Quantitative Research Proposal
Introduction

Nurse residency programs (NRPs) have been used as tools for recruitment and retention
of new graduate nurses as recommended by the Joint Commission in the early 2000s to
improve the delivery of safe, quality care (Friday et al., 2016). The first NRPs were
started in 2004 and led by the American Association of Colleges of Nursing (AACN) in
the intensive care unit setting (Walsh 2018).

Nurse residency programs are recognized by the American Nursing Credentialing Center
(ANCC) and are considered part of the Structural Empowerment component of Magnet
status (Dang & Dearholt, 2018). Best practice for NRPs can be found in initiatives by the
Commission for Collegiate Nursing Education (CCNE), the American Nurses
Credentialing Center (ANCC), Practice Transition Accreditation Program (PTAP), and
the National Council of State Boards of Nursing (NCSBN) (Pillai et al., 2018).

The best practice for NRP is on average, a 12-month program that incorporates clinical
and didactic learning with simulation experiences. It is also important to ensure that the
nurse residents have designated time for learning, reflection, feedback, guidance, and
stress management. Residents are supported by preceptors, mentors, nurse educators,
and nursing leadership (Casse, 2019).

The financial burden of turnover and decreased retention can represent a significant
portion of the healthcare organization's labor costs (Friday et al., 2016). The average
cost of turnover for an RN is estimated at as much as $100,000 per nurse (Woldford et
al., 2019). These costs are incurred from onboarding, recruitment, overtime pay to
existing employees, hiring temporary staff, loss of hospital revenue, and the training and
orientation of new staff (Ackerson & Stiles, 2018).

More than one million nurses are expected to retire in the next ten to fifteen years. Fiftyfive percent of the nursing workforce is over fifty years old (Ackerson & Stiles 2018).
New graduates are the largest pool of registered nurses available for recruitment to
organizations (Friday et al., 2016).

The Joint Commission (2005) has recognized the lack of funding, structure, standards,
and oversight as a disparity between nurse residency programs and other residency
programs (medical, dental, psychology, pharmacy). The lack of funding and support
might explain why approximately 68% of NRP are institutionally developed and vary in
length, content, and design (Pillai et al., 2018).

Additional research and development are needed on measurement tools for outcomes of
NRP. Most research studies have small, individualized population samples. The
evaluation of higher patient acuity, lack of preparedness, increased work stress,
generational differences, and the current state of a global pandemic, impact on nursing
retention should also be considered when evaluating the effectiveness of NRP on the
retention of new graduate nurses.

The study of clinical outcomes for patients who were cared for by nurses who
participated in NRP would demonstrate the impact of the program on patient care.
Future studies that concentrate on the performance, professional development, and
clinical outcomes would further validate the success of NRP goals (Wolford et al., 2019).

A study focusing on leadership styles that most effectively foster engagement and
retention would offer value (Wolford et al., 2019).
The purpose of the study

The purpose of this study is to gain evidence regarding nurse residency programs and
their influence on the retention rates of new graduate nurses.
Significance

New graduate nurses can benefit from additional support, education, and skill
development.

The nurse residency programs help to reduce turnover rates, increase career satisfaction,
and develop professional goals (Cochran, 2017).

Identifying the challenges for new graduate nurses is imperative when helping new
nurses to transition into their roles (Cochran, 2017).

Nurse retention is critical to the health of healthcare organizations, and it has been
demonstrated that NRP is an effective method for retaining new graduate nurses (Pillai
et al., 2018).

Organizational savings were found with increased retention (Ackerson & Stiles, 2018).
Problem statement

In conjunction with the lack of adequate support for new graduate nurses in the early
2000s, the field of nursing was also entering a time of increased healthcare demands
with a critical shortage of registered nurses made worse by decreasing retention rates,
particularly retention of new graduate nurses (Walsh 2018). Such conditions have only
worsened with the impact of the pandemic. From early 2019 the pandemic has impacted
nursing by decreasing educational resources and opportunities for students, decreasing
educators at nursing institutions and clinical organizations, increased retirement,
increased turnover and decreased retention at healthcare facilities. New graduate nurses
are often challenged by skills and tasks that are gained through clinical experience
including delegation, prioritization, decision-making, collaboration, conflict resolution,
and the ability to give and accept criticism, which can create a disconnect between the
new graduate nurses’ expectations of their professional role and can negatively impact
job performance, confidence, job satisfaction and retention (Walsh, 2018).

