Goal is to reduce high-attrition rate for new nurses
This June, 130 students graduated from UBC Okanagan’s School of Nursing. While a new career is an exciting milestone, it can be challenging for new nurses. Statistics show high attrition rates, with many leaving the profession after just two years.
Nursing Professor Kathy Rush has a long history of teaching. Part of her role is ensuring that students who graduate from the School of Nursing succeed at what they do. Rush has recently published a review that evaluated several programs that support nurses as they enter the workforce. We asked why these programs are necessary and more importantly: do they work?
Your recent study looked at a number of programs that support new graduate nurses. Can you explain why this support is important for new nurses as they enter a clinical setting?
Without support, new nurses leave the profession at alarming rates. Within the first two years, 33 to 61 per cent of new nurses change their place of employment or leave the profession entirely.
Transition from being an undergraduate student to a full-fledged graduate or registered nurse is often a stressful and turbulent time. New graduates leave the more protected confines of their student nursing roles to assume the full scope of practice of a professional and are expected to practice independently. Patients are sicker, older and require complex care. When a relatively novice and inexperienced new nurse is confronted with high acuity and expanded responsibilities, coupled with limited organizational resources and heavy workloads, it can be simply overwhelming.
They need support to do this. Evidence shows that new graduate transition programs work. They improve retention, increase new nurse confidence and competence in providing patient care, and reduce organizational costs. This is significant for the new graduate and for the institutions in which they work.
You noted that the majority of programs staggered education over time, with the intent to parallel the evolving developmental needs of new graduate nurses during their first year of practice. Can you explain why this staggered education seems to work?
We found that the majority of programs staggered education, but the evidence was not decisive that it improves outcomes any better than giving education in a concentrated form at the beginning of the program. While programs are staggering education, few have examined the impact. Our research failed to find any differences when education was concentrated or staggered, but we are only a single study and much more work needs to be done to determine if it really has advantages.
Most programs are choosing the staggered approach because theories of new nurse transition—such as my co-author Judy Duchscher’s transition shock theory—show that new graduates pass through fairly predictable stages in their first year of practice. Transition programs need to be able to support new graduates through these stages of development.
Can you explain how vital preceptor support is for the new graduate nurses?
Traditionally one of the most important supports for the new nurse transitioning to clinical practice is the preceptor, or an experienced nurse who supervises, mentors and helps ease the new nurse into the realities of practice.
The quality vs the quantity of preceptor support seems to make a difference in the transition experience and quality appears to be contingent on the use of a bundle of strategies. Having the new nurse and preceptor working the same shifts and sharing the same patient assignment, giving the preceptor fewer patients, keeping the ratio of preceptor to new nurses (preceptees) low, and providing the preceptor with training, are a few of the strategies that seem to make for a satisfying transition experience for the new nurse.
Preceptors enhanced progression when they emphasized the new graduates’ learning and growth, gave feedback, engaged unit staff to build unit support, kept them on track and encouraged their evolving accountability in care decisions.
What is the main goal of your study? Is it to create awareness of the support new nurses need? Or is it to create a universal on-boarding system for all new graduate nurses across the country?
Probably both. Our primary goal was identifying best practices of formal new graduate nurse transition programs and the components that facilitate transition. There is huge body of research in this area but the evidence isn’t always top tier. We wanted to determine the aspects of these programs that were associated with the best outcomes.
We looked at education in these programs, at various types of support, and at the workplace environment to determine what was effective and what wasn’t. With the growing acceptance and mandating of these programs and their benefits, we think it is important to define a minimum dataset of components to maximize outcomes for new graduate nurses.
From your research, what are the best supports for newly-graduated nurses?
- Partnerships between educational and practice institutions to facilitate the transition for newly-graduated nurses
- Transition programs that are grounded in transition theory
- Orientations of sufficient length with qualified, caring, and trained preceptors who use several approaches to support and facilitate progress for newly-graduated nurses
- Staged approaches (e.g., staggered education; simple to complex skills acquisition) that use evidence-based components
- Healthy work environments with supportive unit-based nursing staff
About UBC's Okanagan campus
UBC’s Okanagan campus is an innovative hub for research and learning in the heart of British Columbia’s stunning Okanagan Valley. Ranked among the top 20 public universities in the world, UBC is home to bold thinking and discoveries that make a difference. Established in 2005, the Okanagan campus combines a globally recognized UBC education with a tight-knit and entrepreneurial community that welcomes students and faculty from around the world.
To find out more, visit: ok.ubc.ca.