New graduate nurse transitioning: Necessary or nice?

Best practices of formal new graduate nurse transition programs: an integrative review

OBJECTIVES

The aim of this review was to identify best practices of formal new graduate nurse transition programs. This information would be useful for organizations in their support and development of formal transition programs for newly hired nurses.

DESIGN

An integrative review of the nursing research literature (2000-2011).

DATA SOURCES

The literature search included PubMed (MEDLINE), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Excerpta Medica Database (Embase). Studies that dealt with programs geared toward pre-registration nursing students were removed. At least two researchers evaluated the literature to determine if the article met the inclusion and exclusion criteria. The final number of articles included in this review is 47.

REVIEW METHODS

Cooper's (1989) five-stage approach to integrative review guided the process: problem formulation, data collection, evaluation of data points, data analysis and interpretation, presentation of results.

RESULTS

Transition program literature was examined according to four major themes: Education (pre-registration and practice), Support/Satisfaction, Competency and Critical Thinking, and Workplace Environment. This included new graduates' retrospective accounts of their undergraduate education and examination of orientation and formal supports provided beyond the traditional unit orientation period. Transition programs included residencies, internships, mentorships, extended preceptorships, and generic programs. Common elements of programs were a specified resource person(s) for new graduates, mentor (mentorship), formal education, and peer support opportunities. The length, type of education, and supports provided varied considerably among programs, yet the presence of a transition program resulted in improved new graduate nurse retention and cost benefits.

CONCLUSIONS

The variability in research designs limits the conclusions that can be drawn about best practices in transition programs for new graduate nurses. The presence of a formal new graduate transition program resulted in good retention and improved competency. The stronger evidence suggests that new graduate education should focus on practical skill development, preceptors should receive a level of formal training, formal support should be available at least through the difficult six to nine month post-hire period, opportunities for connection with their peers should be provided, and organizations should strive to ensure clinical units with healthy work environments.

Newly qualified nurses--experiences of interaction with members of a community of practice

AIM

To explore newly qualified nurses' (NQN) interaction with members of community of practice (CoP) and how it affects their participation in the CoP.

BACKGROUND

The entry of NQNs into the health care service is problematic which can result in NQNs leaving the profession within the first years of their career. Studies indicate that interaction between NQNs and their colleagues has an important influence of the way in which the NQNs experience their participation in the community of practice.

METHODOLOGY

Nine NQNs participated in the study. The data collection took place six months after graduating and the data were generated by participant observation and individual interview. The data were analysed inspired by Ricoeur's interpretation theory.

RESULTS

Most of the participants expressed satisfaction in their job. They were employed in CoPs characterised by dialogue and with interest in NQNs as a professional as well as a private person. Participants who expressed some dissatisfaction in their job situation were employed in CoPs with less dialogue and with less interest in NQN. Uncertainty about their own capacity and less professional discussions results in NQNs repeatedly asking for specific answer to their questions.

CONCLUSION

Mutual social and professional interest and acceptance increased NQNs' experience of being valued members of the CoP. Higher levels of dialogue and cohesion within the CoP corresponded with more active participation by NQNs and gave them a greater sense of security. Relevance for Clinical Practice NQNs' participation in a COP is influenced by the extent to which they are included in both professional and social interactions and afforded the opportunity to contribute with knowledge and experience from their nursing studies. Furthermore, the study indicates that NQNs' experience of social cohesion within the community appears to increase their professional performance.

The influence of authentic leadership on newly graduated nurses' experiences of workplace bullying, burnout and retention outcomes: a cross-sectional study

BACKGROUND

Retaining skilled and engaged nurses is critical during a time of shortage, however growing reports of workplace bullying threaten nurses' health and wellbeing, especially the transition of newly graduated nurses entering the profession. High rates of burnout and turnover among new nurses puts additional strain on limited financial resources in healthcare organizations and can compromise the quality of care provided to patients.

