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Journal of Nursing Administration:
doi: 10.1097/NNA.0000000000000073
Departments: Magnet(R) Perspectives

The Value of RN Residency and Fellowship Programs for Magnet® Hospitals

Chappell, Kathy PhD, RN

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Author Information

Author Affiliation: Director of Accreditation, American Nurses Credentialing Center, Silver Spring, Maryland.

The author declares no conflicts of interest.

Correspondence: Dr Chappell, American Nurses Credentialing Center, 8515 Georgia Ave, Suite 400, Silver Spring, MD 20910 (

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This article discusses the need for accreditation of orientation transition programs for nurses and how these programs support Magnet® criteria.

Moving from the academic environment to the clinical setting is a challenging transition for RNs. The need for evidence-based transition programs supporting new graduate RNs and advanced practice RNs (APRNs) has never been more important. Hospitals are increasingly complex organizations, requiring RNs and APRNs to use critical thinking skills, and develop and maintain clinical expertise to provide safe, high-quality patient care. New criteria in the 2014 Magnet Recognition Program® Application Manual specifically address this requirement for organizations pursuing or maintaining Magnet® designation.1

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In 1974, Dr Marlene Kramer2 1st documented the experiences of new graduate nurses transitioning from academic programs into the clinical setting in her seminal publication, “Reality Shock.” New graduate nurses experienced high levels of anxiety, fear, and frustration, particularly in the 1st 12 months of clinical practice. These findings have remained remarkably consistent over the past 40 years as documented both qualitatively and quantitatively in the United States and beyond. New graduates in Australia, Canada, and Norway describe similar stressful transition experiences over the 1st year of practice as do their RN colleagues in the United States.3-5 Failing to adequately support new graduate nurses has resulted in high levels of turnover and vacancy within organizations, as well as the loss of RNs within the profession. While Dr Kramer’s work specifically focused on new graduate nurses, similar findings are being documented for newly certified APRNs.

Due in part to the large number of RNs who leave the profession in the 1st 2 years of practice, The Joint Commission recommended that hospitals implement nurse residency (NR) programs to transition new graduate nurses into practice settings.6 The Joint Commission defined the residency period as “planned, comprehensive periods of time during which nursing graduates can acquire the knowledge and skills to deliver safe, quality care that meets defined (organizational or professional society) standards of practice.”6(pp5,6) The recently published Institute of Medicine (IOM) report, The Future of Nursing, strongly recommends implementation of 1-year new graduate nurse transition programs as well.6

All hospitals provide some type of program to transition new graduate nurses into the clinical setting, although these programs vary significantly in quality and length. Robust transition programs that span 6 months or more have demonstrated positive outcomes such as improvement in work satisfaction, employee engagement, self-confidence, commitment to the organization, time management skills, relations with team members, clinical leadership skill, critical thinking skills, role socialization, absenteeism, and clinical competence.7-16 In general, organizations that have implemented successful transition programs have seen significantly reduced turnover rates among new graduate nurses, resulting in a positive return on investment.17-19 These results have encouraged organizations to develop similar transition programs for newly certified APRNs.

The human capital and organizational resources required to develop and maintain a robust, high-quality transition program can be significant. It is important that nursing leaders evaluate what characteristics of a residency or fellowship program contribute to positive outcomes. Evidence suggests that extended new graduate nurse transition programs significantly increase retention rates in organizations. In addition, programs that include supplemental activities to improve clinical skills, critical thinking/clinical reasoning skills, time management, and delegation skills have demonstrated positive results. New graduate nurses who have the opportunity for peer-to-peer interaction, debriefing and self-reflection, and mentor support in their programs perceive their transition more positively when compared with those who have not had similar support. Integration of the Quality and Safety Education for Nurses ( competencies to include patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics is increasingly important for all practicing RNs and should be included as part of a residency or fellowship curriculum. The ability of RNs to function as members of an interprofessional healthcare team is critical. Newly certified APRNs have similar development needs, although the required transition time to develop clinical competence may vary depending on previous clinical experience.

The Magnet Recognition Program’s new criteria underscore the importance of supporting RNs and APRNs with evidence-based residency or fellowship transition programs. Organizations must show that they “facilitate the effective transition of RNs and APRNs into the work environment” and provide supporting evidence of how this is accomplished. These requirements advance the Magnet Recognition Program’s mission to compel higher levels of evidence-based standards guiding clinical care delivery, organizational performance, and workforce practices. They support the IOM’s Future of Nursing recommendations to implement NR programs that enable nurses to respond effectively to rapidly changing healthcare settings and an evolving healthcare system. Magnet organizations continue to lead the way to remove barriers to ensure nurses are well positioned to drive exceptional performance and results.

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1. American Nurses Credentialing Center. Magnet Application Manual. Silver Spring, MD: American Nurses Credentialing Center; 2014.

2. Kramer M. Reality Shock: Why Nurses Leave Nursing. St. Louis, MO: CV Mosby; 1974.

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