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491 The Journal of Continuing Education in Nursing Vol 43, No 11, 2012

Transition Within a Graduate Nurse Residency


Program
Kendra D. Varner, BSN, MSN, RN-BC, and Ruth A. Leeds, BSN, MS, RN-BC
G
raduate 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 signicant nancial 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: kendra.varner@khnetwork.org.
Received: May 21, 2012; Accepted: September 5, 2012; Posted: Oc-
tober 8, 2012.
doi:10.3928/00220124-20121001-28
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CONTINUING EDUCATION IN NURSING.
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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abstract
As 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 Hours
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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 afliated 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 rst year, matching
national gures (Bowles & Candela, 2005). Graduate
nurses who left the organization cited a poor work en-
vironment due to stafng, 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 signicantly increased and the recom-
mended structure did not meet the organizations needs.
As a result, nursing leadership, in collaboration with the
human resources and nance 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.]
493 The Journal of Continuing Education in Nursing Vol 43, No 11, 2012
2.3 Contact Hours
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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 benets included increased
support for the program throughout the organization.
The task force established a exible 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 debrieng 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.)
494 Copyright SLACK Incorporated
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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.
495 The Journal of Continuing Education in Nursing Vol 43, No 11, 2012
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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-
specic classes throughout the rst year. The NRP ex-
tended orientation was a mandatory addendum for all
contracted graduate nurses. Residents received a badge
pin indicating their program afliation 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 debrieng 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 afliated unit workow
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 ow 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 oated 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 reections 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 stafng, they
were switched to the home unit cost center.
Phase 2: Transition
For the rst 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
condence or dening moment (Fig. 2). The authors of-
ten observed this event as a two-sided coin. For example,
a residents rst patient code might be the crisis. On re-
ection, these experiences can transform into role-den-
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 debrieng
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session and didactic content. Topics included transition
management, communication, delegation, and time man-
agement. Facility-specic training on materials distribu-
tion, pharmacy updates, and case management contin-
ued to provide more of the big picture. Each resident
identied 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 oat 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 rst 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: Transformation
In 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 debrieng,
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 rst 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 debrieng and free
continuing education classes. Participation in facility
events and specialty-specic 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 fulllment of the contract requirements and of-
cially 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 condence and compe-
tence, and tting 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. Signicant variation in gradu-
497 The 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 dened 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 rst year. Rare exceptions occurred based on a
collaborative decision that another unit might be a better
t.
Within the phased program, the rst-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 reect excellent nursing care (Aiken, Clark,
Sloane, Lake, & Cheney, 2008). Because of the existing
reporting system, direct tracking and trending between
specic resident practice and quality measures, such as
medication errors, pressure sores, and failure to rescue,
was not possible. Unit managers occasionally notied
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-specic 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 nancial 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). Efciency 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 identied
the NRP, the opportunity to pursue an area of interest,
positive coworker relationships, and a supportive work
environment as primary retaining factors, reective of
the ndings 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 difcult; 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
exibility 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. Reec-
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 difcult.
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.
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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.
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Duchscher, J. B. (2008). A process of becoming: The stages of new
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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.
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key points
Graduate Nurse Residency Program
Varner., 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.
499 The Journal of Continuing Education in Nursing Vol 43, No 11, 2012
2.3 Contact Hours
CNE ARTICLE
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