Integrating Retired Registered Nurses Into a New Graduate Orientation Program

The Clinical Nurse Specialist: Maximizing Return on Investment

The United States health care system is facing an unprecedented nursing shortage, increasing complexity of care, and fewer experienced nurse mentors. These factors contribute to a cycle of burnout, turnover, decreased quality and safety, and a worsening financial bottom line. Improving these contributing factors depends on our ability to mitigate the structural causes of burnout and turnover. The clinical nurse specialist role is essential to improving the work environment, advancing evidence-based nursing practice, reducing turnover, and stabilizing the bottom line.

Transition to Practice Programs in Nursing: A Rapid Review

Background Transition to practice can be exceedingly stressful for newly qualified nurses as they grapple with the "reality shock" of everyday practice as an RN. Transition to practice programs were implemented as a support strategy to ease the transition from student to RN and are designed to increase graduates' confidence and competence, improve their professional adjustment, and increase their retention. Method This rapid review was framed by the Cochrane Methods Rapid Review, supported by the PRISMA statement checklist, aiming to identify and describe the benefits of transition to practice programs for newly graduated RNs and their impact on workforce retention. Results The literature revealed that mixed evidence exists regarding the value and benefits of graduate nurse transition programs to both the graduate and the health service. Conclusion There are multiple inconsistencies across clinical settings, organizations, and preceptor-ship/mentoring training, among others, particularly in relation to duration of the program and the amount of formalized contact/study days. [J Contin Educ Nurs. 2022;53(10):442-450.].

Using action research to evaluate a nursing orientation program in a multicultural acute healthcare setting

Objectives

Competence motivates newly employed nurses to provide high-quality care, which leads to appropriate patient care and satisfaction. A nursing orientation program can have a positive impact on new nurses who are joining healthcare organizations. The research examined the orientation program for new nurses in a multicultural setting to redesign the program.

Methods

The study was carried out in a multicultural tertiary setting. Action research was used as a research strategy with qualitative content analysis and quantitative evaluation. Seventy nurses were part of the orientation program. The competence of the nurses was assessed using the Nurse Competence Scale. Focus-group discussions were also conducted to find the views of the beneficiaries about the program.

Results

The study revealed that the overall competence was high, and there was an overall gain in the competence score (5.48%) among the nurses. Among their competence in different dimensions, new nurses had a maximum gain in competence for the dimension of ensuring quality. However, they showed low competence gain in teaching coaching. The results show that the difference in the overall pre- and post-test scores was statistically significant (P < 0.05) in all dimensions except teaching coaching and managing situations, and the program was effective. However, a few challenges were identified in the program.

Conclusions

New nurses were found to be competent, and the orientation program had a significant impact on the competence of the nurses. The findings emphasized the need for modification of some content and strategy for future programs. The strategies developed from the findings were presented. This helps hospitals to consider examining specific aspects of the orientation program and redesigning it so it can enrich the experiences of new nurses.

Novice nurses' readiness to practice in an ICU: A qualitative study

BACKGROUND

Novice nurses (newly qualified within the first 3-year period of professional practice after registration) must first face the reality and complexity of caring for high-acuity patients in the critical care setting, which can be an unfamiliar and demanding environment. The successful transition from education to professional practice of novice nurses hired for intensive care must be supported.

AIM

To explore Polish novice nurses' readiness to practice in an intensive care unit (ICU). Our study objectives included investigating pre-registration preparation for work in an ICU, identifying the most needed competencies to work in an ICU, and analysing organizational aspects of the professional orientation period.

STUDY DESIGN

A qualitative phenomenology design was applied.

METHODS

We conducted qualitative content analysis based on individual semi-structured in-depth interviews. Study recruitment was performed using a purposeful and network sampling strategy. The final number of participants was 17 Polish novice nurses.

