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1 JNSD Journal for Nurses in Staff Development & Volume 26, Number 4, 142Y 149 & Copyright B 2010 Wolters Kluwer Health Lippincott Williams &Wilkins A Retention Strategy for Newly Graduated Nurses An Integrative Review of Orientation Programs Mihyun Park, MSN, RN ƒ Cheryl B. Jones, PhD, RN, FAAN To address nurse recruitment and retention issues, hospitals have increased the number of newly graduated nurses in their hiring pools and have simultaneously established orientation programs for those nurses. Structured orientation programs facilitate newly graduated nurse transition from novice to advanced beginner. The outcome of these programs is twofold: First, they promote the confidence and competency level of new nurses in providing patient care, and second, they increase nurse retention. This literature review presents the most useful interventions used in the programs that reported positive affects on new nurses. The U.S. Department of Labor, Bureau of Labor Statistics (2005) predicts that the need for nurses will increase 27% between 2004 and The current shortage of registered nurses (RNs) is due in part to the increasing age of the nursing workforce, as well as the fact that fewer younger nurses are entering the field. Although the enrollment in baccalaureate programs in nursing continues to increase (American Association of Colleges of Nursing, 2007), the increase is not enough to solve the nursing shortage. Consequently, organizations have responded by competitively increasing the recruitment of new graduate nurses in their hiring pools (American Organization of Nurse Executives, 2002). Although these new graduates fill vacancies, hiring new graduate nurses also generates problems. The high turnover of newly graduated nurses is emerging as one of the problems that hospitals need to Mihyun Park, MSN, RN,isDoctoralStudent,SchoolofNursing,University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Cheryl B. Jones, PhD, RN, FAAN, is Associate Professor, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. ADDRESS FOR CORRESPONDENCE: Mihyun Park, MSN, RN, School of Nursing, University of North Carolina at Chapel Hill, Carrington Hall, CB 7460, Chapel Hill, NC 27599Y7460 ( mihyunp@ .unc.edu). The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this educational activity. DOI: /NND.0b013e31819aa130 address. In a current survey of newly graduated nurses in 35 states (Kovner et al., 2007), approximately 13% of responders had changed principal jobs after 1 year, and 37% reported that they planned to change jobs in the near future. Nursing literature reported that poor training, a lack of support systems, and the stress related to the intense working situation and high patient acuity are the main reasons nurses are leaving during their first year after graduation (Bowles & Candela, 2005; Mathews & Nunley, 1992; Patrick, 2000). Furthermore, a high turnover and an influx of new graduates have led to a higher proportion of inexperienced nurses in direct patient care, which may not only be traumatic for the new professional nurse but may also threaten patient safety (Santucci, 2004). Therefore, for patient safety and the well-being of new nurses, hospitals must make efforts to provide safe and effective environments that foster the integration of graduate nurses into their systems. An effective orientation program is one strategy that may address these concerns. The goal of an orientation program is to prepare new staff nurses to be confident and to provide competent and safe patient care. Benner_s (1984) From Novice to Expert framework is relevant to an orientation program. Benner applied the Dreyfus model of skill development to nursing and concluded that nurses pass through five stages of skill development: novice, advanced beginner, competent, proficient, and expert (Benner, 1984). These different levels are accompanied by changes in three aspects of skill performance: (a) a change from confidence about abstract principles to the application of concrete experience, (b) a change in the learner_s awareness of the demand situation as a whole, and (c) a change from observer to active performer (Benner, 1984). Nursing students entering the clinical area can be characterized as novices because their knowledge is limited, they tend to be rather inflexible, and they are inexperienced in actual clinical situations. Successful orientation programs should be those in which teaching and learning are provided to help the new graduate nurse make the transition from novice to advanced beginner who can demonstrate acceptable performance and cope in real situations with a preceptor/mentor (Benner, 1984) July/August 2010

