When I graduated from nursing school in 1971 and began my first job, my orientation lasted three days and was largely spent in class, learning about benefits and policies and procedures. We were also taught to perform CPR and tested on our medication knowledge. When I arrived on the unit where I was to work, a nurse clinician helped me develop my clinical skills. The unit also used the buddy system, wherein new nurses worked alongside more experienced nurses. In working with, and getting to know, the senior staff nurses, I gradually began to feel that I was part of the team.
Today hospitals make a huge investment when they hire new nurses, offering much more extensive orientation and training programs. Yet according to the RN Work Project, a 10-year national longitudinal study of new nurses begun in 2006, more than 18% of new nurses leave their first job within a year and more than 26% leave it within two years—although 92% go on to take another nursing job. So it's understandable that this first year, in which students make the transition to competent professionals, has received much attention; hospitals want to retain these new nurses in whom they've invested so much. To that end, many hospitals and health care organizations have developed transitional programs or contracted with others whose programs have boosted their retention rates above the national norm. For example, the University HealthSystem Consortium and the American Association of Colleges of Nursing jointly developed a one-year, evidence-based Nurse Residency Program aimed in part at “[taking] the novice learner from new graduate to more competent provider.” As Goode and colleagues reported last February in the Journal of Nursing Administration (JONA), this program has increased first-year retention rates for participating hospitals. Ten-year results showed that among new nurses, the rate of turnover within the first year was 13%.
In this month's original research article, “Hearing the Voices of Newly Licensed RNs: The Transition to Practice,” Spiva and colleagues provide insights into new nurses’ experiences as they transition from being students to being hospital staff nurses. As the authors note, earlier research has shown that, for new nurses, having “support, guidance, timely feedback, supervised training, and continued mentorship” from preceptors is vital to positive transitions.
But this kind of support shouldn't be limited to new nurses—and it needn't be. We can all describe the kind of units that people like to work on. Often this has little to do with nursing workloads and everything to do with a unit's atmosphere, especially the attitudes of its nurses. Of my various per diem jobs, I remember certain units that were welcoming and friendly, where coworkers demonstrated mutual caring and respect, and felt an evident sense of joy in their work. On other units, there was little camaraderie, and working on those units made for long, difficult shifts. Usually it was the nurse manager on a given unit who set the tone; sometimes it was the senior staff nurses.
Investing in transition programs that cultivate good mentoring practices is only a partial solution to the question of how to improve retention among new nurses—and experienced nurses as well, for that matter. We also need healthy workplaces. Recognizing this in 2001, the American Association of Critical-Care Nurses went on to develop a set of standards for creating and sustaining healthy workplaces that are applicable to any setting. These standards include skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition, and authentic leadership. (The full document is free online: http://bit.ly/d2kDwg.)
In JONA’s May issue, Josiane Hickson reported on findings from a survey investigating perceptions of workplace hostility and job satisfaction among more than 1,100 new nurses. Nearly half of respondents in both Magnet and non-Magnet facilities reported experiencing hostility from other nurses. Hickson called nursing leaders to task, stating that they have ignored the impact of nursing hostility and that they “have a responsibility to the new generation of RNs to provide an ethical and culturally safe work environment that is committed to professional actualization.” Don't we all?