title: The organizational transformative power of nurse residency programs.
abstract: Residency programs for newly licensed registered nurses (NLRNs) have been strongly advocated by the Institute of Medicine, American Organization of Nurse Executives, and other professional organizations. Their cost-effectiveness as well as their impact on NLRN retention, job and practice satisfaction, improved performance, and reduction in environmental reality shock has been demonstrated. This qualitative study sought answers to the question: what people, components, processes and activities of Nurse Residency Programs (NRPs), and the work environment are instrumental in the transition and integration of NLRNs into the professional practice role and into professional communities? In the course of interviewing 907 nurses-NLRNs, experienced nurses, managers, and educators-practicing on clinical units with confirmed "very healthy work environments" in 20 Magnet hospitals, it became evident that not only did NRPs positively impact the professional socialization of NLRNs, they led to transformative changes in the organization and in the practice of other health care professionals. The organizational transformative changes described by the interviewees are presented for each of the 7 major challenges identified by NLRNs-delegation, prioritization, managing patient care delivery, autonomous decision-making, collaboration with other disciplines, constructive conflict resolution, and utilizing feedback to restore self-confidence. If it can be demonstrated that these transformative changes stimulated by NRPs also lead to improved patient outcomes, NRPs may be the most significant organization transformation instituted by nurse leaders in recent years.
authors.affiliation: Health Science Research Associates, Apache Junction, Arizona 85219, USA. mcairzona@juno.com
authors.forename: Marlene
authors.initials: M
authors.lastname: Kramer
authors.forename: Pat
authors.initials: P
authors.lastname: Maguire
authors.forename: Diana
authors.initials: D
authors.lastname: Halfer
authors.forename: Wendy C
authors.initials: WC
authors.lastname: Budin
authors.forename: Debra S
authors.initials: DS
authors.lastname: Hall
authors.forename: Lauren
authors.initials: L
authors.lastname: Goodloe
authors.forename: Jessica
authors.initials: J
authors.lastname: Klaristenfeld
authors.forename: Susan
authors.initials: S
authors.lastname: Teasley
authors.forename: Lynn
authors.initials: L
authors.lastname: Forsey
authors.forename: Johanna
authors.initials: J
authors.lastname: Lemke
mesh_terms: D001291:Attitude of Health Personnel; D032022:Delegation, Professional; D004511:Education, Nursing, Graduate; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D009718:Nurse Administrators / Q000458:organization & administration*; D015402:Nursing Education Research; D015403:Nursing Evaluation Research; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000458:organization & administration* / Q000523:psychology; D011209:Power, Psychological; D036301:Qualitative Research