It has been studied that NRP can increase a new graduate nurses’ job performance, selfconfidence, professional development, and retention. Researching the effect of NRPs is
important to determine the impact of NRP on the retention of new graduate nurses and
the impact of retaining new graduate nurses as it affects professional development, job
satisfaction, and institutional costs to healthcare facilities.
Definition of terms

New graduate nurse- someone who recently graduated with a Bachelor of Science in
Nursing degree and has passed the NCLEX state board licensing exam. He/she is a
Registered Nurse.

Nurse Residency Program- an individualized and detailed orientation program for new
graduate nurses designed to assist and support their transition to clinical practice.
Nurse residency programs vary in length and may include supportive measures such as
debriefing sessions and simulation.

Retention-ability to keep employees (Ackerson & Stiles, 2018).

Turnover- the rate that nurses leave an organization and are replaced (Ackerson & Stiles
2018).

Casey-fink surveys- instrument/tool used to measure and evaluate stressors, fears,
challenges, retention, and experiences of graduate nurses during their first year of
professional practice with hopes of enhancing their educational formation and advancing
their contribution to leading change as health care professionals

Joint Commission- an accreditation group that develops and upholds patient safety and
care standards for hospitals and other healthcare organizations.

Preceptor- an experienced and competent nurse formally assigned to guide the
professional journey of a student, graduate nurse, or new staff member joining a
workplace.

Mentor- a supportive, professional relationship between two people to help accomplish
goals that are determined ahead of time. A mentor serves in a teaching role and provides
support for personal and professional manners (Van Patten & Bartone, 2019).

Simulation- the use of scenarios, sometimes using manikins and technology, to increase
possible clinical judgment, preparedness for situations, and the knowledge and
confidence of nurses and nursing students.
Research Question

In new graduate nurses working in acute care during their first year of employment, how
does participation in a nurse residency program compared to participation in general
orientation program influence retention rates of new graduate nurses after the first year
of employment?
Theoretical framework

The research study will be based on the theoretical framework of Patricia Benner’s
Novice to Expert nursing practice theory and model (Benner, 1982).

Patricia Benner developed her theory based on studies guided by The Dreyfus Model of
skill acquisition. The Dreyfus model reported that during the acquisition and
development of a skill, one passes through five levels of proficiency: novice, advanced
beginner, competent, proficient, and expert (Benner 1982).

Benner applied the Dreyfus model to nursing by defining the novice as the beginner
nurse, the first year of education, in which the student has no experiential background to
base approach or understanding of the clinical situation (Benner 2005). The advanced
beginner, new graduate nurse which has functioned very close to the level of a beginning
staff nurse or in the final year of nursing education (Benner 2005). The competent
nurse, in practice for 1-2 years, developing skills and clinical grasp in certain situations.
A nurse transition to proficiency when the nurse can read and predict situations and
begins to synthesize the meaning of patient responses. A nurse is considered an expert
when they are response-based and able to integrate his or her grasp of the situation with
her or her responses using theories practiced in multiple different ways (Benner 2005).

Benner’s theory and model were chosen for this research study because it specifically
supports ideas of a clinical performance framework and addressing individual needs of
nurses during each stage of competence (Benner 1982).

This theory fits well within the research as it describes the stages a nurse transforms
through and the teaching strategies and impact of competent, satisfied nursing on
retention. Caring for patients in critical situations will require immediate
implementation of learned skills and situational experience while applying theory and
didactic learning strategies secondarily. Benner (1982) includes retention, recruitment,
and job satisfaction as benefits to competency-based education and training.
Limitations of the study

According to Gray & Grove (2021), validity is the truth or accuracy of the findings. The
four types of validity are:
o
Construct design validity- examines fit between the conceptual definitions and
operational definitions of variables
o
Internal design validity- extent to which the relationships or differences detected
in the study are a true reflection of reality rather than the result of extraneous
variables.
o
External design validity- the extent to which study findings can be generalized
beyond the sample used in the study.
o
Statistical conclusion design validity-degree to which researcher makes proper
decisions about the use of statistics, so that conclusions and analysis are drawn
from analyses are accurate reflections of reality (Gray and Grove, 2021).

Limitations to proposed research study include:
o
Construct design validity- Instruments used in study that will adhere to inclusion
and exclusion criteria. Limitations may include finding supporting research
specific to theoretical framework included in the study.
o
Internal design validity- Staffing issues that may impact feelings, performance
and resources of nurse residents, selection of nurse residents limited to those
within one hospital system, and compliance with interventions and initiatives
designed for research study including subject attrition.
o
External design validity- sample population demographic information, sample
educational background, and the sample working within the same hospital
system. Inclusion and exclusion criteria may be a limitation to external design
validity.
o
Statistical conclusion design validity- availability of conclusive and reliable
research articles within desired five-year time frame.
Proposed study design

The research design is the blueprint for conducting a study, it maximizes control over
factors that could interfere with the validity of the study findings (Gray & Grove, 2021).