2 Some healthcare systems have recently developed and reported orientation programs that have improved the confidence, competency, and retention of newly graduated nurses. However, the research on the effects of these programs is limited by small-size studies and the experiences of single institutions. There are few systematic literature reviews focusing on orientation programs for newly graduated nurses. The purpose of this study was to present an integrative review of the research that was conducted to explore the effects of orientation programs for newly graduated nurses on their confidence, competency, and retention. Recommendations also are made based on an analysis of programs reported as effective in the literature between 1990 and METHODS This review study followed Cooper_s (1989) five-stage process for the integrative literature review: (a) problem formulation, (b) data collection, (c) evaluation of data points, (d) data analysis and interpretation, and (e) presentation of results. This study collected, synthesized, and analyzed published research conducted on orientation programs that train newly graduated nurses using various methods for increasing confidence, competency, and retention. Orientation programs in nursing literature included internships, residencies, and structured orientation programs. Studies were limited to research conducted in U.S. hospitals. Key words used in the search process were new RN graduate, confidence, competency, retention, andorientation program. This review included only English-language research studies published between 1990 and This review began with a search of multiple library databases such as PubMed (MEDLINE), the Cumulative Index to Nursing and Allied Health (CINAHL), and Institute for Scientific Information (ISI) Web of Knowledge. Then, through the Google and Google Scholar Internet search engines, the search expanded to include published reports, white papers, and working papers that were published through channels other than professional and research journals. A total of 99 relevant citations were retrieved from library databases (n = 92) and the Internet (n = 7). Examination of the published abstracts and studies resulted in the elimination of studies that did not match the project inclusion criteria (n = 53), leaving 46 articles for potential inclusion in the study. Research articles meeting the inclusion criteria were then rated using a modified version of the research quality checklist developed by Beck (2001). The checklist included the following items: (a) author expertise, (b) type of sample, (c) reliability and validity of measures, (d) time dimensional design, (e) research design, and (f) research analysis. The checklist used in this study included these items and also items pertaining to new RN orientation programs to determine whether the studies reported information on the outcomes of new RN graduate orientation programs. Through a second level of review incorporating these quality criteria, the researcher excluded several additional articles (n = 29) for one or more of the following reasons: (a) Studies did not examine program outcomes, (b) studies reported programs for nursing students rather than nursing graduates, (c) studies included both newly graduated nurses and experienced nurses as participants, and (d) studies obtained a low score on the quality checklist. The final sample included 17 published reports. RESULTS Table 1 summarizes the research reviewed in this study and the reported outcomes of orientation programs, including confidence, competency, and retention. This review included nine articles evaluating internship programs, five studies related to residency programs, and three structured orientation programs (see Table 1). Of those programs, four residency programs were designed as postbaccalaureate programs (Altier & Krsek, 2006; Herdrich & Lindsay, 2006; Krugman et al., 2006; Rosenfeld et al., 2004), whereas the other programs were orientation programs for all new RNs. All articles dealt with hospital-based programs. Four of these articles focused on internship programs in specialty areas including critical care, neuroscience, and the float pool. Confidence Seven articles of reviewed studies reported improved selfconfidence of new graduates in delivering patient care. The studies included five internship programs, one residency program, and one extended orientation program (see Table 1). To examine