OBJECTIVES

The purpose of this study is to test a model linking authentic leadership to new graduate nurses' experiences of workplace bullying and burnout, and subsequently, job satisfaction and intentions to leave their jobs.

METHODS

This study employed a cross-sectional survey design with 342 new graduate nurses (defined as less than two years of practice experience) working in acute care hospitals in Ontario, Canada. Participants completed a questionnaire with measures of authentic leadership, workplace bullying, burnout, job satisfaction and turnover intentions. The model was tested using path analysis techniques within structural equation modeling.

RESULTS

The model fit indices suggested that the original hypothesized model did not adequately fit the data (χ(2)=33.59, df=5, p=.000, χ(2)/df=6.72, IFI=.937, CFI=.937, RMSEA=.130), thus an additional theoretically justified direct path from authentic leadership to job satisfaction was added, which improved the fit substantially (χ(2)=5.26, df=4, p=.261, χ(2)/df=1.32, IFI=.997, CFI=.997, RMSEA=.030). Authentic leadership had a negative direct effect on workplace bullying, which in turn had a direct positive effect on emotional exhaustion. Authentic leadership also influenced job satisfaction indirectly through bullying and emotional exhaustion. Authentic leadership, workplace bullying and emotional exhaustion all had significant direct effects on job satisfaction, which in turn, was related to lower turnover intentions.

CONCLUSIONS

The findings from this study demonstrate the fundamental importance of authentic leadership in creating supportive working environments. An authentic leadership style may reduce the probability of a unit culture of workplace bullying developing, contributing to a nursing workforce that is less burned out, more satisfied with their job, and ultimately, less likely to leave their position.

Meeting the needs of new graduates in the emergency department: a qualitative study evaluating a new graduate internship program

BACKGROUND

The purpose of this study was to explore the experiences of new graduate emergency nurses participating in a structured internship program. In order to meet the needs of new graduate nurses in emergency departments, these departments have developed a variety of orientation programs, some more successful than others. One type of program involves a combination of didactic content and hands-on clinical experience. This study examines the experiences of new graduate nurses in an internship program at a 200-bed community hospital.

METHODS

A qualitative design was used. Interviews with 8 of 9 nurses who participated in the new graduate internship program between 2006 and 2007 were conducted. Content analysis was used to analyze the data.

RESULTS

Three themes were identified from the experiences and expectations reported in the interviews: (1) the acquisition of new knowledge and skills in a specialty area, (2) becoming more proficient, and (3) assistance with role transition. The significant role and importance of the unit-base clinical nurse specialist (CNS) and the nurse preceptors were also identified.

CONCLUSIONS

The findings of this study suggest that a structured internship program is helpful to new graduate nurses when orienting to a critical care area such as the emergency department. Furthermore, the combination of didactic and clinical content, and the roles of the preceptor and unit-base CNS appear to be key factors in the successful transition from new graduate to emergency nurse.

From student to emergency nurse: a qualitative study of an educational support seminar

The purpose of this qualitative study was to document the transition experience of new nursing graduates who participated in an educational support seminar during their first year of emergency room (ER) practice. Study participants reported that the seminar provided learning and nurturing that facilitated their integration into the ER team, influenced their decision to stay in the ER, and grounded the process of their professionalization. Important considerations regarding education, professionalization, and leadership emerged.

Impact of Healthy Work Environments on New Graduate Nurses’ Environmental Reality Shock

Do healthy work environments (HWEs) facilitate new graduate transition into professional practice in hospitals? Are such environments related to a decrease in Environmental Reality Shock? Experienced nurses in 17 Magnet hospitals completed the Essentials of Magnetism II© (EOMII©) instrument that measures health of unit work environments. New graduates ( N = 468) were then tracked with modified versions of the EOMII© from immediate post hire to 4, 8, and 12 months post hire to ascertain degree of Environmental Reality Shock. New graduate nurses have extremely high anticipations of unit work environments that would enable delivery of quality patient care. HWE is the most-significant variable in Environmental Reality Shock, number of related Issues and Concerns, and perceptions of quality of patient care. Suggestions of how to improve quality of unit work environments are offered.