Research study will include targeted population included in sampling plan consisting of
sample and control groups based on inclusion and exclusion criteria.

Study will evaluated by pre, concurrent and post surveys all utilizing the Casey-fink
methods to promote consistency and limit threats to validity.

All participants (sample and control) will partake in same surveying evaluation
measurement methods.

Surveys will be offered both paper and electronically to promote data collection and
compliance of participants.
Research methodology

Casual, comparative, cross-sectional design will be used to determine the significance of
participation in a nurse residency program as related to retention of new graduate nurses
working in an acute care setting.

Casual comparative design allows the research study to examine the relationships among
variables.

The appropriateness of casual, comparative design is based on the premise that effects of
the independent variables on the dependent variables were measured (Gray & Grove,
2021, p.235).

Research design and methodology will be guided by the research question.
Design strengths

Study purpose narrow and clarifies the focus of the study (Gray & Grove, 2021, p.538)

Organization is established teaching hospital with nurse residency programs practiced in
acute care settings. Study is feasible to conduct in terms of money commitment,
researcher’s expertise, availability of subjects, facilities, equipment, and ethical
considerations (Gray & Grove, 2021, p. 538).

Theoretical knowledge base developed for the problem and purpose (Gray and Grove,
2021, p. 538).

Study framework is related to body of knowledge in nursing and clinical practice at the
time the study will be conducted (Gray & Grove, 2021, p.538).

Operational definitions capture both the concept and the breadth of its manifestations in
the population (Gray & Grove, 2021, p.539).

Sampling method adequate for producing a sample that is representative of the target
population (Gray & Grove, 2021, p.539).

Sample criteria is appropriate for the type of study proposed (Gray & Grove, 2021,
p.539).
Design weaknesses

Ability to provide enough evidence from literature to support the conclusion that the
study is needed due to lack of applicable and timely research (Gray & Grove, 2021,
p.545).

Limited resources to support nurse residents available during study including
availability of same preceptors, nurse staffing, and manager compliance (Gray & Grove,
2021, p.539).

Sample population may have limited vulnerable population related to familiarity of
population demographics (Gray & Grove, 2021, p.539).

Clearly defining, monitoring, and reporting physiological measure may not always be
clearly described (Gray & Grove, 2021, p.540).

Unable to monitor research subjects, variables and resources needed for research study,
may leave room for threats to internal validity (Gray & Grove, 2021, p.540).

May be weaknesses or threats to validity not yet discovered or defined (Gray & Grove,
2021, p.540).
Sampling plan

Sampling method- convenience sample

Population- nurses currently working in acute care employed by organization.

Target population- new graduate nurses participating in nurse residency program in
acute care areas and new graduate nurses hired into acute care settings who are not in
residency program (standard orientation program).

Setting- acute care hospital offering residency program for new graduate nurses.

Sampling frame (accessible population)- all new graduate nurses hired into acute care at
organization

Sampling plan- nonprobability using convenience sampling although probability
sampling plan will be used to randomly select participants within inclusion criteria if
amount surpasses expected capability of research study.

Inclusion criteria- new-graduate nurses with no prior experience hired into residency
program and new graduate nurses with no prior experience hired during projected
research timeframe. New-graduate nurses with both an associate and/or bachelor’s
degree in nursing will be included.

Exclusion criteria- nurses with previous experience, nurses hired before or after allotted
time frame for study. Nurses hired into non acute care clinical settings will not be
included in study.

Factors related to, and method for determining sample size- sample size will be
determined by number of nurses hired into sample and control groups. Nurses will have
option to opt out of participation if desired. When the amount of potential sample size is
determined, purposeful and random sampling will be used if needed to control sample
size.

Procedures related to recruiting participants- Presentation of research to selected groups
that can be included in participation will determine amount of voluntary participation.
Communication with potential participants will be clear and concise with availability to
address possible questions or concerns of potential participants. Benefits, risks,
importance of compliance and retention, and all additional information will be given to
participants in an open format prior to participant selection. Needed consent will be
describe and obtained prior to conducting study.
Hypothesis

Participating in a nurse residency program will increase retention of new graduate
nurses working in acute care during their first year of employment.

