These residency programs appear to do much to help the new nurses address the challenges they face in their new positions. Green and Puetzer (2002) clearly define in their article the issues surrounding the importance of effective recruitment, efficient training and ultimate retention of experience nursing staff. A structured mentoring and precepting program appears to be key to all three of these issues and shows that while the schools prepare the nurses for the basics, mentoring programs are the most effective in the workplace. Without residency programs, there is a significant degree of turnover in the nursing staff, which leads to poor clinical are and burnout. .

             A study by Bowles and Candela in 2005 reviewed involved the experiences of recent RN graduates in their first jobs (Bowles and Candela, 2005). The study was meant to determine new graduate perceptions of first jobs and why they left them, if they had. The results showed that 30% of new graduates left their positions within one year, and 57% had left their first positions within 2 years. Issues cited for leaving consisted of patient care problems, unsafe nurse to patient ratios, and stress associated with the acuity of the patients. Other significant issues (22%) noted a lack of support on the part of management, as well as a lack of guidance and a sensation of being given too much responsibility for patient care as compared to the nurse's level of comfort and experience. This review showed that RNs in the first year of work tend to leave their first position at a much higher rate than RNs who are in second or subsequent positions. It would appear from this study that to improve RN retention one must consider the development of orientation and mentoring programs. This would improve work environments and reduce stress levels. .

             There is a limited availability of preceptors. This often causes nurse interns multiple preceptor assignments that causes problem with educational continuity, follow through on assignments and progress assessments, as well as preceptor burnout.