Abstract
Increased registered nurse vacancy rates have resulted in new graduates being assigned to care for high acuity patients with complex needs. The authors discuss the research related to new graduate preparation, identify the need for a standardized accredited national residency program, and describe a demonstration project under way in academic health centers.
It is increasingly more difficult for new graduates to transition to the staff nurse role in acute care hospitals. To meet the needs of today's hospitalized patients, new graduates must have the knowledge and skills to care for acutely ill patients with complex needs. Schools of nursing emphasize preparation of nurses in a broad knowledge base so that they may work in a variety of patient care settings. Specialty preparation in areas such as oncology, critical care, orthopedics, cardiology, and high-risk obstetrics is not emphasized at the baccalaureate level.
In contrast to patterns in the past, it is impossible to assign new graduates to lower acuity patients while they are learning their new role because these lower acuity patients are no longer in the hospital. New graduates are being asked to care for patients with complex needs much earlier in their first job because of the national nursing shortage. Hospitals must meet Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards, which require the hospital leadership to assure that providers who deliver patient care are competent to provide the assigned care. 1 Thus, hospitals face the challenge of needing more new graduates than ever before and making sure they are competent to care for patients who are very ill.
The situation is further complicated by the perception among deans of baccalaureate programs that there is wide variation in how new graduates are recruited and oriented and the extent to which they are supported in their practice during their first months and the first year. In view of the demands placed upon new graduates, concerns about turnover and burnout, and the lack of a consistent approach to transitioning new graduates into the professional nursing role, it is time for the nursing profession to support a national post-baccalaureate nurse residency program for new graduates.