new RNs_ confidence, these studies asked program participants to rate their level of confidence on a rating scale (Beecroft et al., 2001; Blanzola et al., 2004; Crimlisk et al., 2002; DiIorio et al., 2001; Squires, 2002) or participants_ confidence about their ability was extracted from logs and feedback from the preceptor (Herdrich & Lindsay, 2006; Messmer et al., 2004). These studies reported improved self-confidence of new RNs in delivering patient care after completing the program. In particular, several studies revealed that the internship programs in specialty areas increased the confidence of new nurses in delivering patient care. Evaluating the impact of an internship program in a float pool over time, Crimlisk et al. (2002) reported that 100% of new RN respondents completing the program believed that they were able to provide safe, competent care in the areas of assessment skills, technology, communication skills, medication administration, and critical-thinking skills. Journal For Nurses in Staff Development 143

3 TABLE 1 The Summary of Program Outcomes Articles Type Setting Sample (n) Period (months) Outcomes Confidence Competency Retention (%), (T/V) [Comparison] Beecroft, Kunzman, and Krozek (2001) Internship A children_s hospital (+) Y 86 [63] (T = 14 [36]) Blanzola, Lindeman, and King (2004) Internship A U.S. Navy hospital 18 4 (+) Peer evaluation (+) Y Boyer (2005) Internship Hospitals Y 2.5 Y Peer evaluation (+) 93 [75] (V = 0 [20]) Newhouse, Hoffman, Suflita, and Hairston (2007) Internship A hospital Y Y 90.1 [86.7] Owens et al. (2001) Internship Hospitals 75 2 Y Y 88 (V = 6 [7.3]) Collins and Thomas (2005) Internship Step-down units 13 5 Y BKAT (+) 92 Crimlisk, McNulty, and Francione (2002) Internship A float pool in a hospital 23 4Y5 (+) Y 96 DiIorio, Price, and Becker (2001) Internship A neuroscience clinical area 54 6 (+) BKAT (+) Y Messmer, Jones, and Taylor (2004) Internship An intensive care unit (+) BKAT (+) Y Altier and Krsek (2006) Residency University hospitals Y Y 87 Herdrich and Lindsay (2006) Residency Hospitals 14 6Y12 (+) BKAT (+), CT (+) 90 (V = 1) Keller, Meekins, and Summers (2006) Residency A Magnet hospital Y Y 89.2 Krugman et al. (2006) Residency Hospitals Y 12 Y Y (T = 8 [20Y40]) Rosenfeld, Smith, Iervolino, and Bowar-Ferres (2004) Residency A hospital Y Y 76 Almada, Carafoli, Flattery, French, and McNamara (2004) Preceptorship A community hospital 40 3 Y Y 93 [25] (V =3[10.2]) Marcum and West (2004) A structured orientation A hospital 20 3 Y CT (+) 89 Squires (2002) An extended orientation A community hospital 9 2 (+) Y 77 [33] Note. T/V = Turnover rate/vacancy rate; BKAT = Basic Knowledge Assessment Test; CT = critical thinking; (+) = improvement July/August 2010

4 Furthermore, DiIorio et al. (2001) reported that new RNs in a neuroscience internship program believed the program enabled them to serve as a resource for other nurses unfamiliar with neuroscience patient care and for other new graduates in neuroscience nursing; nurses in this program also showed increased mean scores on the Neuroscience Nursing Self-efficacy Scale by the end of the program. Interns in a Shadow-A-Nurse intensive care unit internship expressed in their logs that the program was very beneficial in building self-confidence (Messmer et al., 2004). Competency Seven studies reported the effects of completing an orientation program on the competency of the new RN graduates. Nursing literature defines competency as the possession of knowledge, practice skills, attitudes, and the ability to perform to a prescribed standard (While, 1994). Professional educators also identified criticalthinking ability in delivering patient care as the core competency that new RNs should acquire (Marcum & West, 2004). In evaluating competency, researchers not only tested the new nurses but also obtained feedback from participants such as nurse educators, nursing managers, peer nurses, and/or preceptors. For competency content, these studies focused on the knowledge and critical thinking of newly graduated nurses. Four studies administered the Basic Knowledge Assessment Test to evaluate the effect of the orientation programs in competency as knowledge (Collins & Thomas, 2005; DiIorio et al., 2001; Herdrich & Lindsay, 2006; Messmer et al., 2004) and reported improvement in test scores between the beginning and the end of the program. Two articles reported that the programs improved the critical-thinking ability of new graduates using several instruments, including the Critical Thinking Inventory (Herdrich & Lindsay, 2006), the