The Effect of Nurse Residency Structure on Novice Navy Nurse Transition to Practice

Background and purpose. Nurse Residency Programs (NRPs) have been shown to enhance transition experiences of new graduate nurses by influencing competence, confidence, job satisfaction, and intent to stay. NRPs administered across Navy Medicine treatment facilities currently have different operating procedures and program lengths, and it is currently unknown how variations in these programs affect transition experiences and outcomes of novice nurses. The purpose of this study was to determine how varying structural aspects of Navy NRPs affect the transition experiences, competence, perceived quality of care, and intent to stay of novice nurse participants.

Methods. A cross-sectional, correlational design, utilizing a web-based survey mode was used. The sample included all Navy Nurse Corps Officers who hold the ranks of Ensign and Lieutenant Junior Grade and completed a NRP in the last two years. The 120-item survey took approximately 60 minutes to complete and was designed to collect data on the following: (1) individual characteristics (2) organizational factors as measured by the Practice Environment Scale of the Nurse Work Index [PES-NWI]) (3) NRP structural characteristics (4) transition experience as measured by the Casey-Fink graduate Nurse Experience Survey [CFGNES], (5) nurse competence as measured by the Nurse Competence Questionnaire [NCQ], (6) intent to stay, and (7) perception of quality of care provided. Analysis was conducted using linear and logistic regression models. The level of significance was set at p <0.05.

Findings. Transition experience was positively affected by the race of the individual, specifically African American, the accession source for commissioning into the Navy (Nurse Candidate Program and the Medical Enlisted Commissioning Program), and the practice environment. Significant structural aspects of the NRP attended which positively affected transition experiences were: fewer number of preceptors assigned to each nurse resident and the hospital type in which the NRP was completed. The practice environment was a predictor of positive transition outcomes (competence, organizational commitment, and perceived quality of care). However fewer preceptors predicted lower organizational commitment.

Discussion. This study demonstrated both direct and mediated effects of NRP structure variation on outcomes indicative of a successful transition in novice Navy Nurses, specifically competence, perceived quality of care provided, and organizational commitment.

Conclusions. This study highlights items that may be important to a successful Naval nurse transition to practice and positive transition outcomes. The practice environment, as demonstrated in this study, plays a significant role in transition to practice. Many sites may have a highly structured and long-standing Nurse Residency Program, but without a healthy practice environment, the transition experience may still be affected. Likewise, facilities with healthy practice environments often are supportive of training initiatives, such as NRPs. Clinical leadership that creates a healthy work environment has a greater influence of new nurse transition than the structure of the NRP.