Effectiveness of nurse residency programs for new graduate nurses: a systematic review and meta-analysis

Background: As many as 35% of new nurses change positions within their first year of work. The costs of turnover incurred by institutions is costly and new graduate nurses feel ill prepared to practice nursing after graduation. Nurse residency programs were developed to address these issues. Objective: To examine the best available evidence on retention rates and perceived competency among new graduate nurses with less than 12 months of acute care clinical experience who completed a nurse residency program in a Magnet designated versus non-Magnet institution. Method: This is a systematic review of quantitative studies involving new graduate nurses who completed a nurse residency program in an acute care setting. The standard 3-step search strategy of the Joanna Briggs Institute was used to find eligible studies. These were independently screened by title, abstract and full review for relevance by 2 reviewers. Critical appraisal was performed by two reviewers working independently using the JBI MAStARI critical appraisal tools. Data were extracted by two reviewers using the JBI MAStARI data extraction form based on the selected study’s design.Findings: Of the 14,882 articles identified, 347 full text articles were retrieved that met inclusion criteria based on abstract or title. The majority (N=338) were excluded as they did not meet criteria. This review, therefore, comprises nine quantitative studies representing 14 U.S. hospitals and 1585 new graduate nurses. A meta-analysis was conducted for retention overall and for Magnet institutions versus non-Magnet institutions. The overall retention rate of 93% [95% CI: 87-99%] indicated effectiveness of nurse residency programs for new graduate nurses in the first meta-analysis. The second meta-analysis revealed no significant difference in effectiveness of nurse residency programs comparing Magnet designated institutions versus non-Magnet institutions. Three studies revealed positive outcomes regarding perceived competency. These are discussed narratively as there was insufficient data to conduct a meta-analysis.Conclusions: Nurse residency programs improved retention rates in this meta-analysis. An increase in retention was found at 93% [95% CI: 87-99%]. Utilization of competency assessment tools revealed improvement in self perceived competency among the new graduate nurses enrolled in a nurse residency program. While Magnet status incorporates multiple elements which impact retention, costs, and perceived competency, it is not conclusive if Magnet status is more effective that non-Magnet institutions that utilize nurse residency programs based on the findings of this systematic review. Further research would be beneficial to understand effectiveness of specific program types or tools to measure retention rates and perceived competency.