Watson-Glaser critical thinking appraisal (Herdrich & Lindsay, 2006), and the Performance Based Development System (Marcum & West, 2004). Peer nurses and managers also evaluated the competency of new graduates as improved after completion of the program (Blanzola et al., 2004; Boyer, 2005). Positive outcomes in new RN competency were also reported in critical care. Two studies, which examined the outcomes of critical care internship programs designed and implemented to assist new nurses in making the transition into a critical care nurse role, reported that nurses demonstrated increased competency in critical care nursing skills and improved self-confidence after completing the program (DiIorio et al., 2001; Messmer et al., 2004). Retention In 15 studies, retention of new nurses was reported as the percentage of program participants remaining employed at the organization at 12 and 24 months after completing an orientation program (see Table 1). The results showed increased retention rates by comparing data from treatment and control groups, before and after programs, or with national trends. The programs reported retention rates ranging from 76% to 96%. The rates were excellent when compared with the baseline rate of each program, ranging between 25% and 75%, and to national data of a 64% retention rate for new RNs in their first year of practice (Nursing Executive Center, 2002). Furthermore, several studies reported a decreased turnover rate of newly graduated nurses after participation in the programs (Beecroft et al., 2001; Krugman et al., 2006) and a decreased vacancy rate in the institutions after implementation of the programs (Almada et al., 2004; Boyer, 2005; Herdrich & Lindsay, 2006; Owens et al., 2001; see Table 1). Two internship programs used the Anticipated Turnover Scale to measure new nurses_ perception of the possibility of voluntarily terminating the position (Beecroft et al., 2001; Newhouse et al., 2007). At 6 months, program interns reported a significantly lower score on the Anticipated Turnover Scale or a decreased possibility of leaving their jobs when compared with their counterparts in the control group. Review of Programs The various programs reviewed produced positive outcomes in nurse confidence, competency, and retention. From these programs, common components, such as the length of a program, structured teaching methods, preceptorship, support system, and evaluation, were examined to help determine effective program attributes (see Table 2). As Table 1 shows, programs varied greatly in length, ranging from 6 weeks to 1 year. All residency programs (n = 5) and internship programs (n = 2) were conducted over a 1-year time frame. Six studies reported program duration of less than 3 months. Eleven of the 17 reviewed studies reported programs that lasted between 4 and 12 months (see Table 1). When an orientation program was the extension of an existing program or focused in a specialty area, the program duration tended to cover for shorter time periods (Almada et al., 2004; Marcum & West, 2004; Messmer et al., 2004; Squires, 2002). All reviewed programs consisted of two main parts: (a) classroom learning and (b) clinical experience with preceptorship. The classroom learning component not only included general hospital orientation requirements but also dealt with various topics related to competencybased practice, including nursing assessment and intervention, pathophysiology, pain management, quality improvement, medication administration, pain management, and so on. Postbaccalaureate residency program Journal For Nurses in Staff Development 145

5 TABLE 2 The Summary of Programs Contents Programs Articles Length 1 year I, R Altier and Krsek (2006), Beecroft et al. (2001), Herdrich and Lindsay (2006), Keller et al. (2006), Krugman et al. (2006), Newhouse et al. (2007), Rosenfeld et al. (2004) 4 to 6 months I Blanzola et al. (2004), Collins and Thomas (2005), Crimlisk et al. (2002), DiIorio et al. (2001) Less 3 months I, S Almada et al. (2004), Boyer (2005), Marcum and West (2004), Messmer et al. (2004), Owens et al. (2001), Squires (2002) Program components Classroom learning I, R, S All reviewed articles Teaching methods Clinical conference I Blanzola et al. (2004), Boyer (2005), DiIorio et al. (2001) Seminar I, R Blanzola et al. (2004), DiIorio et al. (2001), Krugman et al. (2006), Newhouse et al. (2007) Group discussion R, S Blanzola et al. (2004), Herdrich and Lindsay (2006), Keller et al. (2006), Krugman et al. (2006), Owens et al. (2001), Squires (2002) Computer-based training S Blanzola