1. Cosme, Sheryl MSN, RN-BC


In this month's column, the Senior Accreditation Operations Manager of the American Nurses Credentialing Center (ANCC) discusses the value of nursing residency programs and current discussion in the profession, along with criteria offered by the ANCC to support this imperative for both RNs and advanced practice RNs including new graduates and those transitioning between clinical settings.


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Evidence demonstrates that new-graduate nurses typically experience high levels of stress, anxiety, fear, and frustration during their 1st year of clinical practice.1-3 In large part, this has been attributed to the transition process between academic nursing programs and the demands required of RNs in clinical practice settings. Failure to successfully transition new-graduate nurses affects new-graduate nurse retention1-3 and can also lead employers to perceive new nurses as inadequately prepared to care for patients.4 Reported turnover rates for new-graduate nurses range from 35% to 61%,5 with an estimated cost of replacement between 75% and 125% of the nurse's annual salary.6 Furthermore, the implementation of nurse residency programs can drastically improve retention rates-1 hospital new-graduate nurse transition program increased retention of nurse graduates from 50% to 89%, with an associated cost savings of $823,680.2

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The Institute of Medicine (IOM) recognized this issue and addressed it in recommendation 3: "Transformation Practice" of the published report, The Future of Nursing: Leading Change, Advancing Health.7 In the report, the IOM strongly recommends organizations implement nurse residency and fellowship programs to help nurses transition to their practice settings.7 The IOM describes nurse residency programs as "planned, comprehensive periods of time during which nursing graduates can acquire the knowledge and skills to deliver safe, quality care that meets defined (organizations or professional society) standards of practice."7(pp120,121)


While evidence in the literature predominantly reports outcomes of graduate nurse transition programs, postgraduate advanced practice RN (APRN) transition programs are a relatively recent innovation beginning in 2007.8 Yet, some in the nursing profession resist the implementation of APRN transition programs, citing specific concerns. The Nurse Practitioner (NP) Roundtable, a collaborative of organizations representing NPs across the United States, stated that while postgraduate transition programs may provide NPs with management strategies, these opportunities are not necessary for successful entry and functioning in professional NP practice.9 Despite the debate around postgraduate fellowships as a requirement for APRNs, the reaction to the IOM recommendation that practice settings implement nurse residency and fellowship programs to transition new graduates has been encouraging.


A recent white paper by the American Academy of Ambulatory Care Nursing, The Need for an Ambulatory Nurse Residency Program, maintains that nurse residency programs are needed as a bridge between education and practice, as well as a bridge to guide a transition into a new specialty.10 Issues including unclear role expectations, poor environmental orientation, and insufficient knowledge to provide care to a different patient population are cited as reasons for high turnover rates in ambulatory care nursing.10


In July 2014, the American Nurses Credentialing Center (ANCC) launched a new accreditation program focused solely on practice transition programs for nurses. The ANCC Practice Transition Accreditation Program (PTAP) is a peer-reviewed accreditation program for RN residencies, RN fellowships, and APRN fellowships. All nurses and APRNs should be given time and support to transition from academia to the clinical practice setting. ANCC defines each type of transition program as follows:


* RN residency: program for RNs with less than 12 months of experience; program must be at least 6 months in length, encompassing organizational orientation, practice-based experience, and supplemental activities to promote nursing professional development.


* RN fellowship: program for RNs with 12 or more months of experience.


* APRN fellowship: program for currently licensed APRNs at initial entry or between practice settings.



The ANCC criteria provide hospitals and healthcare organizations with a framework for creating or evaluating a nurse residency or fellowship program. ANCC accreditation through PTAP includes 6 criteria domains: program leadership, organizational enculturation, development and design, practice-based learning, nursing professional development, and quality outcomes.


Residency and fellowship programs in other healthcare professions such as medicine and pharmacy ensure that new healthcare practitioners successfully transition from academia to practice. It is time for nursing to embrace and offer the same support system for RNs and APRNs moving into the clinical setting or between different clinical settings. The healthcare system, the nursing workforce, and our patients deserve nothing less. Continued growth of residency and fellowship programs in nursing is necessary to meet the increasing demands on healthcare needs such as patient safety and decreased reimbursement. Moreover, such continued growth will ensure increased self-reflection and spur research that will only serve to better both nursing and healthcare consumers.




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7. Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: National Academies Press; 2011. [Context Link]


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9. Nurse Practitioner Perspective on Education and Post-Graduate Training. May 19, 2014. Accessed June 19, 2015. [Context Link]


10. American Academy of Ambulatory Care Nursing. Ambulatory Registered Nurse Residency White Paper. The Need for an Ambulatory Nurse Residency Program. Pitman, NJ: AAACN; 2014. [Context Link]