Roll out the welcome mat for a successful transition from nursing school to professional practice.
Nurse leaders are often challenged with retaining quality nursing staff. The hard truth is that national nurse turnover rates are on the rise.
In 2015, the bedside RN turnover rate increased to 16%, up from 11% in 2011, according to the 2015 National Healthcare Retention & RN Staffing Report. So, it’s not just experienced nurses that are leaving their roles.
While many nurses probably know the reasons seasoned nurses leave their jobs (insufficient staffing, increased stress, decreased job satisfaction, unhealthy work environments), what factors come into play in retaining new nurse graduates? Take for example, the fact that new nurse grads might have difficulty finding and landing a new job. If that occurs, the graduate will likely take any nursing job offered-- even if it is not an ideal fit. This can lead to job dissatisfaction right from the start.
Reasons for turnover
New nurse grad turnover rates are roughly 30% in the first year of practice, and as high as 57% in the second year. New nurse attrition is costly and can negatively impact patient-care quality.
New nurses report that low job satisfaction is associated with heavy workloads, disillusionment about scheduling, insufficient time with patients, absence of autonomous practice, and the lack of intrinsic and extrinsic workplace rewards. Poor relationships with peers, managers, and interprofessional colleagues also lead to dissatisfaction.
Low salaries can contribute to a weak commitment to stay in a job, but salary is often less important if the work is rewarding, staffing is adequate, and scheduling is satisfactory. Men are twice as likely as women to leave a nursing position for higher pay.
Off to a good start
Retention begins with hiring the right candidate. The hiring process should focus on assessing new nurses’ values and attitudes, and how they fit with your organization. Skills can be taught, but behavior patterns are more difficult to change.
Two effective strategies to ensure a good fit between a new nurse and a work unit are pre-hire job shadowing and behavior-based interviews by both peers and managers. When new nurses job shadow on a unit, they can evaluate workload, role expectations, and cultural norms. Behavior-based interviewing allows managers and peers to assess communication and relational skills through exemplars the candidate shares.
When unit nurses help select new hires, they have a greater interest in retaining them and engage more fully in the on-boarding process. During the peer interview, new nurse grads can gain insight into potential coworkers to estimate an ability to fit in.
Research evidence strongly supports nurse residency programs as a key strategy to retain new nurse grads. The National Academy of Medicine, National Council of State Boards of Nursing, and Commission on Collegiate Nursing Education all advocate for nurse residency programs. Retention rates of nurses in residency programs range from 88% to 96%.
The right support
Preceptors are vital support persons when new nurse grads enter the workplace, both in residencies and traditional orientation programs. The preceptor is the first nurse who intensely invests in the new nurse grad, planning patient assignments on a daily basis, nurturing confidence and competence, and overseeing the development of skills and clinical judgment. Preceptors socialize new nurse grads into workplace processes and norms.
Mentoring programs also improve retention for new nurse grads. Mentors differ from preceptors in that mentors invest years of time, rather than weeks or months. Some mentoring programs don't begin until the residency or orientation ends to avoid overlap between mentors and preceptors. Mentors provide professional development advice and serve as consultants for complex cases and workplace issues.
Preceptors and mentors are not only experienced clinicians; they should have expert communication skills, relational abilities, and a positive attitude toward nursing and the organization. Preceptors who consistently convey caring support can reduce anxiety for new nurse grads and facilitate learning. Some studies suggest increased new nurse satisfaction when they can choose their own preceptors and mentors.
With the help of preceptors and mentors, new nurse grads will feel at home in their new work environment. They will commit to stay in an organization when they are empowered in practice, have a sense of belonging in a work group, and perceive that resources balance job stress.
Before long, new nurse grads become the seasoned professionals who serve as mentors for the next wave of new nurses, leading the way to a successful professional transition.