et al. (2004), Crimlisk et al. (2002), Keller et al. (2006), Squires (2002) Case study I, R, S Collins and Thomas (2005), Crimlisk et al. (2002), DiIorio et al. (2001), Herdrich and Lindsay (2006), Krugman et al. (2006), Marcum and West (2004), Owens et al. (2001), Squires (2002) Clinical experiencevpreceptor I, R, S All reviewed articles Rotation I, R, S Almada et al. (2004), Beecroft et al. (2001), Blanzola et al. (2004), Collins and Thomas (2005), Krugman et al. (2006), Marcum and West (2004), Newhouse et al. (2007) Rounding I Blanzola et al. (2004), DiIorio et al. (2001) Preceptorship Preceptorship program All reviewed articles Training program I, S, R Almada et al. (2004), Boyer (2005), Keller et al. (2006), Krugman et al. (2006), Marcum and West (2004), Messmer et al. (2004), Owens et al. (2001) Criteria I, S, R Collins and Thomas (2005), Krugman et al. (2006), Marcum and West (2004), Messmer et al. (2004), Owens et al. (2001) Support system Support personnel Program director, coordinator I, R Altier and Krsek (2006), Blanzola et al. (2004), Collins and Thomas (2005), Krugman et al. (2006), Messmer et al. (2004), Rosenfeld et al. (2004) Professional development staff S, R Almada et al. (2004), Collins and Thomas (2005), Squires (2002 CNS/NP, clinical educator, facilitator I, R Altier and Krsek (2006), Blanzola et al. (2004), Boyer (2005), Crimlisk et al. (2002), Krugman et al. (2006), Marcum and West (2004), Newhouse et al. (2007), Owens et al. (2001) Leadership support I, R Blanzola et al. (2004), Boyer (2005), Collins and Thomas (2005), Crimlisk et al. (2002), Keller et al. (2006), Newhouse et al. (2007), Rosenfeld et al. (2004) (continues) July/August 2010

6 TABLE 2 Continued Support program Contents Programs Articles Debriefing/Self-care session I, R Beecroft et al. (2001), Keller et al. (2006), Messmer et al. (2004) Mentorship I, R, S Beecroft et al. (2001), Blanzola et al. (2004), Boyer (2005), Herdrich and Lindsay (2006), Krugman et al. (2006), Newhouse et al. (2007), Rosenfeld et al. (2004) Evaluation of program Timeline I, R, S Almada et al. (2004), Beecroft et al. (2001), Collins and Thomas (2005), Crimlisk et al. (2002), Herdrich and Lindsay (2006), Krugman et al. (2006), Marcum and West (2004), Squires (2002) Tools I, R, S All reviewed articles Models I DiIorio et al. (2001) Note. CNS = clinical nurse specialist; I = internship; NP = nurse practitioner; R = residency; S = structured orientation program. curricula contained three additional parts: leadership, evidence-based patient outcomes, and professional role (Altier & Krsek, 2006; Krugman et al., 2006). During classroom activities, the programs used various teaching methods and traditional lectures by educators. The teaching methods mainly cited in the literature included conferences, seminars, group discussion, case studies, and computer-based training (see Table 2). In particular, the studies suggested that the teaching methods such as conferences, seminars, and group discussion encouraged mutual learning among new RNs through sharing clinical experiences and were more effective for developing critical thinking than were the traditional lecture format. Crimlisk et al. (2002) also reported the creation of an internship program that used the case study format. They reported the following benefits of the case study approach: (a) sharing clinical experiences, (b) identifying critical thinking, (c) guiding clinical decision making, (d) nurturing professional clinical practice, and (e) facilitating transition into the RN role. The studies evaluated that the use of a one-on-one preceptorship contributed to developing the competencies of new graduates and to enhancing their clinical experiences. Also, key to a successful preceptorship was the preparation of a qualified preceptor. Therefore, a preceptor training program was developed, as well as criteria for the selection of preceptors (see Table 2). The training program focused on building characteristics believed to be important for a preceptor, including competency in clinical practice, strong communication and leadership skills, and interest in professional development. Furthermore, to foster new RNs_ competence in various clinical experiences, most of the programs planned rotations through several clinical areas (e.g., medical, surgical and critical care areas, outpatient clinic, or emergency). Two articles introduced the idea of presenting and attending rounds as one of the teaching methods in clinical practice (Blanzola et al., 2004; DiIorio et al., 2001). All studies described various