The effectiveness of strategies and interventions that aim to assist the transition from student to newly qualified nurse

EXECUTIVE SUMMARY

Background: The transition period from student to newly qualified nurse where nurses are adjusting to their new role and consolidating their knowledge and skills can be stressful. It is a time when many newly qualified nurses are left feeling inadequately prepared. A variety of strategies to ease the transition process have been reported, which aim to increase confidence, competence, sense of belonging of new graduates, improve recruitment and retention and reduce turnover costs.

OBJECTIVES

To synthesise the best available evidence on the effectiveness of support strategies and interventions aimed for newly qualified nurses.

METHODS

A comprehensive search was undertaken on major electronic databases to identify both published and unpublished studies from 2000 to the present date. Reference lists of retrieved papers were searched and authors contacted. Only quantitative studies published in English language were considered.Methodological quality and data extraction: Two reviewers independently assessed methodological quality and extracted data from the included studies. A third reviewer resolved any disagreements through discussion.

DATA SYNTHESIS

The review did not identify comparable Randomised Controlled Trials (RCTs), and as such meta-analysis of the data was not appropriate. The data extracted from the included studies were synthesized into a narrative summary.

RESULTS

Thirty three studies were included in the review: RCT (1), Quasi-experimental (3) and observational/descriptive studies (29). Countries of origin were: USA (25), Australia (4), England (2), New Zealand (1) and Thailand (1). Studies were categorised according to the type of programme or support strategy provided: nurse internship/residency programmes (14) and graduate nurse orientation programmes (7), preceptorship (4), simulation (3) and mentoring (2), final year nursing students transition programs (2) and externship (1).Outcomes were categorised as being important to the employer (recruitment, retention, turnover rates, competence, confidence and costs), or to the new graduate (stress and anxiety reduction, job satisfaction, knowledge/skills acquisition, critical thinking and interpersonal skills, confidence and professional nursing behaviours).

CONCLUSIONS

The range of outcomes reported across the studies made it difficult to report firm conclusions. A general increase in level of confidence was noted, along with reduction in stress and anxiety. Some success in relation to increases in knowledge, critical thinking and levels of job satisfaction were reported. A number of studies reported a V shaped pattern (initial high levels, dipping at 6 months and then reverting to baseline levels) for autonomy, job satisfaction, and professional transition. Research relating to improvements in retention and reduction in turnover was generally poor.

IMPLICATIONS FOR PRACTICE

The overall impact of intervention programmes appears positive, irrespective of the intervention. This may suggest that it is the organisation's focus on new graduate nurses with support from colleagues that is important. .Mentors/preceptors need to be adequately prepared for the role.

IMPLICATIONS FOR FUTURE RESEARCH

Future research should build on the strengths and limitations of the current studies. A lack of experimental studies means there is commonly little control over other variables that might influence the outcome. There is a need for larger studies using more objective and reliable measures.

Factors associated with the intention to leave among newly graduated nurses in advanced-treatment hospitals in Japan

AIM

The early resignation of newly graduated nurses (NGNs) will become a concern in Japan as the need for nurses increases. The aim of this study was to conduct an investigation using the Effort-Reward Imbalance (ERI) questionnaire to examine the effect of stressful experiences in the work environment and over-commitment on NGNs' intention to leave and to identify the factors that were associated with their intention to leave, clarifying the appropriate times at which to conduct interventions to prevent NGNs from leaving advanced-treatment hospitals.

METHODS

Anonymous self-administered questionnaires were distributed to all the NGNs (n = 1364) in 14 advanced-treatment university hospitals. Questionnaires with no missing data were returned by 737 NGNs (54%). For the development of the questionnaire, we designed a framework that consisted of the factors that occur during three stages of the NGNs' transition into the workplace. The questions addressed items for individual attributes, employment and organizational characteristics, the Role Model Scale, the ERI questionnaire, two scale items for health status, and the intention to leave. In order to determine the factors that related to the dependent variables, hierarchical multiple linear regression analyses were carried out.

