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Nurse residency programs

Evidence Rating

Some Evidence

Health Factors

Nurse residency programs are intended to ease the transition from nursing student to practicing nurse, similar to the first year of a physician residency program (). Programs vary in design and length, but often include an orientation period, a relationship with a more experienced nurse serving as a mentor or preceptor, and guided practice toward independence ().

Expected Beneficial Outcomes (Rated)

  • Increased nurse retention

  • Increased job satisfaction

  • Increased job skills

Other Potential Beneficial Outcomes

  • Reduced stress

Evidence of Effectiveness

There is some evidence that nurse residency programs increase retention, job satisfaction (, , , , , IOM-Nursing 2010), and nursing skills among newly licensed nurses (, , , ). Additional evidence is needed to confirm effects and determine which elements of residency programs are most effective ().

Residency programs appear to improve retention in pediatric hospitals (), religiously affiliated hospitals (Pine 2007), and hospitals with Magnet status (). Nurse residency programs may also reduce stress and anxiety for new nurses (, ). Programs may increase nursing knowledge and skills in both urban and rural areas (), though new nurses in rural residency programs report lower levels of stress and greater job satisfaction than peers in urban areas (). Nurse residency programs may also improve nurses’ organizational commitment () and increase participants’ clinical leadership skills over time ().

Some experts suggest that allocating appropriate resources, creating partnerships, evaluating efforts, and having a sustainability plan contribute to effective residency programs (). Securing the support of stakeholders such as deans and faculty of nursing schools, chief nursing officers, and government and philanthropic entities (), and appointing a nurse residency coordinator may also contribute to program success (). Mentorship in nurse residency programs may contribute to stress reduction among participants (); new nurses may receive mentor support after program completion ().

Cost is often cited as a barrier to starting nurse residency programs (). However, some studies suggest that by increasing retention of new nurses, nurse residency programs avert the costs of hiring replacement nurses (, , ).

Impact on Disparities

No impact on disparities likely

Implementation Examples

Nurse residency programs are increasingly common across the country; one study estimates that over one-third of US hospitals had programs in place as of 2011 (). As of 2017, 25 nurse residency programs have been accredited by the Commission on Collegiate Nursing Education (CCNE), including 10 programs at US Department of Veteran Affairs (VA) medical centers (CCNE-ANRP). The University of Colorado Hospital’s Post-Baccalaureate Nurse Residency Program was the first program to receive CCNE accreditation; accreditation was received in 2009 (CCNE-ANRP).

The University HealthSystem Consortium and the American Association of Colleges of Nursing (UHC/AACN) Nurse Residency Program partner to operate yearlong residencies at 187 practice sites in 32 states (UHC-AACN). Hospitals and health systems may develop their own programs or purchase the rights to use established nurse residency training systems such as Versant New Graduate RN Residency (Versant) or the National Council of State Boards of Nursing (NCSBN) Learning Extension’s Transition to Practice program (NCSBN Learning extension-TTP). 

Implementation Resources

CNHS-NRP - Children’s National Health System (CNHS). Nursing residency program (NRP).

Citations - Evidence

* Journal subscription may be required for access.

IOM-Nursing 2010 - Institute of Medicine (IOM). The future of nursing: Leading change, advancing health. Washington, DC: National Academies Press; 2010.

Anderson 2012* - Anderson G, Hair C, Todero C. Nurse residency programs: An evidence-based review of theory, process, and outcomes. Journal of Professional Nursing. 2012;28(4):203-12.

Hillman 2011* - Hillman L, Foster RR. The impact of a nursing transitions programme on retention and cost savings. Journal of Nursing Management. 2011;19(1):50–6.

Pine 2007 - Pine R, Tart K. Return on investment: Benefits and challenges of baccalaureate nurse residency program. Nursing Economics. 2007;25(1):13-8, 39.

Pittman 2013* - Pittman P, Herrera C, Bass E, Thompson P. Residency programs for new nurse graduates: How widespread are they and what are the primary obstacles to further adoption? The Journal of Nursing Administration. 2013;43(11):597–602.

Edwards 2015* - Edwards D, Hawker C, Carrier J, Rees C. A systematic review of the effectiveness of strategies and interventions to improve the transition from student to newly qualified nurse. International Journal of Nursing Studies. 2015;52(7):1254–1268.

