The importance of nurse residency programs is addressed in the literature; however, a review of residency program outcomes and effectiveness is needed. Guided by Roy's adaptation model and Deming's plan-do-check-act model, the purpose of this quality improvement project was to assess the current state of a longstanding critical care nurse residency program in meeting organizational goals and objectives and to recommend modifications to the program related to external factors, internal challenges, and educational deficits of nurses entering the program. A review of the evidence-based literature and feedback from focus groups of leadership stakeholders were used to develop recommendations for residency program improvement. Using qualitative analysis of the focus group data, three common themes emerged related to external factors: financial resources, patient acuity, and generational differences that influence nurse satisfaction with the residency program. Three additional themes emerged related to organizational barriers to satisfaction with the program: preceptor availability and development, limited training hours due to productivity standards, and leader time to support novice nurses. Reality shock when starting to practice in the high acuity critical care area was the most frequently reported educational deficit among new nurses. Recommendations for program improvement included obtaining feedback from residency program participants and preceptors, initiating preceptor development pathways, reinstituting a dedicated cost center for nurse residents' training, and using competency assessment tools to customize training plans for residency program participants. This project has the potential for social change by increasing job satisfaction and retention of new nurses and improving health outcomes in critical care patients.