NURS 527 Improving Nurse Retention with Nurse Residency Programs Essay

NURS 527 Improving Nurse Retention with Nurse Residency Programs Essay

NURS 527 Improving Nurse Retention with Nurse Residency Programs Sample Essay

Nurse Staffing Shortage

Background Information

The United States’ healthcare industry faces a staffing shortage that could seriously affect patient care and safety. The AHA (2021) reports that job vacancies among nursing personnel increased by 30% between 2019 and 2020, and shortages could increase to 3.2 million healthcare workers by 2026. Furthermore, the source reveals that America needs to hire 200,000 annually to meet the increased demand for healthcare and to replace the aging and retiring healthcare workers (American Hospital Association, 2021). This nursing shortage is attributed to several factors, including an aging population, increased demand for services due to changes in health policy, and a decrease in the number of healthcare workers entering the field (Hassmiller & Wakefield, 2022). As a result of this shortage, existing staff are being asked to take on additional responsibilities or work longer hours than before. Considering the impact of the healthcare staffing shortage in the U.S. healthcare system, employers and policymakers should develop strategies to address the subsequent implications of these shortages.

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Problem Statement

In recent years, the U.S. has faced a severe healthcare staffing shortage as demand for medical services continues to rise due to an increasingly aging population requiring greater access to medical resources. Zhang et al. (2020) argue that the demand for healthcare workers in the U.S. far outstrips the supply, and by 2030, the country will face a deficiency of about 121,300 physicians. Unfortunately, the healthcare staffing shortage has had far-reaching implications on many aspects of the U.S. health system, such as longer hospital wait times and inadequate staff numbers in places like geriatric care facilities (Butler et al., 2019). In addition, the shortage has led to an overall decreased quality of service for patients seeking help with different medical needs. While there have been some attempts by government and industry stakeholders to address this issue, more must be done to ensure patients’ needs are met across all settings.

Purpose Statement

This study aims to identify trends in healthcare staffing shortages in the U.S., examine the underlying causes, and propose strategies to eliminate these staffing gaps, such as new opportunities related to technology advancements and policy changes that may further reduce healthcare shortages. The study will also advocate for increased governmental support of public health initiatives to address healthcare staffing shortages and recommend how all stakeholders can help address this issue.

Research Question Using the Pico Format

For new graduate nurses at acute care hospitals (P), how does the use of a nurse residency program (I), compared with no nurse residency program (C), impact the retention of nurses at one year of service (O)?

Literature Review

The availability and cost-effectiveness of healthcare services depend on the availability of nurses and other healthcare practitioners. The rampant nursing shortage demonstrates a problem that can severely hamper care quality and patient safety if not adequately addressed. As governments, healthcare professionals, and stakeholders in the healthcare industry continue inventing different interventions to address the nursing shortage, the importance of nursing residency programs continues to be explored and implemented in different organizations. Current and past literature has evaluated how nurse residency programs impact nurse retention and provides different findings for guiding healthcare facilities’ adoption.

Extensive research has explored the importance of nurse residency programs from multiple dimensions. The current search was restricted to research exploring the impact of nurse residency programs on nurse retention among new graduate nurses. Relevant articles were searched from leading nursing databases, including CINAHL, PubMed, Medline, and Proquest. Only articles published within the last five years were selected to obtain relevant articles for the literature review to ensure currency and relevancy. Key terms for researching relevant articles included: nurse residency programs, nurse retention, nurse turnover, and new graduate nurses. Among the six articles selected, there is a common theme that nurse residency programs effectively improve nurse retention by reducing nurse turnover.