RESULTS

The majority of responders replied that they were not prepared to work in an ICU after graduation. Professional orientation was planned-generally for a period of 3 months; however, in most places it was shortened. The respondents identified the five competencies most needed to work in an ICU: communication, teamwork, professional self-confidence, and knowledge and its practical use. Their enhancement could be achieved through simulations during both pre-registration and professional training.

CONCLUSION

Analysis of the novice nurses' orientation period revealed many difficulties that indicated a lack of readiness to practice in an ICU after graduation. Identifying novice nurses' strengths and weaknesses regarding clinical competence is important to guide the design of orientation programmes in ICU settings and nursing education programmes.

RELEVANCE TO CLINICAL PRACTICE

Readiness for ICU work may be improved by enriching education with simulations that enable training in the practical use of knowledge and critical care procedures. A supportive work environment is crucial during professional orientation.

The perceptions of older nurses regarding continuing to work in a nursing career after retirement: A qualitative study in two Chinese hospitals of different levels

BACKGROUND

There is a shortage of nurses worldwide, and a large number of older nurses will be entering retirement in the near future. Older nurses have rich nursing experience, and their retirement is a major loss of resources for the nursing profession. Returning to work after retirement is becoming increasingly popular among retirees today, but there is limited knowledge of the perceptions of older nurses regarding continuing to work in a nursing career after retirement.

OBJECTIVES

To explore older nurses' perceptions of continuing to work in a nursing career after retirement.

DESIGN AND SETTINGS

We conducted a descriptive, qualitative study of older nurses from two public hospitals of different levels in China in 2018.

PARTICIPANTS

A total of 27 older nurses aged 50-60 years were recruited, 15 from a tertiary hospital and 12 from a secondary hospital.

METHODS

Individual semi-structured interviews were conducted with older nurses. An interview guide was developed to explore nurses' perceptions of continuing to work in a nursing career after retirement. Thematic analysis was used for the data analysis. We developed an interview guide and analysed the data based on the three essential conditions of the framework for understanding behaviour.

FINDINGS

Based on the definition of the three essential conditions of the framework for understanding behaviour, 14 subthemes emerged from the data were categorised under this framework. The three main themes were as follows: the nurses' perceptions of their capability, motivation, and opportunity related to engaging in a nursing career after retirement. A number of older nurses with rich clinical experience have the ability and motivation to engage in nursing a career after retirement. However, discrimination against nurses, burnout, and the effects on young people's employment are barriers to older nurses considering working in a nursing career after retirement. Regarding re-employment after retirement, older nurses also expressed concerns about their physical health, family responsibilities, and salary as well as lack of managerial and policy support.

CONCLUSIONS

These themes confirmed previous findings and offered new perspectives on older Chinese nurses' perceptions of working in a nursing career after retirement. These findings will influence future policy development and research directions. Policies for facilitating a prolonged working life should be developed. Future research should focus on how to address the challenges confronted by older nurses.

Nurses' intention to work after retirement, work ability and perceptions after retirement: a scoping review

Nurses have been identified as active workforce post-retirement. Little is known about nurses' intention to work post-retirement and their work ability and perceptions post-retirement. The aim of this scoping review is to identify studies that have investigated nurses' intention and recruitment strategies to work post-retirement and their work ability and perceptions post-retirement. PubMed, CINAHL, Web of Science, Nursing and Health Database and in addition Google scholar were searched using different keywords (retired nurses, retired RNs, work intention, work ability, work perceptions, and older nurses) and an independent reviewer cross-validated all the identified articles. Of the thirty-seven studies identified from the search, 26 papers were excluded based on exclusion criteria, with a total of 11 studies finally included in the study sample. The review found in two studies low and high intentions to work as nurses after retirement. Factors influencing both intentions and recruitment strategies to work as a nurse post-retirement focused on lighter and flexible work conditions, supportive environment, financial incentives and formal rehiring policies. Nurses working post-retirement reported benefits (intrinsic factors such as self-worth, overcoming social isolation) and barriers (such as job demands and reduced physical work ability). The review found low and high intentions to work as nurses after retirement and identified factors influencing both intentions and recruitment strategies to work as a nurse post-retirement and benefits and barriers of working as nurses post-retirement that can inform strategies to retain nurses post-retirement.