A casual hypothesis is appropriate for the proposed research study. A casual hypothesis
proposes a cause-and-effect relationship between variables in which one causes the
other. The cause, or independent variable, is manipulated or varies by the dependent
variable, or outcome/response (Gray & Grove, 2021, p.136).
Variables

Nurse residency program-independent variable

Competency, satisfaction, and confidence of new graduate nurses-dependent variable

Conceptual description- new graduate nurses placed into nurse residency program will
be offered individualized, orientation process exposing them to more clinical experiences
and opportunities to gain knowledge, competencies, and nursing skills.

Operational definitions:
o
Independent variable- Casey fink surveys to measure nurse residency program
o
Dependent variable- Casey fink surveys to measure psychomotor, affective, and
cognitive competency along with confidence and satisfaction of new graduate
nurses before, after and during orientation.
Protection of Human Subjects

Type of IRB approval requested- IRB approval will be obtained by Daemen University
and Catholic Health System.

Exempt approval will be requested as it is anticipated that there would be no potential
risks to the participants and there will be no direct benefit from participation in study.

Informed Consent Process- Consent from subjects will be obtained and written
information about the study will be given to the participants following exempt IRB
review and approval

Ethical Considerations- Research study is guided by three ethical principles, respect for
persons, beneficence, and justice.
Plan for Data Collection

The Casey-Fink Graduate Nurse Experience survey will be given to all participants at the
beginning of the study. Every four months groups will be given section I-IV to obtain
data trends, frequencies, or needed adjustments of participants or program throughout
their residency program and following their first year of acute care.

The Casey-Fink Readiness for Practice Survey will be given every four months to
develop baseline competency, comfort and confidence and measure for evaluation and
needs adjustments.

Revised Casey-Fink Nurse Retention Survey will be given to all participants at the
beginning of the study. Every four months groups will be given sections I-III to continue
data collection.

Retention rates of new graduate nurses who in both groups obtained from Human
Resources

Casey-Fink Surveys will be collected and measured using a 4-point Likert Scale.

Each survey will consist of 10 questions and be given to each participant at different
phases of the study (before, during, after)

1=strongly disagree, 2=disagree, 3=agree, 4=strongly agree

Written permission granted, population surveyed for participation, identify independent
and dependent study groups, collect data during each phase, retain HR data prior,
annually, and at completion of nurse residency program
Plan for Data Analysis

Data collected from surveys will be entered into Excel for analysis

Descriptive statistics will be used to evaluate demographics of the population

Measures of central tendency, percentages and frequencies will be used to analyze
survey results

The retention rate of both groups will be obtained by HR and analyzed comparing
participation in NRP and retention annually
Summary

This research study will provide an evidenced-based description of the relationship
between retention, competency, and satisfaction of new graduate nurses participating in
a nurse residency program in acute care

The results of the project will indicate that new graduate nurses have a higher rate of
competency, job satisfaction, and retention than those who do not participate in nurse
residency programs.