Nurse residency programs represent the kind of organizational support that management should prioritize for new graduate nurses. In a scoping review of the effectiveness of such programs, Alshawush et al. (2022) found that transition programs improve nurse retention in healthcare settings by empowering nurses to cope with hostility, bullying, and threatening situations. From a practice viewpoint, unhealthy workplaces characterized by bullying and other forms of workplace incivility prompt many nurses to leave work. In a different study, Lysaght Hurley et al. (2020) found that nurse residency programs improved the retention rate of nurse residents by 92% in one year. As a result, the study confirmed the effectiveness of nurse residency programs in increasing nurse retention. Lysaght Hurley et al. (2020) recommended implementing such programs in healthcare facilities since they offer solid preparation for new nurses to overcome workplace challenges that trigger nurse turnover.

Warren et al. (2018) evaluated program outcomes in acute care hospitals. The primary finding was that implementing nurse residency programs in acute care hospitals reduces nurse turnover by 6% to 10%, translating to about $17.6 million in annual statewide cost savings. Shinners et al. (2021) further affirmed the effectiveness of nurse residency programs during new graduate nurses’ transition from education to practice. In this study, Shinners et al. (2021.) found nurse residency programs effective for nurses’ transition. They should be prioritized in healthcare settings as an essential component for workforce development since they reduce turnover intent. Pelletier et al. (2019) found that the turnover rate in a freestanding hospital in California reduced from 11.7% to 2.9% in one year after implementing a nurse residency program. The reduction translated to a 97.1% retention rate, which is a massive achievement considering the detrimental effects of a workforce shortage in the highly demanding care environment.

Besides confirming the effectiveness of nurse residency programs in increasing nurse retention, the reviewed literature further explored the characteristics that make the programs effective. The first success factor is the implementation period. Brooks et al. (2019) found that effective nurse residency programs last between 27-52 weeks. Besides, they should include teaching, preceptor, and mentor components. The second success factor is the focus area. Alshawush et al. (2022) stated that nurse residency programs should improve nurses’ skills to cope with hostility, bullying, and threatening situations. Other valuable skills include resilience, confidence, communication, and delegation (Lysaght Hurley et al., 2020). Broadly, these findings confirm the need for multidimensional programs that orient, teach, and prepare new graduate nurses to understand their roles and transition from education to regular practice seamlessly.

The reviewed studies have different strengths and weaknesses. Concerning strengths, the reviews (Alshawush et al., 2022; Brook et al., 2019) explore the issue in-depth from multiple high-level evidence studies. The implication is that the authors conduct a rigorous search of relevant articles and ensure that only the best and most relevant to the study question are included in the review. Other notable strengths include the studies quantifying the impact of nurse residency programs on nurse retention. For instance, Pelletier et al. (2019) and Warren et al. (2018) showed the percentage difference in nurse retention achieved by implementing nurse residency programs. Such quantification helps readers understand the programs’ significance in addressing the nursing shortage problem.

The main area for improvement in some studies is generalizability. The inference is that the findings have generalizability limitations, affecting their extensive application in the broader nursing practice. For instance, Lysaght Hurley et al. (2020) conducted research in one hospice setting. The study by Alshawush et al., (2022) also needs to be more generalizable since the studies included were only from the United States, Canada, and Australia.

Summary

The nursing shortage continues to be a significant concern for healthcare professionals, governments, and stakeholders. This literature review confirms that nurse residency programs can effectively improve nurse retention among new graduate nurses. These programs help nurses understand their new roles, cope with workplace issues, improve confidence, and develop communication and delegation skills. Their effectiveness underlines their importance as workplace development programs that should be implemented in healthcare facilities. For better outcomes, implementers should adequately understand the factors that make the programs successful such as the implementation period and core components such as teaching, mentorship, and preceptor guidance.

Conceptual and Operational Definitions

To clarify the meanings of terminologies used in this research, conceptual and operational definitions will be provided. The first variable relevant to the study is nurse residency programs. Warren et al. (2018) defined a nurse residency program as a program for helping nursing graduates gain knowledge and skills to transition from education to practice effectively. In order to assess the connection between a nurse residency program and nurse retention, operational definitions by Woodward and Willgerodt (2022) will be used. According to Woodward and Willgerodt (2022), nurse retention is the ability of a healthcare organization to prevent nurse turnover and attract committed and competent staff. From a healthcare perspective, nurse turnover involves separating an employee from their organization due to dissatisfaction, workplace stress, and other factors (Woodward & Willgerodt, 2022). A high turnover implies low retention.

