Secondary Logo

Share this article on:

Changing New Graduate Nurse Profiles and Retention Recommendations for Nurse Leaders

Tyndall, Deborah E., PhD, RN; Scott, Elaine S., PhD, RN, NE-BC, FNAP; Jones, Lenna R., MA, BS; Cook, Kristy J., BSN, RN

JONA: The Journal of Nursing Administration: February 2019 - Volume 49 - Issue 2 - p 93–98
doi: 10.1097/NNA.0000000000000716
Articles

OBJECTIVE This study compares and contrasts new graduate nurse attributes and perceptions using findings from a 2010 study and a recent analysis of new graduate nurses participating in the same residency program.

BACKGROUND As millennials saturate the healthcare work environment, their unique views and needs will influence the evolution of new graduate nurse residencies.

METHODS This study used previously reported data on new graduate nurses between 1999 and 2009 and compared it with a secondary analysis of data collected on new graduate nurses between 2011 and 2016.

Results This study provides evidence that millennial new graduate nurses' levels of commitment and satisfaction do not moderate turnover intentions in the 1st 2 years of practice as they did in the previous group of new graduate nurses.

Conclusions Job embeddedness, a construct that measures the likelihood of whether a person is going to stay, may be a better measurement among new graduate nurses than commitment or satisfaction because millennials, a generation that is predominant in current new graduate nurses, are more engaged than loyal.

Author Affiliations: Assistant Professor (Dr Tyndall), Professor (Dr Scott), and PhD Student (Ms Cook), College of Nursing, East Carolina University; and Data Analyst (Ms Jones), Vidant Medical Center, Greenville, North Carolina.

This study was supported by Versant Center for the Advancement of Nursing.

The authors declare no conflicts of interest.

Correspondence: Dr Tyndall, College of Nursing, East Carolina University, Health Sciences Bldg, Greenville, NC 27858 (tyndalld@ecu.edu).

According to the National Nursing Workforce Survey,1 the nursing workforce is changing with a continued lowering of the average age of RNs from 50 in 2013 to 48 in 2015. Undoubtedly, this is influenced by the influx of younger new graduate nurses (NGNs) and the retirement of aging RNs. Most new nurses entering practice are millennials (born in 1980-1999), a generational cohort that constitutes the largest in history.1 Millennials look for meaning and purpose in their work, and they will change jobs to find it.2 Thus, turnover is a critical concern for nurse leaders, and it is a major issue in the management of NGNs.

New graduate nurses participating in nurse residency programs are reported to have increased retention rates.3 Nurse residency programs are increasingly more common, with a recent review of 198 hospitals reporting almost 50% with a program.4 The Versant New Graduate Nurse Residency (VNGNR) is a standardized transition-to-practice program that hospitals can implement to support NGNs in becoming safe and competent nurses in practice. The residency varies in length with an average of 18 weeks. The VNGNR includes guided clinical experiences with a preceptor, a standardized and evidence-based curriculum, formal mentoring and debriefing sessions, and a 360-degree evaluation and measurement process. It has engaged in comprehensive measurement of NGN outcomes since its inception.5

In 2010, Ulrich and colleagues5 reported results from a 10-year exploration of a longitudinal database of NGNs who participated in the national VNGNR. This study was among the 1st to provide a large-scale overview of the efficacy of a consistently implemented transition-to-practice program for NGNs. Since that time, the evidence on the criticality and effectiveness of nurse residencies has continued to advance.6,7

The aim of this study was to compare and contrast NGN attributes and perceptions between 2 groups of VNGNR residents, those entering the workplace between the years 1999 and 2009, and those entering between the years 2010 and 2015. To evaluate changing NGN patterns, this study compares demographic data, work environment perceptions, commitment, satisfaction, and turnover intentions using findings from the earlier study5 and a recent analysis of a 5-year longitudinal database of NGNs participating in the same residency program. Understanding the changing perspectives of new nurses entering the workplace is critical information for nurse leaders who are charged with motivating and retaining these newest members of the nursing team.

