Current literature supports the creation and implementation of nurse residency programs to support new graduate nurses as they transition into nursing practice. Additionally, nurse residency programs have been shown to increase nurse satisfaction and retention (Crimlisk et al., 2017; Olson-Sitki et al., 2012). Currently, there are only three nurse residency programs in the state of Alabama. The lack of this important post-licensure resource poses a problem for new graduate nurses who are seeking additional assistance and guidance during the transition to professional practice. This qualitative study examined the decision-making process of hospital leaders in the implementation of the nurse residency program at their facility. This study also explored factors that impacted hospital leaders’ decision to implement a nurse residency program. This study found a relationship between the decision to implement a nurse residency program and the desire to increase nursing development in the facilities. The benefits that were identified included building a solid foundation, recruitment and retention, and building relationships. Other factors that influenced the hospital leaders’ decision to implement the nurse residency programs were demand and excessive turnover of staff. In addition, multiple barriers such as logistics, manager buy-in, and curriculum development were identified by the hospital leaders as potential barriers to implementation. This study will also be able to help hospital leaders who are struggling with the decision to implement nurse residency programs in their facilities.