Nursing school is arguably one of the most challenging degree plans in existence. The level of professionalism and intelligence of newly graduated nurses (GNs) is exceptional, and the expectation is that they will excel in whatever field of nursing they choose. That said, navigating the theory-practice gap between school and a GN’s first job can be extremely intense, especially in specialty areas such as critical care. According to Belvins (2016), both The Joint Commission and the Institute of Medicine recognize that many GNs are not prepared for fast-paced, high-acuity healthcare environments. The recommendation is the implementation of additional education and skills structured into Nurse Residency Programs (NRPs) provided by onboarding facilities. Not only have NRPs been proven to increase GN satisfaction and retention rates, but they are also cost-effective because these facilities are able to retain these nurses.

GNs entering the nursing workforce are extremely vulnerable during their transition into practice. Role stress, skill deficiency, and lack of confidence are just a few factors influencing the success of new nurses (Crimlisk et al., 2017). While nursing schools are proficient at preparing student nurses for their state boards, they often fail to provide adequate clinical socialization into nursing practice. The result is new nurses who are unhappy, stressed out, and at times scared to the point of not only leaving their first nursing positions, but sometimes nursing altogether. It is the duty of experienced nurses and onboarding organizations to ease the theory-practice transition and to give new nurses the tools they need to practice independently. While many organizations have adopted NRPs, many are geared towards med-surg because most hospital GNs start out on these floors. However, up to 60% of GNs choose to work in critical care areas (Rush (2013). Critical care areas such as Emergency Departments (EDs), Intensive Care Units (ICUs), and Operating Rooms (ORs) have more specialized training, such that med-surg-specific education may not be relevant for these nurses. Another issue found in literature searches is that many authors suggest adopting NRPs, but actual studies with standardized programs are lacking. In an effort to address both issues, a critical care NRP was designed to be piloted at a large level one trauma hospital in Texas. But how effective will this program be? PICOT Question: In GNs (P), how does a critical care specific NRP (I), compared with a traditional internship (C), affect retention rates and satisfaction levels (O) within one year (T) in the ED at a large trauma hospital?

Date of publication

Spring 4-19-2020

Document Type

MSN Capstone Project



Persistent identifier



Masters of Science in Nursing Administration

Included in

Nursing Commons