Back to Top | Article Outline

The Millennial Workforce

Millennials are projected to be the majority of employees by the year 2020.8 Currently, the percentage of nurses who are 35 years or younger is growing, with recent reports that this age group comprises one-third of US nurses.9 Demographics from a large national study of NGNs (N = 1088) revealed new career nurses are primarily white women with an average age of 28 years.10 The National League of Nursing reported that, for the 2015-2016 academic year, 75% of baccalaureate students, 37.5% of associate degree students, and 51.1% of diploma nursing students were younger than 25 years.11 Overall, millennials are the best-educated generation, with almost half of all millennial women holding a bachelor's degree.12 This value for higher education is evident among millennials in nursing with reports of 65% currently matriculating or planning to matriculate to graduate education within 2 years.13

Millennials have several differences in job attitudes and needs. A number of studies found millennials have a weaker work ethic, believe work is not the center of their lives, and value work-life balance more than previous generations.14 Yet, newly licensed millennial nurses expressed greater organizational commitment and reported higher means on the cohesion among their team and supervisor support in a study comparing generational needs.15 Millennials are staying in jobs just as long as previous Generation Xers, although nursing turnover in this generation within the 1st 3 years of practice continues to be a major concern.16 A recent study of healthcare organizations conducted by the Advisory Board in 2015 found that 27.3% of employee turnover was attributable to those employed for less than 1 year.17 The unique dynamic millennials bring to the work environment requires generational strategies to mobilize their full potential within health systems.18

Back to Top | Article Outline

Contemporary Nursing Work Environments

Nursing work environments have evolved and increasingly been connected to both nurse and patient outcomes since the establishment of the Magnet Recognition Program®. New graduate nurse research evidences a strong relationship between the quality of the work environment and both job satisfaction and turnover.19,20 Job satisfaction and organizational commitment are associated with turnover reduction, a major goal for nurse leaders because turnover is costly and disruptive to healthcare organizations.21 Previous research demonstrates that organizational and leader behaviors promote skill development and engagement of NGNs.22 Leader empowering behavior and positive work environments are associated with stronger organizational engagement, increased organizational commitment and job satisfaction, and, ultimately, decreased turnover intention in NGNs.23

Back to Top | Article Outline

Methodology

This study used data reported in 20105 and compared it with a secondary analysis of data collected on NGNs between the years 2011 and 2016. The VNGNR collects initial metrics on NGNs within the 1st 2 weeks and then follows up with evaluation at week 12, the last week of the residency immersion period, and annually for up to 5 years. New graduate nurses access and complete scheduled metrics via a software system designed by Versant Holdings, LLC. New graduate nurses report demographic information using a company-designed survey. Three standardized instruments, the Conditions of Work Effectiveness II,24 Group Cohesion,25 and Leader Empowering Behavior scale,26 capture data on NGN perceptions of the work environment. Four additional instruments, the Organizational Commitment Questionnaire,27 Nurse Satisfaction and Work Satisfaction Scales,28 and Turnover Intent,5 are completed to gather data regarding NGN responses to transitioning into practice. Versions of these metrics have been used by Versant since the inception of the program. Details on these metrics are available in the original published findings.5

This study received approval from the university's institutional review board. Because raw data from the original study5 were unavailable to compare the findings from the 2010-2015 database, data were expressed either as means or percentages, mimicking variable expression in the 1st NGN analysis. Sample size and other relevant information was unavailable for NGN group 1, hence it is only reported for NGN group 2. Factor analysis was performed on all standardized metrics using a principal components extraction and varimax rotation with Kaiser normalization. Eigenvalues less than 1.0 were rejected. All metrics and derived subscales demonstrated acceptable or better internal reliability.

Back to Top | Article Outline

Results

Comparison of NGN Demographics

From 2010 to 2015, more than 9000 residents across 30 healthcare systems and 115 healthcare facilities completed the VNGNR. There was a total of 290 cohorts included in these data, with the largest cohort containing more than 200 residents. These organizations ranged from small rural facilities (<30 beds) to large urban medical centers (>800 beds). There was a 9% increase in the number of residents with a baccalaureate degree in NGN group 2 as compared with group 1. In addition, the number of residents younger than 23 years increased by 10%, and residents older than 40 years decreased by 5%. Table 1 illustrates demographics for both groups of NGNs.

Table 1

Table 1

Back to Top | Article Outline

NGN Perceptions of the Work Environment

Overall, for every interval measured, the mean scores for NGN group 2 perceptions of the work environment and leader empowering behaviors were higher than those reported in NGN group 1. Group cohesion means were comparable for both groups. In addition, some trending changes were evident. On the information and support subscales of the Conditions of Work Effectiveness, the means progressively increased from the end of residency to the month 24 measurement in NGN group 1. In contrast, these means decreased across time in NGN group 2. Table 2 reflects the responses to NGN perceptions of the work environment for both groups.

Table 2

Table 2

Back to Top | Article Outline

NGN Levels of Organizational Commitment, Satisfaction, and Turnover

The mean scores for overall organizational commitment were higher in NGN group 2 than NGN group 1 (Table 3). However, whereas mean scores for organizational commitment increased across the 2-year period for group 1, they declined over time in group 2. Nurse and work satisfaction scores were relatively similar for the 2 groups with the exception of NGN perceptions of time to complete work. Nurse and work satisfaction scores decreased over time in both groups.