Conceptual Framework

The conceptual framework congruent to this research is Neuman Systems Model. As Montano (2021) noted, the model was primarily created to depict nurses and nursing clients as systems in constant energy exchange with their immediate environments. The implication is that nurses’ performance depends on the attributes of the work environment. Sampaio et al. (2022) suggested that the Neuman System Model can effectively illustrate nurses’ responses to stress. Under stressful work conditions, nurses must adapt effectively, but their adaptation depends on coping mechanisms. If they do not respond effectively, vulnerability to fatigue, burnout, and emotional stress increases. Eventually, nurses lose interest in the job hence increasing absenteeism or quitting.

Relationships among Variables

The independent variable for this research is nurse residency programs, while nurse retention is the dependent variable. The study hypothesizes that implementing a nurse residency program in the acute care hospital can increase nurse retention. In this case, a nurse residency program is an effective protective cover against new graduate nurses quitting jobs.

The Neuman Systems Model

(The Neuman’s Systems Model: nurse retention depends on nurses’ response to stress (Akhlaghi et al., 2020; Sampaio et al., 2022)).

Neuman’s Systems Model will provide the framework for this research since it demonstrates the links among workplace stress, protective covers, and nurse retention. Broadly, a nurse residency program improves nurses’ satisfaction with the job by ensuring they transition effectively from education to practice. Besides, a nurse residency program can be used to prepare nurses to cope with workplace stress. The model will guide this research by demonstrating a nurse residency program prepares nurses for the job and increases job satisfaction hence increasing nurse retention.

Methods

Research Methods

The study explores how a nurse residency program impacts the retention of nurses at one year of service. Previous studies conjecture that nurse residency programs benefit nurses by preparing them to transition from education into practice (Pelletier et al., 2019; Warren et al., 2018). Accordingly, its purpose is to evaluate the effectiveness of a nurse residency program in nurse retention among new graduate nurses. Participants will be new graduate nurses in an acute care hospital. The nurses will be interviewed about their experiences with a nurse residency program to understand its most impactful areas and how it improves nurse retention.

Sampling Method

Selected nurses will be interviewed about their experiences with the nurse residency program. As a result, purposive sampling will be used to get adequate participants for the study. Ames et al. (2019.) described purposeful sampling as a selective approach to participants’ recruitment to provide in-depth and detailed information about the research phenomena. A similar approach will help the researcher identify and pick the research sample for interviewing.

Potential Benefits and Risks

There are no direct benefits to subjects. However, their participation will be instrumental in knowledge generation to improve nursing practice. The study is not associated with any risk. Ethical risks are further prevented by informed consent and engaging in a study involving adults who can make independent decisions.

Maintaining Privacy and Confidentiality

Privacy and confidentiality are mandatory in research involving human subjects. To observe the confidentiality principle, the researcher will not disclose any research information, including personal information and responses to other people outside the study. Regarding privacy, all data will be kept securely and free from intrusion. Electronic data will be stored securely in a password-protected computer, while manual (printed) data will be stored in a safe cabinet.

Use of Information

Researchers collect data for different purposes. In the current study, information will be used to evaluate the effectiveness of a nurse residency program on nurse retention. As a result, the study’s findings will be a foundation for practice improvement since organizations can implement such programs, if found effective, in preventing nurse turnover. To achieve this goal, data will be disseminated within and outside the implementation setting among healthcare professionals.

