive Case Study with repeated measures, time series mixed- methods design

Purpose: To evaluate a year- long nurse residency program using a non-

Sample: 50 new nurse graduates (Both BSN and ADN) who were hired in the summers of 2006 and 2007 into their first nursing position after graduation in facility's nurse residency program

- Nurse turnover rate for those in the NRP a year post hire was 7% compared to 15% before the implementation of the program.

Participants reported a high level of satisfaction with

The Casey-Fink tool was used to analyze results

There was a 38% attrition rate of those who started in the study and completed it.

- The one-year post hire mark signified a time of economic decline in the United States. It is unknown if this

III A

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experimental, repeated measures design with qualitative questions.

Setting: A 207- bed Magnet- designated regional medical center

the program at 6 and 12months post hire.

had an influence on the low turn- over rate

Evaluating the short and long-term outcomes of a post-BSN residency program

Rosenfeld, P., Glassman, K., & Capobianco, E. (2015).

Retrospective case study

Purpose: To evaluate the short and long-term outcomes of the nurse residency program (NRP) at NYO Langone Medical Center from the perspective of former residents

Sample: 671 former nurse residency program participants from 2005 to 2012

Setting: New York University Langone Medical Center

- 90.6% of NR was still employed one year after their hire date.

- 65.6% of these residents were still employed in 2013

A survey, developed by Qualtrics survey in Utah was sent electronically to the residency participants who were located by the Human Resources department at NYU Langone Medical Center

- Study was conducted in one institution with a consistently large number of nurse residents - Super Storm Sandy in 2012 closed the facility for 3months, making it difficult to assess the impact of these developments on responses to this evaluation study

III A

Long-term care nurse residency program: Evaluation of new nurse experiences and lessons learned

Salmon, S. W., Cadmus, E., Black, K. K., Bohnarczyk, N., & Hassler, L (2017).

Mixed-Methods study

Purpose: To identify if implementing a new nurse residency program increase retention and job satisfaction in long-term care environments

Sample: 37 nurse residents of mixed bachelor and associates degree background

Setting:36 LTC facilities in NJ

- Retention rates after one year were 86% - Total Satisfaction decreased 9% from pre to post test. However, personal satisfaction, satisfaction workload, and satisfaction with training increased 9%, 6%, and 5% respectively.

Surveys were administered and analyzed by the John J. Heldrich Center for Workforce Development. The Casey-Fink tool were used to analyze data

Nonparticipants workload on new nurse education days, the perception that the program was not always valued by the nurse residents' managers or colleagues, and inconsistent preceptor support

III A

Exploring the structure and content of hospital- based pediatric nurse residency programs

Smith, J. B., Robinson, D., Echtenkamp, D., Brostoff, M., McCarthy, A. (2015)

Longitudinal Quantitative Survey

Purpose: To present the results of the survey regarding benefits and challenges of the pediatric nurse residency program

Sample Size: 83 nurse educators responsible for NRP or traditional orientation programs

Setting: 81 hospitals across the United States who have a certified pediatric unit

❑ N/A

- Turnover after one year ranged from 0 to 16%.

- Survey was developed by the Pediatric Nursing (IPN) Board of Directors and dispersed to the participants through Survey Monkey

- Poor response to survey of 25.6%

IV A

New graduate nurse residency program: A cost-benefit analysis based on turnover and contract labor usage

Trapanier, S., Early, S., Ulrigh, B., & Cherry, B. (2012)

Stepwise regression analysis

Purpose: To conduct a cost- benefit analysis of nursing residency program utilizing turnover rate and contract labor usage

Sample: 524 nurses – 87% female, 13% male, with 52% between the ages of 23 and 30 years of age.

Setting: 15 hospitals in California, Florida, Georgia,

- Nurse Graduate 1-year turnover rate went from 36.8% pre- residency to 6.41% post- residency.

- Decreased turnover rates lead to a $15,228,000

Data was analyzed using the health care system Accounting and Human Resources databases and residency company database

-Study utilized a secondary analysis of a health care corporation's community- hospital database and may not be applicable to other health care settings

III A

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Nebraska, Missouri, Tennessee, and Texas

❑ N/A

profit across the 15 hospitals studied.

- The time the study was conducted (2008 to 2010) was during an economic decline which could've contributed to increased turnover rates

The effectiveness of nurse residency programs on retention: A systematic review

Van Camp, J. & Chappy, S. (2017)

Systematic Review

Purpose: examine new graduate NRPs, perceived satisfaction, and retention rates

❑ N/A - Studies showed a high level of job satisfaction

- Studies showed between a 78.3–100% retention rates after the first year hired.

- Manual review of 48 articles for inclusion.

- Many organizations did not clearly define measurement of retention at one year

- More quasi- experimental studies are needed to compare retention rates amongst graduate students compared to non- NRP.

II B

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