Table 3

Table 3

Table 4 contains turnover intention data for the 2 groups. Ten percent more residents in group 2 reported no intention to turnover at the end of residency compared with group 1, whereas 3% of group 2 residents reported intention to turnover at the end of residency compared with 5% in group 1. At 12 months, the resident groups had similar turnover intent; however, at month 24, group 2 reported greater intent to turnover than NGNs in group 1.

Table 4

Table 4

Back to Top | Article Outline

Discussion

The aim of this study was to compare NGN attributes and perceptions between 2 groups, those entering the workplace between 1999 and 2009 and those entering between 2010 and 2015, and to determine the perspective changes contemporary NGNs bring to the workplace. Demographic changes evident across these groups demonstrate the increasing saturation of millennials in NGN residency programs and the increased educational level of this cohort of nurses. This study provides evidence that millennial NGNs value the same organizational environment and work components but that these values and levels of commitment and satisfaction do not moderate turnover intentions in the 1st 2 years of practice as they did in the previous group of NGNs. This affirms previous turnover research demonstrating that organizational loyalty and resulting lowered turnover intentions of millennial nurses with less than 3 years in the organization are not associated with levels of engagement and organizational commitment as in previous generations of NGNs.17

In addition, these findings reveal that, whereas satisfaction levels of NGNs remain comparable with those in previous and current generations of NGNs, perceptions of the work environment and leader behaviors have improved in recent years. However, of concern is the downward trending during the transition period of 2 particular work conditions: the availability of information and the amount of support during the 1st 2 years of practice. Because millennials value personal attention, information, and supervisory feedback,29 nurse leaders need to consider these shifts in NGN perspectives and ensure increased levels of communication and feedback. Typically, after an intensive programmed residency ends, preceptors and unit leaders provide the main support systems for NGNs.

Retention research in nursing has traditionally focused on measuring perceptions of the work environment, organizational commitment, and satisfaction because these data are highly associated with turnover intentions.30 However, this study shows that higher levels of commitment and satisfaction in the more recent NGN group 2 are not associated with a decrease in turnover intention. Instead, these NGNs reported an increase in turnover intentions at 24 months. Addressing delayed, increased turnover requires consideration of new metrics that might better aid nurse leaders in managing retention. Job embeddedness, a construct that measures the likelihood of whether a person is going to stay, may be a better NGN measurement than commitment or job satisfaction because millennials are more engaged than loyal.31

Job embeddedness examines aspects of retention based on fit, links, and sacrifices within the organization and community in which they live.32 When millennial nurses were embedded in their jobs, they were more likely to stay in their jobs.31 A meta-analysis of job embeddedness evidenced that both on-the-job embeddedness and off-the-job embeddedness had a significant effect on actual turnover.33 A recent study of nurse retention found that the quality of the leader relationship with the employee has a direct and significant effect on the nurse's embeddedness in the organization.34 Furthermore, this study provided evidence that the more a nurse identifies with the employing organization, the higher the level of job embeddedness.

Back to Top | Article Outline

Recommendations for Nurse Leaders

The linkage between job embeddedness and leader relationships with staff affirms the criticality of nurse leaders in retaining NGNs. Nurse leaders are important to NGNs not only because they provide resources and recognition but also because they foster healthy work environments where communication and support are available.35 New graduate nurses in this study reported feeling that levels of information they received decreased over time. Millennials need more information and communication during the 1st 2 years of practice as they are acclimating to the organization and the profession. Therefore, nurse leaders should prioritize communication strategies that include both individual feedback (eg, work performance) and organizational updates (eg, financial status and workplace changes) to keep millennials engaged and committed to the organization.36 Millennials are accustomed to high levels of communication about their performance, and these behaviors promote a sense of being respected and valued—essential elements for retention.31,37

New graduate nurses in this study reported feeling reduced levels of support over time. Because perceptions of supervisor and peer support are critical to the development of job embeddedness, and job embeddedness is associated with retention, activities that promote the development of peer and supervisor relationships are critical. Fostering the development of peer relationships and providing opportunities for continued meetings of NGNs beyond the 1st year of residency might increase perceptions of ongoing support. In addition, 1-on-1 brief, focused meetings with NGNs and the nurse leader might improve the sense of feeling supported. Ongoing support can also be encouraged by the nurse leader increasing growth opportunities for NGNs. Growth opportunities can be promoted by implementing early-career ladder programs, facilitating role transitions within the organization to retain millennial staff, and directing tuition assistance to areas of future need because millennials value education.17

Unlike organizational commitment and job satisfaction, job embeddedness is a construct that measures attributes that promote loyalty and retention. This differing focus from commitment and satisfaction holds promise for nurse leaders working with millennial NGNs who are committed and satisfied, but not necessarily loyal. Adding a measurement of job embeddedness to outcomes assessed in NGN residency programs can help evaluate those newcomers most at risk for leaving the organization.