Results of this survey should indicate a need for advanced training, support and
structure for new graduate nurses working in acute care.
References
Ackerson, K., & Stiles, K. A. (2018). Value of Nurse Residency Programs in Retaining
New Graduate Nurses and Their Potential Effect on the Nursing Shortage. The
Journal of Continuing Education in Nursing, 49(6), 282-288.
doi:10.3928/00220124-20180517-09
American Nurses Credentialing Center. (2016). Practice transition accreditation
program: 2016 Application manual. Retrieved from
http://www.nursecredentialing.org/2016-PTAP-Manual.
Benner, P. (1982). From novice to expert…the Dreyfus model of skill acquisition. AJN
American Journal of Nursing, 82, 402-407
Benner, P. (2005) Using the Dreyfus Model of Skill Acquisition to describe and interpret skill
acquisition and clinical judgment in nursing practice and education. The Bulletin of
Science, Technology, and Society Special Issue: Human Expertise in the Age of the
Computer. Vol. 24 (3) 188-199.
Casey, K., & Fink, R. (2017). Casey-Fink surveys. Retrieved from
https://www.uchealth.org/professionals/professional-development/casey-finksurveys/
Casse, K. (2019). ED opportunities for new graduates: Implementing an emergency
nurse residency program. Nursing Management, 50(4), 36–41. https://doiorg.ezproxy.daemen.edu/10.1097/01.NUMA.0000554339.24766.ed
Cochran, C. (2017). Effectiveness and best practice of nurse residency programs: A
literature review. MEDSURG Nursing, 26(1), 53–63.
Church, C. D., Zhaomin He, & Yarbrough, S. (2018). Factors influencing organizational
commitment and turnover in nurse residents. Journal of Continuing Education in
Nursing, 49(10), 482–488. https://doi.org/10.3928/00220124-20180918-09
Dang, D., & Dearholt, S. L. (2018). Johns Hopkins evidence-based practice: Model and
guidelines (3rd ed.). Indianapolis, IN: Sigma Theta Tau.
DuBois, C. A. & Zedreck Gonzalez, J. F. (2018). Implementing a Resilience-Promoting
Education Program for New Nursing Graduates. Journal for Nurses in
Professional Development, 34 (5), 263-269. doi:
10.1097/NND.0000000000000484.
Friday, L. , Zoller, J. , Hollerbach, A. , Jones, K. & Knofczynski, G. (2015). The Effects of
a Prelicensure Extern Program and Nurse Residency Program on New Graduate
Outcomes and Retention. Journal for Nurses in Professional
Development, 31 (3), 151-157. doi: 10.1097/NND.0000000000000158.
Pillai, S. , Manister, N. N. , Coppolo, M. T. , Ducey, M. S. & McManus-Penzero,
J. (2018). Evaluation of a Nurse Residency Program. Journal for Nurses in
Professional Development, 34 (6), E23-E28. doi:
10.1097/NND.0000000000000499.
Van Patten, R. R., & Bartone, A. S. (2019). The impact of mentorship, preceptors, and
debriefing on the quality of program experiences. Nurse Education in Practice,
35, 63–68. https://doi.org/10.1016/j.nepr.2019.01.007
Walsh, A. L. (2018). Nurse Residency Programs and the Benefits for New Graduate
Nurses. Pediatric Nursing, 44(6), 275–279
Williams, F. S. (2018). New Nurse Graduate Residency Mentoring: A Retrospective
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Appendices
INFORMED CONSENT
Impact of Nurse Residency Programs on Retention of New Graduate Nurses Working in Acute Care
Researcher(s): Jennifer Dougherty
Jennifer.dougherty@daemen.edu
Faculty Research Advisor: Dr. Deborah Merriam
Deborah.merriam@daemen.edu
Dear Registered Nurse,
We are inviting you to be in a research study. The purpose of this consent form is to give you information
you will need to help you decide whether to be in the study or not. Please read the form carefully. You may
ask any questions about the purpose of the research, what I (we) would ask you to do, the possible risks
and benefits, your rights as a volunteer, and anything else about the research or this form that is not clear.
When we have answered all your questions, you can decide if you want to be in the study or not. The
process is called “informed consent.” We will give you a copy of this form for your records.
Your participation in research is voluntary and confidential. If you do not wish to participate, there are no
penalties or loss of benefits or services that you are otherwise entitled. Whether or not you choose to
participate in this project will have no effect on your relationship with [state affiliate from where
participants are being recruited here] or Daemen College now or in the future.
1. DESCRIPTION OF RESEARCH PROJECT:
The purpose of this study is to gain evidence regarding nurse residency programs and their influence on
the retention rates of new graduate nurses.
2. EXPLANATION OF PROCEDURES
As a participant in this study, you would be asked to complete surveys regarding the nurse residency
program and person competency, satisfaction and readiness to practice in three phases: before, during,
and after participation in the nurse residency program. Participants of control group will complete the
same surveys in regard to the general orientation process
3. CONFIDENTIALITY (or anonymity if applicable and appropriate):
All information will be published in group form and there will be no publication that could link your
participation with the data. Confidentiality of each participant will be maintained, and no identifying data
will be linked to the transcriptions. Any identifying information, such as this consent form, will be stored
in a secure location separate from other data. All participants will be given codes so no names will be
associated with any participant data. We will store de-identified data indefinitely.
4. BENEFITS/COMPENSATION:
There will be no direct benefits or compensation to you related to being a participant in this study.
5. RISKS:
There are no known risks to you beyond that encountered in usual daily life related to being a participant
in this study.
6 RESEARCH PARTICIPANT’S STATEMENT:
This study has been explained to me. I volunteer to take part in the research. I have had a chance to ask questions. If I
have any questions later about the research, I can ask one of the researchers listed above. If I have any questions
about my right as a research subject, I can contact the Human Subjects Committee (HSRRC) Chairperson at
hsrrc.chair@daemen.edu or (716) 839-8508. I have received a copy of this consent form.
______________________
Printed name of participant
_______________________
Researcher’s Signature
_________________________
Signature of participant
______________
Date
_______________
Date
Appendix B
Casey-Fink Graduate Nurse Experience
Casey-Fink Nurse Retention Survey
Casey-Fink Readiness for Professional Practice Survey