Effective orientation programs for new graduate nurses: A systematic review

OBJECTIVE

To determine the most effective orientation program for new graduate nurses (NGNs) in hospital settings.

METHOD

A systematic review of existing literature was conducted following a search of the electronic databases Science Direct, PubMed, EBSCOhost, ProQuest, and Wiley Online (2008-2018). Searches utilized the following keywords nurse orientation, new nurse orientation, practical orientation, nurse transition, and nurse transition program.

RESULTS

A total of fourteen studies met our review criteria. Evidence from these studies showed that current orientation protocols consist of preceptorship, classes, and simulations of patient care. The most efficacious orientations had well-established goals and utilized proven learning materials, support systems such as preceptorship and mentorship, learning methods, and evaluation instruments within the organization.

CONCLUSION

Well-designed orientation programs will result in positive effects on NGNs and patient care in the hospital.

Transition support for new graduate nurses to rural and remote practice: A scoping review

BACKGROUND

New graduate nurses undertaking transition to practice encounter enormous challenges in their first year, and this is expounded in rural and remote locations. In rural and remote settings where geographical isolation and inadequate resources impact health care delivery, there is a perceived shortage of support systems to assist new graduate nurses to transition smoothly, with reported negative effects for all staff and on recruitment and retention.

OBJECTIVES

To investigate what transition support was reported for new graduate nurses to function effectively in rural and remote settings.

DESIGN

A study protocol was developed using principles for scoping reviews that have been developed over the past fifteen years.

DATA SOURCES

CINAHL, Medline, Proquest, Embase, Informit, PubMed, and Science Direct were systematically searched according to a predetermined search strategy.

REVIEW METHODS

Search terms included New Graduate AND Rural OR Remote AND Education. Studies were selected according to an inclusion and exclusion criteria. Three reviewers were involved in independent screening of articles. The degree of agreement for an article to be included was based on a Kappa score calculation for inter-rater reliability.

RESULTS

Of the 662 articles searched, 13 met the inclusion criteria and their findings synthesised to form this review. Three overarching themes (and a number of subthemes) were identified within the context of rural and remote nursing workforce development, and included: new graduates' support needs, multifaceted support strategies and recruitment and retention strategies.

CONCLUSIONS

Challenges faced by new graduate nurses when transitioning to practice are exacerbated in most rural and remote settings due to resourcing, lack of structured support programs, lack of training for support staff to mentor and give feedback and this impacts on recruitment and retention as well. Structured, well supported transition programs that provide flexible support are urgently required in these settings.

Value of Nurse Residency Programs in Retaining New Graduate Nurses and Their Potential Effect on the Nursing Shortage

BACKGROUND

More than 1 million nurses are expected to retire in the next 10 to 15 years. Retaining new nurses is important to help decrease turnover, vacancies, and organizational cost. The objective of this review was to explore what the literature informs us regarding nurse residency programs implementation in acute care settings and their ability to retain nurses.

METHOD

Through a search of the Cumulative Index to Nursing and Allied Health Literature, Ovid Nursing Journals, and ProQuest Health and Medical Complete databases, 42 articles were selected for full review.

RESULTS

Twenty-six articles met the inclusion criteria; most studies were descriptive. Established programs with at least a 12-month time frame were slightly more effective at retention. However, retention was not sustained at year two.

CONCLUSION

Future research should focus on the issues of sustaining retention in year two. If using proxy measurement tools, reliability and validity of those tools must be conducted. In addition, robust studies are needed to explore the effect of nurse residency programs on retention. J Contin Educ Nurs. 2018;49(6):282-288.