administrative systems needed to support the program and encourage the transition of new RNs into the organization. The systems reported focused on both personnel and programs. Within support personnel, three essential roles were identified: (a) a program coordinator who serves as a main resource for implementing and maintaining the program, (b) a program facilitator or clinical expert nurse who promotes continuous learning and development through regular contact with new graduates participating in the program, and (c) nurse managers on units who provide leadership on clinical, staffing, and administrative issues and who evaluate the progress of new graduates. Two program supports were reported as important aspects of orientation programs: peer group support (e.g., debriefing/self care session) and mentorship by senior leaders. A peer group discussion enabled new nurses to share the problems or difficulties with peers who were experiencing similar stress and provided strategies to deal with them. The use of mentorship as a support program was reported in seven articles. Three of the seven articles described a mentor as one of the roles of the preceptor (Boyer, 2005; Herdrich & Lindsay, 2006; Rosenfeld et al., 2004), whereas the other four articles reported that mentorship was a separate program altogether (Beecroft et al., 2001; Blanzola et al., 2004; Krugman et al., 2006; Newhouse et al., 2007). All reviewed programs used several methods and tools for program evaluation, including the use of multiple data Journal For Nurses in Staff Development 147

7 resources and qualitative and quantitative data gathered from preceptors, nursing managers, staff, and new graduates. Program outcomes also varied but generally focused on retention, confidence, competency (e.g., critical thinking and knowledge), communication, satisfaction, and cost effectiveness. Program coordinators were important in the continuous evaluation of orientation program processes, content, and outcomes. Guiding and tracking learning and performance provided consistency across the programs and helped to improve them. DISCUSSION The findings of this study provide information on the effect of orientation programs on new RNs_ confidence, competency, and retention. The reviewed studies suggest that the orientation programs are successful in improving new RNs_ confidence in caring for patient and in enhancing their competencies such as knowledge and critical-thinking skills in the clinical environment. By doing so, these programs may encourage new graduates to stay and to participate in a supportive system. Furthermore, as Benner_s (1984) model would suggest, this review shows that an orientation program with certain characteristicsvthat is, structured teaching methods, clinical experiences with qualified preceptors, and support systemsvfosters the transition of new RNs from novices to advanced beginners. Reviewed studies reported a wide variability in the time frames of orientation programs, with program length ranging from 6 weeks to 1 year. Several studies (n = 7) reported successful results in programs of 1-year length, and the 1-year time frame is used in the National Post-Baccalaureate Graduate Nurse Residency Program, a partnership between the University Health Systems Consortium and the American Association of Colleges of Nursing. This program is based on the premise that transition into practice is not completed until 9 to 12 months after starting a job and that a 1-year time frame for the successful transition of new graduates is reasonable (Krugman et al., 2006). Given the variability in program length reported in the literature, more research is needed to determine the most effective length of orientation programs for new RN graduates. An extended program length, however, also poses additional costs. For example, several studies reported benefits resulting from the recruitment and retention of newly graduated nurses, although these programs incurred additional training costs (Beecroft et al., 2001; Krugman et al., 2006; Pine & Tart, 2007). Beecroft et al. (2001) calculated the return on investment (ROI) to determine the cost effectiveness of their 1-year program and reported an ROI of 67.3%, meaning that the program not only paid for itself but also saved money. Pine and Tart (2007) also reported the cost effectiveness of a 1-year residency program with an ROI of %. Further, Krugman et al. (2006) reported that the average budget for managing the 1-year National Post-Baccalaureate Graduate Nurse Residency Program was less than the costs to advertise and