References

Akhlaghi, E., Babaei, S., & Abolhassani, S. (2020). Modifying stressors using Betty Neuman system modeling in coronary artery bypass graft: a randomized clinical trial. Journal of Caring Sciences, 9(1), 13–19. https://doi.org/10.34172/jcs.2020.003

Alshawush, K., Hallett, N., & Bradbury‐Jones, C. (2022). The impact of transition programs on workplace bullying, violence, stress and resilience for students and new graduate nurses: A scoping review. Journal of Clinical Nursing, 31(17-18), pp. 2398–2417. https://doi.org/10.1111/jocn.16124

American Hospital Association. (2021). Fact sheet: Strengthening the health care workforce. American Hospital Association (AHA). https://www.aha.org/fact-sheets/2021-05-26-fact-sheet-strengthening-health-care-workforce

Ames, H., Glenton, C., & Lewin, S. (2019). Purposive sampling in a qualitative evidence synthesis: A worked example from a synthesis on parental perceptions of vaccination communication. BMC Medical Research Methodology, 19(1), 1-9. https://doi.org/10.1186/s12874-019-0665-4

Brook, J., Aitken, L., Webb, R., MacLaren, J., & Salmon, D. (2019). Characteristics of successful interventions to reduce turnover and increase retention of early career nurses: A systematic review. International Journal of Nursing Studies, 91, 47-59. https://doi.org/10.1016/j.ijnurstu.2018.11.003

Butler, M., Schultz, T. J., Halligan, P., Sheridan, A., Kinsman, L., Rotter, T., Beaumier, J., Kelly, R. G., & Drennan, J. (2019). Hospital nurse-staffing models and patient- and staff-related outcomes. Cochrane Database of Systematic Reviews, 2019(4). https://doi.org/10.1002/14651858.cd007019.pub3

Hassmiller, S. B., & Wakefield, M. K. (2022). The future of nursing 2020–2030: Charting a path to achieve health equity. Nursing Outlook, 70(6), S1-S9. https://doi.org/10.1016/j.outlook.2022.05.013

Lysaght Hurley, S., Welsh, D. M., Roy, K. M., & Godzik, C. (2020). Bridging the gap: a hospice nurse residency program. The Journal of Continuing Education in Nursing, 51(8), 371–376. https://doi.org/10.3928/00220124-20200716-07

Pelletier, L. R., Vincent, C., Woods, L., Odell, C., & Stichler, J. F. (2019). Effectiveness of a psychiatric–mental health nurse residency program on retention. Journal of the American Psychiatric Nurses Association, 25(1), 66-75. doi: 10.1177/1078390318807968

Warren, J. I., Perkins, S., & Greene, M. A. (2018). Advancing new nurse graduate education through implementation of statewide, standardized nurse residency programs. Journal of Nursing Regulation, 8(4), 14-21. https://doi.org/10.1016/S2155-8256(17)30177-1

Woodward, K. F., & Willgerodt, M. (2022). A systematic review of registered nurse turnover and retention in the United States. Nursing Outlook, 70(4), 664-678. https://doi.org/10.1016/j.outlook.2022.04.005

Zhang, X., Lin, D., Pforsich, H., & Lin, V. W. (2020). Physician workforce in the United States of America: Forecasting nationwide shortages. Human Resources for Health, 18(1). https://doi.org/10.1186/s12960-020-0448-3

