Challenges of New Graduate Nurses: Transition to Practice

McKenna, L., & Newton, J. M. (2009). After the graduate year: a phenomenological exploration of how new nurses develop their knowledge and skill over the first 18 months following graduation. Australian Journal of Advanced Nursing, 25. Retrieved from http://web.a.ebscohost.com.proxymu.wrlc.org/ehost/pdfviewer/pdfviewer?sid=57a243af-c0d3-4f81-addf-041456493db3%40sessionmgr4005&vid=1&hid=4206

The report encouraged the assessment of NRPs’ efficacy, predominantly their capability to enhance patient outcomes, nurse retention, and professional proficiency. Despite the increasing amount of research on residency program outcomes, best practices for implementation are still changing. Therefore, this paper focuses on the best practice recommendations. NRPs have made a tremendous impact on the nursing field to both novice nurses as well as the expert nurse. The main themes appearing when reviewing the literature were reports about clinical competency, preparing new graduates for interprofessional teamwork, training, orientation, and mentorship for newly graduated nurses. These topics will be discussed in this paper as they pertain to nurse residency programs and newly licensed

The rising rates of seasoned nurses have resulted in replacing the more experienced and skilled professionals by infusing fresh graduates who lack the required skill and experience needed to effectively adapt to a clinical environment. This is coupled by the booming level of workload witnessed by these graduates who many are unable to cope with. Adding fuel to fire the initial work experience is discouraging for many graduates who hence are exhausted .This results in numerous fresh graduates completely burning out in just 18 months of their introduction to professional medical environment (World Health Organization, 2006).

Booth, B. (2011). Alarming Rise of New Graduate Nurse Attrition. Journal of Practical Nursing, 61(1), 3-5.

Transitioning from nursing school to working in a hospital setting can be a challenging time for a new graduate. Due to the nursing shortage, new graduate nurses are being hired with little to no experience. This is overwhelming for new nurses, especially when they are not getting adequate support or training from the hospital. The amount of stress, pressure, and lack of training is leading to a high turnover rate for new graduate nurses. With patient acuity on the rise, new graduate nurses that are filling these vacancies in the hospitals, need to be competent nurses to provide proper and safe care to the patients.

In excess of 1/3 of new graduate nurses consider departure from their place of employment during their first year of practice (Woten, M. B., & Heering, H. C., 2016).

The key learning points and insights learned is that in nursing, learning never ends. As the health care system continues to change, it is the nurse’s obligation to do the same. By reflecting on previous clinical feedback I realized that entering my first year of practice, I will be a novice nurse that will have a lot of personal and professional development to gain. The CNO style-learning plan will aid me in my first year of practice on a medicine floor.

It is very important for graduate nurses to fit in to a hospital as this gives them a chance to practice safely and effectively. For a New Graduate Nurse (NGN), fitting-in is about establishing secure and meaningful social bonds with ward staff (Rush, Adamack, Gordon, and Janke, 2014, p. 222). Fitting in, or the wish to fit in with ward staff is one of central piont of NGN transition experiences; it gives the NGN a feeling that they are a part of a social group with common goals, common experiences and a shared culture (Tingleff and Gildberg, 2014, p. 537). Success for the New Graduate Nurse would depend on how fast they establish friendly relationships and a sense of belonging. Hospitals understand the importance of NGN getting used to the

Across the United States, hospitals are experiencing a nursing shortage. Yet, according to the American Association of Colleges of Nursing, 63,857 students graduated from nursing school in 2015 alone and enrollment is increasing. It seems like a lot of new nurses to fill those vacancies, does it not? Studies show, however, that within a year, about thirty percent of those new graduates have voluntarily left their job (Hillman). Further studies have attributed the high turnover rate to new nurses’ lack of competency to handle conflict, make critical decisions, and function autonomously (Bratt). Many of the new graduates are disappointed with the hospital’s orientation, or lack thereof. Lack of knowledgeable preceptors and lack of nursing staffing in general has led to new nurses being thrown into autonomous function more quickly. Without proper training, these nurses must make sound clinical judgements and provide competent care to patients, which anyone can imagine is stressful. Today, Nurse Residency Programs (NRPs) are being instituted in numerous hospitals as a way to improve new graduate nursing skill, but research shows many other benefits to these programs. NRPs also reduce hospital spending costs, increase patient safety, and most importantly increase new nurse retention rates.

Staff satisfaction is empirical in retention of nurses in any healthcare setting. Although a slight turnover is necessary to maintain the diversity of ideas, too much of it causes instability that might affect patient and employee satisfaction negatively (Marquis & Huston, 2015). The planned change is to be executed at a small, private hospital (SPH) in Los Angeles with a 200-bed capacity, which offers emergency and medical-surgical services for adults. After a six-week hospital orientation, only 20% of new RNs hired at SPH in 2015 rated their confidence levels at >70% (Appendix A). Out of 32 new hires, 7 left during orientation, and 12 left before reaching 1 year- leading to 41% retention or a 59% turnover (Appendix B). The RN turnover of SPH is thrice the

The cost to train new nurses becomes so enormous for hospitals it would be much smarter to figure out why new nurses are leaving and provide tools to assist new nurses with their transition. Looking at reasons NGRN leave their new chosen profession seems simple enough find out what it is that decreases job satisfaction and fix it. One study looked at burnout in new nurses and possible causes, they looked at workplace environment, workplace incivility and empowerment.(Spence Laschinger et al., 2009) They found

Setter, Walker, Connelly, and Peterman (2011) found between 27%-53% of new graduates changed jobs during their first year of work. According to a recent survey, 37% of graduate nurses stated they were ready to change jobs after one year

Nursing career is one of the few fastest growing fields in the health care industry not only in the United States but also in the world. Nurse practice has drastically changed in the last decade and as a result the need for changes in nursing practice is becoming more and more important. The Institute of Medicine report discusses so many aspects in nursing but this paper requires detailing the impacts on Nursing Practice (Transforming Practice), Nursing Education (Transforming Education), and the Nurse’s role as a Leader (Transforming Leadership). These three key aspects are discussed in the following pages.

Many people believe mandatory residency programs for newly licensed nurses are long overdue. The knowledge needed to practice nursing has grown to include health policy, ethics, public health, research, healthcare delivery improvements, as well as leadership skills. Nurses are part of the multi-disciplinary team and must work together with healthcare providers who possess masters or doctoral degrees. Nursing school prepares nurses with the basic information they need to know in order to practice safe nursing. However, modern nurses are faced with ever increasing demands. New nurses must know how to collaborate with the healthcare team, manage their priorities, stay organized and recognize life-threatening situations. Many new grads are overwhelmed with the demands of nursing, which can lead to compromised patient care and safety. Formalized, supervised guidance will improve patient care and retain nurses. The study also recommended doubling the amount of nurses with a masters or doctoral degree by 2020 in order to provide an adequate supply of nurses who are able to assume nurse faculty, primary care providers, and researcher positions.

In today’s world, it is essential to incorporate nursing theory into practice. Patricia Benner, through her work, “has provided essential understanding of how knowledge and skills are acquired and directly applied to nursing practice, education, research and administration” (Altmann, 2007, p. 114). According to Benner’s model of skill acquisition, “the nurse passes through five stages of career development, novice, advanced beginner, competent, proficient and expert” (English, 1993, p.387). Specific patterns of behavior, thinking, and performance is present in each stage. The most experience is associated with the expert nurse and the least experience is possessed by the novice nurse (Benjamin, 2007). This model is based on ascending level of proficiency and the key concepts of this model are: competence, skill attainment, experience, clinical knowledge and practical knowledge