recruit two nurses. Although this review did not examine the cost effectiveness of newly graduated RN orientation program per se, these studies suggest that an extended program length may be worth the added costs. This review also revealed that the specialized orientation programs, which trained newly graduated nurses to work in critical care units, had a positive impact on their confidence, competency, and retention. In an effort to deal with the urgent nursing shortage, current healthcare systems increasingly recruit newly graduated nurses for highly specialized areas that once were available only to experienced nurses. Therefore, it would be meaningful to conduct further research to evaluate the impact of specialty orientation programs on new nurse retention and patient safety in critical care units. Many reviewed studies used a descriptive research design. That is, the authors described interviews with participants in a program or the studies did not have a control group with which to compare the intern or resident group. Therefore, the design used in the primary research may limit this study_s ability to accurately capture the extent of new RN orientation program impact. However, the authors tried to overcome this limitation by examining data from similar hospital programs and analyzing differences and similarities between the programs to present more comprehensive information and recommendations. This study has several other limitations that are important to address. The focus of this integrative review was on hospital-based new RN orientation programs. However, several articles related to new RN orientation programs in other settings, such as long-term care, were excluded during the review process. Future reviews of this nature are needed to compare and contrast new RN orientation programs across types of settings to better inform future program development. Furthermore, this review was restricted to programs focusing on outcomes in only three areasvconfidence, competency, and retention. By restricting the focus in this way, other important outcomes of new RN orientation programs could have been missed. However, given that these are three very important outcomes of new RN orientation programs, the studies reported here and the conclusions reached represent an important first step in the examination of outcomes across different types of hospital-based new RN orientation programs. Finally, despite best efforts to conduct an in-depth scan of the literature, some studies may have been missed in the search process. The authors tried to overcome this limitation by scanning the literature broadly across numerous search engines and by incorporating extensive search and elimination strategies July/August 2010

8 Therefore, the authors believe that the studies reviewed here adequately characterize hospital-based new RN orientation programs during the time period of study. CONCLUSIONS In the face of a shortage of nurses, the new RN orientation program should be an initial, basic step in a healthcare organization_s retention strategy. Healthcare systems have attempted to address this concern by revising existing orientation programs or introducing new programs to retain newly graduated nurses. This integrative review examined the impact of orientation programs reported in the literature between 1990 and Innovative orientation programs have strong merits: They facilitate the transition from newly graduated nurses to professional RNs and create environments that promote the retention of newly graduated nurses. These programs have the potential to address the nursing shortage in healthcare organizations. For hospitals to pursue successful staff retention, the information in this review can serve as a resource for evidence-based management. References Almada, P., Carafoli, K., Flattery, J. B., French, D. A., & McNamara, M. (2004). Improving the retention rate of newly graduated nurses. Journal for Nurses in Staff Development, 20(6), 268Y273. Altier, M. E., & Krsek, C. A. (2006). Effects of a 1-year residency program on job satisfaction and retention of new graduate nurses. Journal for Nurses in Staff Development, 22(2), 70Y77. American Association of Colleges of Nursing. (2007). Nursing shortage. Retrieved August 9, 2007, from nche.edu/media/factsheets/nursingshortage.htm American Organization of Nurse Executives. (2002). Acute care hospital survey of RN vacancy and turnover rates in Washington, DC: Institute for Patient Care Research and Education, American Organization of Nurse Executives. Beck, C. T. (2001). Predictors of postpartum depression: An update. Nursing Research, 50(5), 275Y285. Beecroft, P. C., Kunzman, L., & Krozek, C. (2001). RN internship: Outcomes of a one-year pilot program. Journal of Nursing Administration, 31(12), 575Y582. Benner, P. E. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park, CA: Addison-Wesley. Blanzola, C., Lindeman, R., & King, M. L. (2004). Nurse internship pathway to clinical comfort, confidence, and competency. Journal for Nurses in Staff Development, 20(1), 27Y37. Bowles, C., & Candela, L. (2005). First job experiences of recent RN graduates: Improving the work environment. Journal of Nursing Administration, 35(3), 130Y137. Boyer, S. A. (2005). Vermont nurse internship projectva transition to practice model. Retrieved April 13, 2006, from Collins, M. L., & Thomas, T. L. (2005). Creation of a stepdown nurse internship program. Journal for Nurses in Staff Development, 21(3), 115Y119. Cooper, H. M. (1989). Integrating research:a guide for literature reviews (2nd ed.). Beverly Hills, CA: Sage Publications. Crimlisk, J. T., McNulty, M. J., & Francione, D. A. (2002). New graduate RNs in a float pool. An inner-city hospital experience. Journal of Nursing Administration, 32(4), 211Y217. DiIorio, C., Price, M. E., & Becker, J. K. (2001). Evaluation of the neuroscience nurse internship program: The first decade. Journal of Neuroscience Nursing, 33(1), 42Y49. Herdrich, B., & Lindsay, A. (2006). Nurse residency programs: Redesigning the transition into practice. Journal for Nurses in Staff Development, 22(2), 55Y62. Keller, J. L., Meekins, K., & Summers, B. L. (2006). Pearls and pitfalls of a new graduate academic residency program. Journal of Nursing Administration, 36(12), 589Y598. Kovner, C. T., Brewer, C. S., Fairchild, S., Poornima, S., Kim, H., & Djukic, M. (2007). Newly licensed RNs, characteristics, work attitudes, and intentions to work. American Journal of Nursing, 107(9), 58Y70. Krugman, M., Bretschneider, J., Horn, P. B., Krsek, C. A., Moutafis, R. A., & Smith, M. O. (2006). The national post-baccalaureate graduate nurse residency program: A model for excellence in transition to practice. Journal for Nurses in Staff Development, 22(4), 196Y205. Marcum, E. H., & West, R. D. (2004). Structured orientation for new graduates: A retention strategy. Journal for Nurses in Staff Development, 20(3), 118Y124. Mathews, J. J., & Nunley, C. (1992). Rejuvenating orientation to increase nurse satisfaction and retention. Journal of Nursing Staff Development, 8(4), 159Y164. Messmer, P. R., Jones, S. G., & Taylor, B. A. (2004). Enhancing knowledge and self-confidence of novice nurses: The BShadow- A-Nurse[ ICU program. Nursing Education Perspectives, 25(3), 131Y136. Newhouse, R. P., Hoffman, J. J., Suflita, J., & Hairston, D. P. (2007). Evaluating an innovative program to improve new nurse graduate socialization into the acute healthcare setting. Nursing Administration Quarterly, 31(1), 50Y60. Nursing Executive Center. (2002). Nursing_s next generation: Best practices for attracting training and retaining new graduates. Washington, DC: Advisory Board Company. Owens, D. L., Turjanica, M. A., Scanion, M. W., Sandhusen, A. E., Williamson, M., Hebert, C., et al. (2001). New graduate RN internship program: A collaborative approach for system-wide integration. Journal for Nurses in Staff Development, 17(3), 144Y150. Patrick, S. (2000). Managers shoulder burden of retaining staff. Retrieved March 20, 2006, from dallas/stories/2000/08/14/ story7.html Pine, R., & Tart, K. (2007). Return on investment: Benefits and challenges of a baccalaureate nursing residency program. Nursing Economic$, 25(1), 13Y18, 39. Rosenfeld, P., Smith, M. O., Iervolino, L., & Bowar-Ferres, S. (2004). Nurse residency program: A 5-year evaluation from the participants_ perspective. Journal of Nursing Administration, 34(4), 188Y194. Santucci, J. (2004). Facilitating the transition into nursing practice: Concepts and strategies for mentoring new graduates. Journal for Nurses in Staff Development, 20(6), 274Y284. Squires, A. (2002). New graduate orientation in the rural community hospital. Journal of Continuing Education in Nursing, 33(5), 203Y209. U.S. Department of Labor, Bureau of Labor Statistics. (2005). Occupational outlook handbook: Registered nurses. Retrieved April 13, 2006, from While, A. (1994). Competence versus performance: Which is more important? Journal of Advanced Nursing, 20, 525Y531. For more than 28 additional continuing education articles related to education, go to NursingCenter.com\CE. Journal For Nurses in Staff Development 149