Have you ever gotten into a car and started driving only to realize after several miles you did not know where you were going? I would venture to guess that very few of us set out on a trip somewhere without doing a little planning first. Often, we know why we are taking the trip and where our end destination is going to be. (Unless, you have already been able to retire to the good life of wandering around the countryside in a Winnebago, if this is this case this may not apply). However, for the rest of us, we spend several weeks and even months planning our trip before we take off. We know when we are going to leave, where we will stop along the way, the places we will visit, and the sites we will see once we reach our destination. After setting out on our trip we might even take the time to check in with someone at home to let them know the trip is going well, what we have done so far, and when they can expect to hear from us again. We plan our trip with an end in mind. This is no different from when you begin planning anything, especially a nurse residency or transition to practice program for your new graduate nurses. You must begin with an end in mind.  

If you are just starting to think about implementing nurse residency at your organization, it can be overwhelming to know where to start. It can be difficult to ‘make your case’ and get the buy-in and support necessary from all levels of stakeholders, including new graduate nurses, clinical bedside nurses, leadership, and everyone in between. Many of us like to jump to the planning and development stage of building a program, but how can you do that without first knowing where you are headed. You can't start planning all the fun things you will do on your trip if you first don’t know where you are going and the same holds true for a nurse residency program. Here are some basic steps you should complete before you start planning your program:  

1. Identify your ‘why’ – Start identifying why your organization needs to implement a nurse residency program. Unfortunately, it isn’t enough that research tells us nurse residency is best. Each organization has their individual and specific needs. Figure out what those are in your organization. Is it retention of new graduate nurses that is an issue? Is it recruiting higher caliber new graduate nurses to your organization? Or you have many new graduate nurses that need help getting to the competent stage a little quicker than they would on their own. Be sure to identify your organization’s specific needs and use them to make your case. 
2. Set your AIM – Once you figure out your ‘why’ (and there might be several of them) it is important that you set an AIM for what you are trying to accomplish. It is important that you set an AIM that is precise, measurable, and time specific. For example, it may be to “Decrease turnover rates of new graduate nurses by 5% over the next 2 years.” Or “Increase retention rates of new graduate nurses to 90% or greater in the next 2 years.”  You must set an AIM to know when you have reached your destination.  
3. Pinpoint your measures – How will you know that the nurse residency program is helping? There are many different measures you can use to support the implementation and ongoing support of nurse residency in your organization. You can think of these as your check-in points on your trip; an opportunity to take a step back, see what you have done so far, and evaluate the impact. The ANCC Practice Transition Accreditation Program TM Application Manual has an extensive list of quality outcomes as does the CCNE Standards for Accreditation of Entry-to-Practice Nurse Residency Programs. Identifying quality outcome measures in the beginning will allow you to collect necessary information that shows your program is making a difference. This is necessary if you choose to accredit your program, and when making your case, year after year, to your organizations leadership on why the program is essential. Here are just a few measures to get you started:

Process measures 

• Confidence, competence, job satisfaction, professional satisfaction of the nurse residents – using a tool such as the Casey Fink Survey can show the growth of these areas over time.  
• Program completion statistics. 

Outcome measures  

• Academic progression of the residents (i.e. AD to BSN, BSN to MSN, BSN to DNP, MSN to DNP)  
• Clinical quality outcomes such as error rates and patient safety issues  
• Advancement of organizations practices and policies through completion of projects 
• Retention and turnover of those who complete the program 

Balancing measures  

• Return on Investment  

It is so important to begin with an end in mind. Knowing why your organization needs a residency program will help guide you in developing a program that meets the specific needs of your organization. As well as help you achieve the buy-in and support from key stakeholders that is vital to your success. Once you have done this you are ready to move on to next step of planning your program.

Nicole Weathers, Program Manager, IONRP nicole-weathers@uiowa.edu