Back to Top | Article Outline

Limitations

The ability of the authors to compare 2010-2015 NGN data with the 1999-2009 data was limited to what was available in the publication itself. In addition, sample sizes and measures of variation were not reported in the earlier study hindering our ability to report whether findings were statistically significant. Although this study reports data from 1 NGN residency curriculum, resident samples were generated from 115 healthcare facilities and may support generalizability of the findings.

Back to Top | Article Outline

Conclusions

The purpose of this study was to evaluate changing NGN demographic patterns, perceptions of the work environment, and levels of commitment, satisfaction, and turnover intent. The study found evidence that work environments and leader behaviors have improved in response to an emphasis on the role these play in retention. However, there were a substantial change in the trending of commitment and satisfaction during the 1st 2 years of practice and a higher percentage of NGNs with turnover intentions at the end of year 2. In an effort to reduce the experience of turnover in the 1st 2 years of practice, residency program coordinators and professional development staff must collaborate with nurse leaders and unit preceptor/mentors to use strategies that increase job embeddedness. This construct should be piloted as a metric for determining NGNs at risk for turnover.

Back to Top | Article Outline

References

1. Budden JS, Moulton P, Harper KJ, Brunell ML, Smiley R. The 2015 national nursing workforce survey. J Nurs Regul. 2016;7(1):S1–S90. doi:10.1016/S2155-8256(16)31055-9.
2. Gallup, Inc. State of the American workplace. http://news.gallup.com/reports/199961/state-american-workplace-report-2017.aspx. Accessed September 4, 2018.
3. Van Camp J, Chappy S. The effectiveness of nurse residency programs on retention: a systematic review. AORN J. 2017;106(2):128–144.
4. Barnett JS, Minnick AF, Norman LD. A description of U.S. post-graduation nurse residency programs. Nurs Outlook. 2014;62(3):174–184.
5. Ulrich B, Krozek C, Early S, Ashlock CH, Africa LM, Carman ML. Improving retention, confidence, and competence of new graduate nurses: results from a 10-year longitudinal database. Nurs Econ. 2010;28(6):363–376.
6. Goode CJ, Reid Ponte P, Sullivan Havens D. Residency for transition into practice: an essential requirement for new graduates from basic RN programs. J Nurs Adm. 2016;46(2):82–86.
7. Pittman P, Herrera C, Bass E, Thompson P. Residency programs for new nurse graduates: how widespread are they and what are the primary obstacles to further adoption? J Nurs Adm. 2013;43(11):597–602.
8. Toosi M. Labor force projections to 2020: a more slowly growing workforce. Mon Labor Rev. 2012;1:43–64.
9. Bureau of Labor Statistics, US Department of Labor. Occupational outlook handbook: registered nurses. https://www.bls.gov/ooh/healthcare/registered-nurses.htm. Updated 2017. Accessed September 4, 2018.
10. Spector N, Blegen MA, Silvestre J, et al. Transition to practice study in hospital settings. J Nurs Regul. 2015;5(4):24–38.
11. National League for Nursing. Biennial survey of schools of nursing. http://www.nln.org/docs/default-source/newsroom/nursing-education-statistics/percentage-of-students-enrolled-by-age-and-program-type-2016-(pdf).pdf?sfvrsn=0. Accessed September 4, 2018.
12. GrafPew Research Center. Today's young workers are more likely than ever to have a bachelor's degree. http://www.pewresearch.org/fact-tank/2017/05/16/todays-young-workers-are-more-likely-than-ever-to-have-a-bachelors-degree/. Accessed September 4, 2018.
13. Schwartz J, Sharts-Hopko NC, Bhattacharya A. Comparison of demographics, professional outcomes, and career satisfaction in accelerated and traditional baccalaureate nursing graduates. J Nurs Educ. 2015;54(3):S39–S46. http://dx.doi.org/10.3928/01484834-20150218-11.
14. Twenge JM, Campbell SM, Hoffman BJ, Lance CE. Generational differences in work values: leisure and extrinsic values increasing, social and intrinsic values decreasing. J Manage. 2010;36(5):117–1142.
