Return on Investment: Benefits and Challenges of a Baccalaureate Nurse Residency Program

Rosemary Pine, MSN, RN, CDE; Kathryn Tart, EdD, RN, CNE


Nurs Econ. 2007;21(5):13-18, 39. 

In This Article

Program Background

Retention of graduate nurses during the first year of employment is crucial and challenging in an acute care hospital. The high turnover rate, the high cost of recruitment, and replacement costs seem an insoluble problem. Yet, the pressures on hospitals to be cost effective and to provide reliable safe care are daunting. The Methodist Hospital's UHC Bacca laureate Nurse Residency program was initiated to provide the support and structure necessary to help transition graduate nurses from the student nurse role to be leaders at the bedside. Thus, the program was selected because it was tailored to meet the advanced beginner's needs to deliver competent care and it would be cost effective for the hospital.

The Methodist Hospital's UHC Baccalaureate Nurse Residency Program is a 1-year program for graduates of baccalaureate nursing programs who are employed as staff nurses on clinical units. The program's focus is on the transition to professional nursing practice using Patricia Benner's theoretical framework of From Novice to Expert: Excellence and Power in Clinical Practice (1984). This is a developmental model which stages skills acquisition from be ginner level to expert. In this model the baccalaureate graduate nurse is exemplified as an advanced beginner. The advanced beginner is characterized by having difficulty in prioritizing competing tasks and trusting those with more experience or authority to know how to problem solve. Advanced beginners have limited confidence in their abilities and have difficulty imagining their solving situations successfully; thus, they limit their ability to successfully problem solve complicated clinical situations (Benner, 1984). The purpose of the BSN nurse residency program is two-fold:

  1. Assist the new nurse graduate in transitioning from the role of advanced beginner to the competent nurse role and meeting its demands.

  2. Provide supports that would afford better understanding of the organizational and bureaucratic structure of the medical center environment.

The UHC and the AACN Nurse Residency Program (UHC & AACN, 2005) is designed as a series of learning and work experiences to assist baccalaureate graduate nurses as they transition from the student role to the role of leader at the bedside. The graduate nurse will:

  • Transition from the advanced beginner role to competent nurse in the acute care environment.

  • Develop effective decision-making skills related to clinical judgment and performance.

  • Provide clinical leadership at the point of care.

  • Strengthen commitment to nurs ing as a professional choice.

  • Formulate an individual development plan as related to their clinical role.

  • Incorporate research-based ev i dence linked to practice outcomes (p. 1).

The resident commits to 1-year of participation in the program. The resident meets for 4 hours per month. In addition to meeting all the obligations of a full-time employee, the resident commits to:

  • Participating in general and specialized learning experiences as part of the nurse residency program.

  • Completing demographic and outcomes measurements tools.

  • Completing evaluations of the program, preceptors, and facilitators.

The overall structure of the program involves several key components:

  • A partnership between an academic medical center and a school of nursing.

  • After general nursing orientation, full and active participation in systematically designed experiences.

  • The resident cohort meets for 4 to 8 hours per month as a group. The seminar time is paid time.

The conceptual framework is the Dreyfus Skills Acquisition Model as described by Benner (1984). The graduate nurse enters the program as an advance beginner. The advanced beginner relies on rules to determine action rather than incorporating experience and rules to make decisions. They typically are overwhelmed by the volume of the information received (Casey et al., 2004).

There are four broad content areas of the core curriculum: (a) leadership, (b) patient outcomes, (c) professional role development (see Figure 1), and (d) critical thinking.

Curriculum Concepts


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