Rush 2013* - Rush KL, Adamack M, Gordon J, Lilly M, Janke R. Best practices of formal new graduate nurse transition programs: An integrative review. International Journal of Nursing Studies. 2013;50(3):345–356.

Harrison 2014* - Harrison D, Ledbetter C. Nurse residency programs: Outcome comparisons to best practices. Journal for Nurses in Professional Development. 2014;30(2):76–82.

Al-Dossary 2014* - AL-Dossary R, Kitsantas P, Maddox PJ. The impact of residency programs on new nurse graduates’ clinical decision-making and leadership skills: A systematic review. Nurse Education Today. 2014;34(6):1024–1028.

Bratt 2013* - Bratt MM. Nurse residency program: Best practices for optimizing organizational success. Journal for Nurses in Professional Development. 2013;29(3):102–110.

Chappell 2015* - Chappell KB, Richards KC. New graduate nurses, new graduate nurse transition programs, and clinical leadership skill: A systematic review. Journal for Nurses in Professional Development. 2015;31(3):128–137.

Goode 2013* - Goode CJ, Lynn MR, McElroy D, Bednash GD, Murray B. Lessons learned from 10 Years of research on a post-baccalaureate nurse residency program. Journal of Nursing Administration. 2013;43(2):73–79.

Bratt 2014* - Bratt MM, Baernholdt M, Pruszynski J. Are rural and urban newly licensed nurses different? A longitudinal study of a nurse residency programme. Journal of Nursing Management. 2014;22(6):779–791.

Rosenfeld 2016* - Rosenfeld P, Glassman K. The long-term effect of a nurse residency program, 2005-2012: Analysis of former nurse residents. Journal of Nursing Administration. 2016;46(6):336–344.

Letourneau 2015* - Letourneau RM, Fater KH. Nurse residency programs: An integrative review of the literature. Nursing Education Perspectives. 2015;36(2):96–101.

Bratt 2012* - Bratt MM, Felzer HM. Predictors of new graduate nurses’ organizational commitment during a nurse residency program. Journal for Nurses in Staff Development. 2012;28(3):108-119.

Greene 2016* - Greene MA, Warren JI, Perkins S. Transforming nursing organizations through implementation of nurse residency programs. Journal for Nurses in Professional Development. 2016;32(5):267-268.

Kram 2016* - Kram SL, Wilson J. Nurse residency program attracts and retains novice nurses. Nursing. 2016;46(2):15-16.

Goode 2016* - Goode CJ, Reid Ponte P, Sullivan Havens D. Residency for transition into practice: An essential requirement for new graduates from basic RN programs. JONA: The Journal of Nursing Administration. 2016;46(2):82-86.

Cochran 2017* - Cochran C. Effectiveness and best practice of nurse residency programs: A literature review. MEDSURG Nursing. 2017;26(1):53-63.

Trepanier 2017* - Trepanier S, Mainous R, Africa L, Shinners J. Nursing academic-practice partnership: The effectiveness of implementing an early residency program for nursing students. Nurse Leader. 2017;15(1):35-39.

Pasila 2017* - Pasila K, Elo S, Kääriäinen M. Newly graduated nurses’ orientation experiences: A systematic review of qualitative studies. International Journal of Nursing Studies. 2017;71:17-27.

Citations - Implementation Examples

* Journal subscription may be required for access.

CCNE-ANRP - American Association of Colleges of Nursing (AACN). CCNE accredited nurse residency programs.

Pittman 2013* - Pittman P, Herrera C, Bass E, Thompson P. Residency programs for new nurse graduates: How widespread are they and what are the primary obstacles to further adoption? The Journal of Nursing Administration. 2013;43(11):597–602.

UHC-AACN - American Association of Colleges of Nursing. The University HealthSystem Consortium and the American Association of Colleges of Nursing (UHC/AACN) Nurse Residency Program.

Versant - Versant. Versant new graduate RN residency.

NCSBN Learning extension-TTP - National Council of State Boards of Nursing (NCSBN) Learning Extension. Transition to practice (TTP) program.

Date Last Updated

May 11, 2017