The report is a product of the VA/HSR Evidence Synthesis Program.

Registered Nurse Transition to Practice Programs: A Systematic Review

Takeaway: Registered nurse transition to practice programs (RNTTPs) have been piloted and implemented in healthcare systems throughout the country and have the potential to alleviate the nurse staffing shortage. However, reviews and the original research evidence suffer from widescale methodological limitations. RNTTPs that have multiple components (e.g., mentorship, peer support, training, and assessment) may be helpful, but the specific arrangement of components and methods of choosing components to match specific contexts remain unclear. RNTTPs deserve more rigorous evaluation to answer critical questions about their benefits, implementation, best practices, and sustainment so they can be scaled and sustained.

First-year registered nurses (RNs) have the highest turnover rate of all hospital-based RNs, and often face many challenges. Comprehensive RN transition to practice programs (RNTTPs) that have multiple components (e.g., mentorship, peer support, training, and assessment) may help improve retention among new RNs, but RNTTP characteristics and implementation practices vary.

In response to a request from VA’s Office of Nursing Services, HSR’s Evidence Synthesis Program (ESP) Center in Greater Los Angeles conducted a systematic review of published evidence syntheses on RNTTPs. The ESP team identified 19 eligible reviews in PubMed/MEDLINE and CINAHL Plus from 1/1/15–12/15/22, with additional citations identified by hand-searching reference lists of evidence syntheses and by consultation with content experts.

Summary of Findings

• There was no seminal study or set of studies that all reviews included, and no single review that included the majority of identified original research studies.
• One systematic review met the standard of high confidence, three reviews met the standard of moderate confidence, and the remaining reviews were appraised as low or critically low overall confidence in the review results. The ESP team prioritized reporting on the conclusions for outcomes that were included in two reviews that had high or moderate confidence in the review results and addressed the team’s key questions most directly.
• Multi-component RNTTPs may be helpful, but the specific arrangement of components and methods of choosing components to match specific contexts remain unclear. There appeared to be a set of key components represented in the published evidence syntheses, including a defined resource person (e.g., mentor, clinical coach, navigator, preceptor), mentorship, peer support opportunities, education/professional development, assessment, and workplace environment.
• The best quality evidence, which used a mix of methodological approaches, indicated a connection between RNTTPs and increased critical thinking, competency, and retention.
• The evidence for program length was inconclusive, with published evidence syntheses suggesting around 6–12 months.
• Patient-level outcomes were absent from the identified reviews.

Implications

Given the number of RNTTPs in healthcare systems across the country and RNTTPs’ potential to alleviate RN staffing shortages and support the development of the future nursing workforce, these programs deserve rigorous evaluation to answer critical questions about their implementation and sustainment. The benefits of RNTTP programs should be documented, and best practices should be ascertained so they can be scaled and sustained.

Limitations

This review was limited by the low methodological quality of most of the included reviews and original research literature. In addition, the published literature on RNTTPs might not accurately reflect all experiences with these programs.

Future Research

Rigorous evaluations and original research studies on RNTTPs are needed that take into account the recommendations of many of the included reviews, such as using standardized outcome measurement to assess typical outcomes at the nurse and organizational levels; employing sophisticated evaluation study designs that involve comparator groups, longitudinal designs, and/or multiple sites; and including patient outcomes and economic analyses.

Citation:

Thies J, Higgins PS, Schlak AE, Begashaw MM, De Vries G, Miake-Lye IM. Registered Nurse Transition to Practice Programs: A Systematic Review. Washington, DC: Evidence Synthesis Program, Health Systems Research, Office of Research and Development, Department of Veterans Affairs. VA ESP Project #05-226; 2024.

To view the full report, go to vaww.hsrd.research.va.gov/publications/esp/rn-transition.cfm (This report is available via intranet only.).

How can VA leadership work with the ESP? Nominations for systematic review topics may be submitted to the program at any time. When you submit a topic nomination form, ESP Coordinating Center staff will work with you to determine the appropriate research approach and ESP product to address your questions of interest. Topics are selected and assigned to an ESP Center based on program capacity and alignment with VA national goals.

This Management Brief is provided to inform you about recent HSR findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR Resource Center charged with disseminating important HSR findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.

This report is a product of VA/HSR's Evidence Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers; and to disseminate these reports throughout VA.

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