PhD in Nursing Science Program

A Description of U.S. Post-Graduation Nurse Residency Programs and Patient Outcomes They May Affect

Dissertation under the direction of Professors Linda Norman and Ann Minnick

Research Objective: The objective of this study was to establish a description of Nurse Residency Programs (NRPs) to identify if there is treatment fidelity across programs, a first step to enable a study that assesses the impact of NRPs on patient outcomes.

Background: The increasing complexity of the healthcare environment and concern regarding newly licensed RNs’ ability to cope with the reality of care has resulted in the development of a variety of nurse residency program initiatives. Unknown is the extent to which various elements and components are implemented across programs. Unknown are which nurse-sensitive outcomes may be influenced by nursing residencies.

Study Aims: 1) To describe NRPs across US community, public, and teaching hospitals and 2) To identify patient outcomes believed by critical care nurses to be influenced by nursing residencies.

Methods: Aim 1: Program attributes were measured using a 24-item survey based on the Minnick and Robert’s conceptual framework. The survey was sent to known NRP Directors or Chief Nursing Officers at 1,011 US hospitals identified in the 2010 American Hospital Association dataset. Two-hundred and three surveys were returned. Aim 2: Data were collected from three focus groups that included 19 critical care nurses from the Southeastern US region.

Results: Aim 1: 9.4% of hospitals reported operating a NRP. NRP Models included: University HealthSystem Consortium (UHC, 22.1%), Facility-Based (FBM, 53.7%), and “Other” (24.2%). Small hospitals (< 250 beds) are not likely to support nursing residencies. Significant (p < .01) differences among and within program model types, in terms of career planning, project requirements and project type, and mentoring were noted. Aim 2: Critical care nurses identified outcomes for NRPs that were consistent with nurse-sensitive outcomes described in the health services literature.

Conclusions: The extent of differences within and across program types indicates a lack of treatment fidelity needed to detect objectively the impact of NRPs on patient outcomes. The expansion of NRPs may be limited by the number of hospitals of a size able to support such programs. Efforts to identify patient outcomes likely to be influenced by NRP participants should be expanded beyond critical care.