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Appendix

First Author (Year)	Methods	Sample and Setting	Findings	Appraisal (Strengths & Weaknesses)
Alshawush et al. Journal of Clinical Nursing. 2022.	A scoping review	Sample: the data from 19 studies were reviewed to analyze the impact of transition programs on new graduate nurses. Setting: selected healthcare facilities in the United States, Canada, and Australia.	Transition programs improve nurse retention by supporting nurses in coping with hostility, bullying, and threatening situations. Transition programs support nurses’ transition from education to clinical practice by improving knowledge and confidence, hence improving socialization and retention.	Strengths: A comprehensive search was undertaken to identify relevant studies. The studies included in the review used a range of designs and methodologies. Weaknesses: Publication bias: the grey literature search was conducted on one database only due to time constraints. Questionable generalizability since the studies included was only from the United States, Canada, and Australia.
Brook et al. International Journal of Nursing Studies. 2019	Systematic review	Sample: the data were obtained from 53 studies that analyzed the features of successful interventions for reducing nurse turnover and increasing retention of early career nurses. Setting Selected healthcare facilities in the United States, Canada, the UK, and Australia	Internship/residency programs are promising interventions for improving nurse retention. Effective programs last between 27-52 weeks and should include teaching, preceptor, and mentor component.	Strengths A highly rigorous review process is done according to PRISMA guidelines. A large sample (11,000 papers and inclusion of 53). Secondary scrutiny of the studies to mitigate subjectivity. Weaknesses Difficulties in studies’ comparison due to differences in outcome measures (retention or turnover). Publication bias considering that some studies reported negative findings.
Lysaght Hurley et al. The Journal of Continuing Education in Nursing. 2020.	A program implementation survey	Sample: the program was developed and delivered to 12 nurses. Setting: the program was implemented at a large, nonprofit hospice and palliative care agency in New England.	The nurse residency program increased the nurses’ confidence, communication skills, delegation, and management skills of treatment teams and families. Therefore, it prepares new hospice nurses to overcome workplace challenges that increase nurse turnover. The retention rate of the nurse residents was 92% in 1 year, which aligns with other nurse residency programs in the United States.	Strengths The study quantifies the effects of a nurse residency program and discusses the skills that nurse residents attain through its implementation.   Weaknesses The study was conducted within one hospice setting. This hampers its replicability and generalizability. The small sample size also affects generalizability.
Pelletier et al. Journal of the American Psychiatric Nurses Association. 2019.	A quantitative time-sequenced comparative study of multiple cohorts.	Sample: 34 new graduate nurses Setting: a freestanding hospital in California.	The turnover rate reduced from 11.7% to 2.9% in one year, translating to a 97.1% retention rate. Nurse residency programs effectively attract and retain competent, confident new graduate nurses in psychiatric-mental health nursing.	Strengths The study compared findings among multiple cohorts of new graduate nurses.   Weaknesses Only 38% of the participants completed the 6-month survey. Hence, the study was associated with a low response rate.
Shinners et al. Nursing Economic$. 2021.	A retrospective study	Sample: over 6,700 new graduate nurses Setting: United States (Versant Nurse Residency).	Nurse residency programs positively affect new graduate nurses’ transition and are an essential element of workforce development since they reduce turnover intent. To achieve the desired outcomes in nurse retention, organizational leadership should value and support nurse residency programs.	Strengths A large sample size; data outcomes were analyzed from over 6.700 new graduate nurses. It evaluates the characteristics of the most successful programs.   Weaknesses The study does not quantify nurse retention rates achieved through nurse residency programs.

 

You will complete the attached IRB form based on your proposed research project.  In order to complete the IRB form you will need to develop your methods, or how you plan to do your research, gather your data, etc.  After completing the expedited IRB form, you will take the new information you have written related to sampling and methods and include that in the paper you have been developing throughout the semester.  You will submit 2 documents, the expedited IRB form AND the paper.  You may attach the IRB form to your paper as an appendix if you wish, but if you choose to do so you must format according to APA.

*If your project will require informed consent, you are NOT required to submit your informed consent with this paper.

IRB expedited ap.docx

Chooses the type of research that their project most closely aligns with on the Expedited review form.	10%
Incorporates the previously completed background and purpose of the research.	10%
Explains the methods for the research in detail.  What exactly you are going to research, study, do, and how you will get the data you need.	30%
Explains the sampling method.	15%
Discusses the potential benefits and risks.	10%
Discusses how privacy and confidentiality will be maintained.	15%
Explains how the collected information will be used.	10%
Total	100%