15. Keepnews DM, Brewer CS, Kovner CT, Shin JH. Generational differences among newly licensed registered nurses. Nurs Outlook. 2010;58:155–163.
16. Koppel J, Deline M, Virkstis K. The case for focusing on millennial retention. J Nurs Adm. 2017;47(7/8):361–363.
17. Son Y, Vonderhaar K, Tanner S, Terry A, Carbery C. Stop Turnover in the First Three Years. Washington, DC: The Advisory Board Company; 2016.
18. Diesing G. Millennials who they are, what they want, & why you need them. Hosp Health Netw. 2016;90(11):22–27.
19. Kutney-Lee A, Wu ES, Sloane DM, Aiken LH. Changes in hospital nurse work environments and nurse job outcomes: an analysis of panel data. Int J Nurs Stud. 2013;50(2):195–201.
20. Van Bogaert P, Clarke S, Roelant E, Meulemans H, Van de Heyning P. Impacts of unit-level nurse practice environment and burnout on nurse-reported outcomes: a multilevel modelling approach. J Clin Nurs. 2010;19(11–12):1664–1674.
21. Yin L, Jones CB. A literature review of nursing turnover costs. J Nurs Manag. 2013;21(3):405–418.
22. Fallatah F, Laschinger HKS. The influence of authentic leadership and supportive professional practice environments on new graduate nurses' job satisfaction. J Res Nurs. 2016;21(2):125–136.
23. Spence Laschinger HK, Wilk P, Cho J, Greco P. Empowerment, engagement and perceived effectiveness in nursing work environments: does experience matter? J Nurs Manag. 2009;17(5):636–646. doi:10.1111/j.1365-2834.2008.00907.x.
24. Laschinger HKS, Finegan J, Shamian J, Wilk P. Impact of structural and psychological empowerment on job strain in nursing work settings: expanding Kanter's model. J Nurs Adm. 2001;31(5):260–272.
25. Good LR, Nelson DA. Effects of person-group and intragroup attitude similarity on perceived group attractiveness and cohesiveness: II. Psychol Rep. 1973;33(2):551–560.
26. Hui C. Effects of Leader Empowerment Behaviors and Followers' Personal Control, Voice, and Self-efficacy on In-role and Extra-ROLE Performance: An Extension and Empirical Test of Conger and Kanungo's Empowerment Process Model. Indiana University: ProQuest Dissertations Publishing; 1994.
27. Mowday RT, Steers RM, Porter LW. The measurement of organizational commitment. J Vocat Behav. 1979;14(2):224–247.
28. Hinshaw AS, Atwood JR. Nursing staff turnover, stress, and satisfaction: models, measures, and management. Annu Rev Nurs Res. 1983;1:133–153.
29. Thompson C, Gregory JB. Managing millennials: a framework for improving attraction, motivation, and retention. Psychol Manag J. 2012;15:234–246.
30. Blegen MA, Spector N, Lynn MR, Barnsteiner J, Ulrich BT. Newly licensed RN retention: hospital and nurse characteristics. J Nurs Adm. 2017;47(10):508–514. doi:10.1097/NNA.0000000000000523.
31. Halfer D. Job embeddedness factors and retention of nurses with 1 to 3 years of experience. J Contin Educ Nurs. 2011;42(10):468–476.
32. Holtom BC, Tidd ST, Mitchell TR, Lee TW. A demonstration of the importance of temporal considerations in the prediction of newcomer turnover. Hum Relat. 2013;66:1337–1352. doi:10.1177/0018726713477459.
33. Jiang K, Liu D, McKay PF, Lee TW, Mitchell TR. When and how is job embeddedness predictive of turnover? A meta-analytic investigation. J Appl Psychol. 2012;97(5):1077–1096.
34. Dechawatanapaisal D. Nurses' turnover intention: the impact of leader-member exchange, organizational identification and job embeddedness. J Adv Nurs. 2018;74(6):1380–1391.
35. Regan S, Wong C, Laschinger HK, et al. Starting out: qualitative perspectives of new graduate nurses and nurse leaders on transition to practice. J Nurs Manag. 2017;25(4):246–255.
36. Walden J, Jung EH, Westerman CYK. Employee communication, job engagement, and organizational commitment: a study of members of the millennial generation. J Pub Relat Res. 2017;29(2-3):73–89. doi:10.1080/1062726X.2017.1329737.
37. Ng TWH. Embedding employees early on: the importance of workplace respect. Pers Psych. 2016;69:599–633.
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.