meets defined (organization or professional society) standards of practice. This recommendation was most recently endorsed by the 2009 Carnegie study on the nursing profession (Benner et al., 2009). Versant24 and other organizations have launched successful transition-to-practice residency programs for nurses in recent years, while the University HealthSystem Consortium (UHC) and the American Association of Colleges of Nursing (AACN) have developed a model for postbaccalaureate nurse residencies (Goode and Williams, 2004; Krugman et al., 2006; Williams et al., 2007). The residency model developed by the UHC/AACN addresses needs identified by new nursing graduates and organizations that employ them. These needs included developing skills in ways to organize work and establish priorities; communicate with physicians, other professionals as well as patients and their families. In addition, nurses and employers indicated the need for nurses to develop leadership and technical skills in order to provide quality care (Beecroft et al., 2001, 2004; Halfer and Graf, 2006). As an example, in one hospital, the total cost for a residency program is $93,100, with a cost per resident of $2,023.91. Given that the average cost of replacing just one new graduate RN is $45,000, a return on investment can be significantly dependent on a reduction in RN turnover (AAN, 2010a).

The AACN has also adopted accreditation standards for these programs (AACN, 2008). Meanwhile, the National Council of State Boards of Nursing, after reviewing the evidence in favor of nursing residencies, has developed a regulatory model for transition-to-practice programs, recommending that state boards of nursing enforce a transition program through licensure (NCSBN, 2008).

Residencies Outside of Acute Care

Residency programs are supported predominantly in hospitals and larger health systems, with a focus on acute care. This has been the area of greatest need since most new graduates gain employment in acute care settings, and the proportion of new hires (and nursing staff) that are new graduates is rapidly increasing (Kovner et al., 2007). It is essential, however, that residency programs outside of acute care settings be developed and evaluated. Chapter 2 documents the demographic changes on the horizon; the shift of care from hospital to community-based settings; and the need for nursing expertise in chronic illness management, care of older adults in home settings, and transitional services. In this context, nurses need to be prepared for new roles outside of the acute care setting.

24

Versant is a nonprofit organization that provides, supervises, and evaluates nurse transition-to-practice residency programs for children’s and general acute care hospitals. See http://www.versant.org/item.asp?id=35.



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