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![Page 1: Nurturing Future Nursing Leaders : Strategies for Improved Transition and Retention of New Graduate Nurses Cherry Pie de Veyra RN, BSN c NURS 558 San Francisco.](https://reader038.fdocuments.us/reader038/viewer/2022103112/551c3f89550346a3488b4a35/html5/thumbnails/1.jpg)
Nurturing Future Nursing Leaders:
Strategies for Improved Transition and Retention of New Graduate
Nurses
Cherry Pie de Veyra RN, BSNc
NURS 558San Francisco State University
Dr. Mercy Popoola
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Issue of Nursing Retention
Approximately 30% and up to 50% of new graduate nurses will quit within the first year of employment.(Hillman & Foster, 2011)
High staff turnover is expensive – costs anywhere from $22,000 to over $64,000 per nurse. (Finkelman, 2012, p.285)
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Problematic Cycle of High Turnover or Poor Retention
Turnover/
Retention
Staffing Shortage
Increased Workload
Excessive Overtime
Stress Burn Out
$$$, disrupts work teams productivity
Experienced RNs may compromise patient safety
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The Crucial Two Years
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The first two years…Phase 1
Anticipatory Socialization Pre-work experience
O Education: BSN vs. ADNO Other experiences r/t age, race,sex, marital status and personality
All of these determine the expectations nursing
students may have about life after graduation.
realistic expectationsvs.
unrealistic expectations reality shock
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The first two years…Phase 2
Organizational Socialization Actual work experience
O Orientation – The amount of time and depth of training greatly impacts the new graduate’s perception of work stress and satisfaction.
O Working conditions and environment• Stress level r/t work demands• Relationship with supervisors and other
staff
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The first two years…Phase 3
Socialization OutcomesPositive work experience
✚Effective
orientation/transition program
________________Work satisfaction
and retention
Conflict in the work environment
✚Inadequate transition
program/period✚
Unrealistic expectations of
nursing role________________
Dissatisfaction and Turnover rates
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Patricia Benner’sFrom Novice to Expert
Novice
Advanced Beginner
Competent
ProficientExpert
A nursing student or any nurse transitioning to a new specialty
A nurse who has some experience, including mere observation
A nurse in the same setting for 2-3 years; able to anticipate & plan long-term goals for specific patient population
A nurse in the same setting for more than 2-3 years; able to understand situations as a whole and makes decisions based on previous experiences
A nurse with intuitive understanding of clinical situations; able to anticipate potential problems; can be a mentor to other nurses
(Potter & Perry, 2009, p.9)
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Role Transition
O Survey of 270 graduate nurses working in 6 acute care hospitals in metropolitan area of Denver, Colorado in 1999.O Data collected at specific intervals: at
baseline, after 3, 6 and 12 months, additional follow-up for groups employed >1 year.
O Survey included open-ended questions asking nurses to identify any difficulties during their role transition from student to staff nurse
(Casey, Fink, Krugman, & Propst, 2004)
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Factors Affecting Role TransitionO Lack of confidence
• anxiety, insecurity & feeling incompetent during the 1st year of employment
• Difficulty with making critical decisions about patient care, setting priorities and time management
O Tension among peers & preceptors• New nurses did not feel welcomed
& respected by experienced nurses
• Some preceptors were less patient and sympathetic – They forgot how it was like to be
the inexperienced nurse.
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Factors Affecting Role TransitionO Struggle with dependence & independence
• Lack of a guiding figure or mentor r/t absence of consistent preceptors during orientation period
• Others were overwhelmed with responsibilities yet were uncomfortable delegating work to unlicensed personnel.
• Others felt “babied” which hindered their ability to grow & develop professionally.
O Stressful work environment• nurse-to-patient ratio r/t shortage• A few of the new nurses had to assume the role of
charge nurse or preceptor after only 9 months of experience and training stress r/t responsibility
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Strategies to Improve Role Transition –
Evidenced-Based Residency program
Changes Implemented:O 5 day orientation changed
to 22 weeks (later reduced to 16 weeks in 2008) residency program
O Content experts (e.g., advanced practice nurses, respiratory therapists) lectured about the specific conditions & diseases of the pediatric population
O Mandatory preceptor workshops for both novice & advanced preceptors
O Annual recognition program for preceptors to recognize their contributions and commitment in mentoring new nurses
(Hillman & Foster, 2011)
Implemented in 2004 by the Magnet-designated Children’s
Hospital of Michigan in Detroit
BEFORE: 1-year retention rate
of newly hired RNs was 50-70%;
2-year retention rate was 40-63%AFTER: 1-year was as high as
100%; 182 of 251 new graduate
nurses, who completed the program from June 2005 to October 2009, still employed
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Strategies to Improve Role Transition – Collegial Clinical Model for Orientation (CCM)
Stages of ZPD:O Stage 1: Assisted
performance – learning occurs with the support & assistance of a more experience peer or the instructor
O Stage 2: Self-directed – instructor’s support decreases & eventually ceases while the learner assumes more responsibility
O Stage 3: Assistance is no longer needed as learning has been internalized; occurs at the end of the orientation period
(Salera-Vieira, 2009)
Implemented in the Women and Infants’ Hospital in Providence, Rhode Island
CCM is the same format used
in nursing programs – one clinical instructor for several students in a clinical setting
Learning Theory used is Lev Vygotsky’s sociocultural development theory, which uses the concept known as zone of proximal development (ZPD)
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What can Nurse Leaders do?
Nurse leaders can help address the issues of nursing shortage and staff retention by supporting new graduate nurses by:
O Advocating for transition or residency programs to competency, confidence & satisfaction of new RNs
O Maintaining a healthy working environment Not using novice RNs to cover for staffing shortage
before the end of orientation period Zero tolerance for lateral violence or bullying
O Supporting experienced RNs who are serving as preceptors and mentors for novice RNs
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Shaping our Future Nurse Leaders
O New graduate nurses are the future employee pool
O Job satisfaction & retention are greatly influenced by the quality of orientation and support received by the new graduate nurse.
O A positive experience will encourage the now proficient nurse to mentor novice nurses & give them the same positive experience he/she had during the transition period.
The mediocre teacher tells. The good teacher explains. The superior teacher demonstrates. The great teacher inspires. - William Arthur Ward
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ReferencesCasey, K., Fink, R., Krugman, M., & Propst, J. (2004). The graduate nurse
experience. Journal of Nursing Administration, 34(6), 303-311.Finkelman, A. W. (2012). Leadership and management for nurses: core
competencies for quality care (2nd ed.). Boston: Pearson.Green, C. (2012). Nursing intuition: a valid form of knowledge. Nursing
Philosophy, 13(2), 98-111. http://0-onlinelibrary.wiley.com.opac.sfsu.edu/doi/10.1111/j.1466-769X.2011.00507.x/full
Hillman, L., & Foster, R. R. (2011). The impact of a nursing transitions programme on retention and cost savings. Journal of Nursing Management, 19, 50-56.
Potter, P. A., & Perry, A. G. (2009). Fundamentals of nursing (7th ed.). St. Louis, Mo.: Mosby Elsevier.
Salera-Vieira, J. (2009). The collegial clinical model for orientation of new graduate nurses: a strategy to improve the transition from student nurse to professional nurse. Journal for Nurses in Staff Development, 25(4), 174-181. doi: 10.1097/NND.0b013e3181b1d146
Scott, E. S., Engelke, M. K., & Swanson, M. (2008). New graduate nurse transitioning: Necessary or nice?. Applied Nursing Research, 21, 75-83. http://0-dx.doi.org.opac.sfsu.edu/10.1016/j.apnr.2006.12.002