RESULTS

We revealed that effort, subjective health status, role models, and effort were important factors that related to the NGNs' intention to leave, as well as their age and city size. Over-commitment and reward were not significant factors. We also found that three subscales of the Job Readiness Scale independently related to the NGNs' intention to leave.

CONCLUSION

These findings can help employers, supervisors, and senior staff of advanced-treatment university hospitals in Japan to improve their work environment in order to benefit NGNs and aid in their retention.

Acute nursing episodes which challenge graduate's competence: perceptions of registered nurses

On successful completion of nurse education programmes new graduate nurses are expected to meet the requirements for registration as a professional practitioner. Nurse educators need to collaborate with clinical colleagues to be responsive to changes in health care. Identifying challenging acute nursing episodes (CANE) that nurses' encounter in clinical practice and the aspect of competence that new graduate nurses require to manage these episodes effectively can inform undergraduate nursing curricula. Thus a qualitative, descriptive design was employed when undertaking a study to identify challenging acute nursing episodes which new graduates will encounter in clinical practice. Six focus groups were conducted in three university teaching hospitals in Ireland where a total of 28 registered nurses were recruited. Thematic analysis was used to extract themes from the focus group data. The results of this study identified 41 challenging acute nursing episodes and 4 key aspects of competence namely; patient assessment, technical/clinical skills; interactions and communications and clinical decision making. Findings of this study identify both the episodes which challenge new graduates and aspects of competence required by new graduates. These findings provide evidence for nurse educators to develop and deliver curricular content which is congruent with the realities of current day nursing practice.

A longitudinal study of factors associated with intentions to leave among newly graduated nurses in eight advanced treatment hospitals in Japan

This study aimed to examine the factors associated with intentions to leave among newly graduated nurses (NGNs), using a longitudinal design. We distributed self-administered questionnaires (to be returned anonymously) to all the NGNs (n=567) in nine advanced treatment hospitals in Japan on two separate occasions (Time 1 and Time 2, which were approximately 6 months apart). The questionnaire items addressed individual attributes, employment and organizational characteristics, and subjective health, and also included the 22-item Job Content Questionnaire, a scale of intentions to leave, and a novel 21-item job readiness scale. The data from 301 NGNs who had participated in both questionnaire instances was used, and a hierarchical multiple regression analysis was conducted to investigate the factors associated with intentions to leave. The results showed that while psychological distress was a more important predictor of intentions to leave than was cumulative fatigue at Time 1, cumulative fatigue was a more important predictor at Time 2. Among the job stressors, a lack of coworker support consistently led to increased intentions to leave, while a lack of supervisor support had a greater impact on intentions to leave at Time 1. "Being personally suited for nursing work", which was one of the job-readiness subscales, was found to independently and consistently influence intentions to leave. Our study findings revealed the predictors of intentions to leave among NGNs early in their careers in Japan.

Can an ADN Internship Program Prepare New RNs for Careers in Home Health Care Nursing? Findings From an Evaluation Study at Visiting Nurse Service of New York

In view of shortages of baccalaureate-trained nurses, the Visiting Nurse Service of New York embarked on an initiative to determine whether associate degree nursing graduates, through an intensive internship program, can perform on par with baccalaureate nursing (BSN) graduates. The associate degree in nursing (ADN) internship resembles the existing internship for BSN graduates but includes supplemental educational components. A quasi-experimental evaluation design was developed to examine the formative and summative outcomes of the initiative. ADN interns were compared with BSN interns on retention in the internship, clinical thinking, assessment skills, productivity, and intention to remain in nursing. Data were collected at pre- and postintervention intervals. Findings reveal few significant differences between the ADN and BSN interns, suggesting that with competitive recruitment, appropriate support, and supplementary training, ADN interns can perform on par with their BSN counterparts. The small number of participants in the internship programs presents a significant limitation to the study findings.