...article identifies crucial lessons that will assist leaders in designing and implementing a nurse residency program in their own institutions. The lessons are drawn from the experience of the successful University of Utah program. Four important practical components of such programs are described: an adaptive curriculum, promotion of autonomy, mentoring, and meeting the needs of participants with associate degrees. Although the lessons are based on the perspective of one nurse residency program, they hold import for the design of nurse residency programs in diverse settings.

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The percentage of new graduate nurses who leave a healthcare organization within the first year of employment is estimated at 35 percent to 60 percent (Beecroft, Kunzman, and Krozek 2001). The cost of this turnover is staggering. A 2004 economic analysis published in the Journal of Nursing Administration estimated that the dollar cost of turnover per registered nurse at one 600-bed acute care hospital is $62,100 to $67,100 (Jones 2004; Jones 2005). Nurse turnover also weakens the ability of the patient care team to ensure quality patient outcomes. According to the National Quality Forum (NQF 2007), "Nurses, as the principal caregivers in any healthcare system, directly and profoundly affect the lives of patients and are critical to the quality of care patients receive." The NQF has endorsed the following inpatient-nurse-sensitive, patient-centered outcome measures: "the percentage of major surgical inpatients who experience a hospital-acquired complication and die; pressure ulcer prevalence; falls prevalence; falls with injury; rate of urinary tract infections associated with use of urinary catheters for ICU [intensive care unit] patients; rate of blood stream infections associated with use of central line catheters for ICU and high-risk nursery patients; and, rate of pneumonia associated with use of ventilators for ICU and high-risk nursery patients." Breakdowns in communication are identified by the Joint Commission (2007) as the number one root cause of sentinel events. When communication is considered at the care team level, "it is difficult to build working relationships in environments that experience high turnover and/or staffed with continuous streams of temporary employees" (Kelly 2007).

In an effort to reduce turnover among new graduate nurses, numerous healthcare organizations have implemented nurse residency programs (Beecroft, Kunzman, and Krozek 2001; Airier and Krsek 2006; Lindsey and Kleiner 2005; Owens et al. 2001). These residency programs typically facilitate the transition of new graduate nurses from student to registered nurse or prepare registered nurses (new or experienced) for specialty practice. Most hospital administrators and leaders, especially those in academic medical centers, are familiar with traditional medical or administrative residencies, but the nurse residency is structurally different from these programs. The nurse residency is specialty-independent, requires only four hours of participation each month, and augments the contextual learning that takes place in each nurse resident's specific practice setting.

In recent years, to assess the nurse residency programs' impact on nurses' satisfaction with the nursing role, nurses' sense of control over practice, and nursing turnover, the University HealthSystem Consortium/American Association of Colleges of Nursing (UHC/AACN) Post- Baccalaureate Nurse Residency Program has led a process of standardization and outcomes measurement for its residency programs (Jones 2005; Krugman et al. 2006). As one of the original UHC/AACN nurse residency sites and one of three sites funded by the federal Health Resources and Services Administration (HRSA), the University of Utah Nurse Residency Program (Utah NRP) has produced eight cohorts of nurse residents in three years, with 171 graduate nurses completing the program. Both Utah NRP data and national UHC/AACN data indicate that nurse residents are satisfied with the residency programs. The programs have also reported high retention and low turnover, compared to nationally reported new-graduate turnover rates (Lynn 2006; Poynton 2006; Altier and Krsek 2006).

This article discusses important practical considerations in the design and implementation of one Utah NRP. We detail four key lessons from the Utah experience, related to curriculum design, promotion of autonomy, the importance of mentoring, and special considerations for associate-degree participants. Although this article is based on one program's experience, the program is similar to other UHC/AACN nurse residency programs in that it implements the same basic curriculum over the same time period. Ongoing data analysis indicates that measures of job satisfaction, sense of control over nursing practice, graduate nurse experience, and program evaluations of the Utah NRP are largely similar to those of other participating UHC/AACN nurse residency programs (Lynn 2006). Thus, the lessons presented here--learned through the hands-on process of designing and implementing one nurse residency program--should be applicable to the design of other nurse residency programs in academic medical centers. Because the unique experience of a novice nurse is the same across practice settings, these lessons can inform nurse residency programs in other settings as well.

BACKGROUND

Previous studies have described the goals and...

NOTE: All illustrations and photos have been removed from this article.



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