NURS 558 Final PPT

Nurturing Future Nursing Leaders:
Strategies for Improved Transition and
Retention of New Graduate Nurses
Cherry Pie de Veyra RN, BSNc
NURS 558
San Francisco State University
Dr. Mercy Popoola
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)
Problematic Cycle of High
Turnover or Poor Retention
 Turnover/
 Retention
Stress 
Burn Out
$$$, disrupts
work teams 
 productivity
 Experienced RNs may
compromise patient safety
The Crucial Two Years
The first two years…Phase 1
Anticipatory Socialization
 Pre-work experience
O Education: BSN vs. ADN
O 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 expectations
unrealistic expectations  reality shock
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
The first two years…Phase 3
Socialization Outcomes
Positive work
Work satisfaction
and retention
Conflict in the work
Inadequate transition
expectations of nursing
Dissatisfaction and
Turnover rates
Patricia Benner’s
From Novice to Expert
A nurse in
the same
A nurse in
setting for
the same
more than
A nurse
setting for
2-3 years;
A nursing
2-3 years;
who has
able to
student or
any nurse
transitioning including
& plan long- as a whole
term goals and makes
to a new
for specific decisions
observation patient
based on
population previous
(Potter & Perry, 2009, p.9)
A nurse with
g of clinical
able to
problems; can
be a mentor
to other
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)
Factors Affecting Role Transition
O 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.
Factors Affecting Role Transition
O 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
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
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
The mediocre teacher tells. The good
teacher explains. The superior teacher
demonstrates. The great teacher inspires.
- William Arthur Ward
Casey, 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.
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:
Scott, E. S., Engelke, M. K., & Swanson, M. (2008). New graduate nurse transitioning:
Necessary or nice?. Applied Nursing Research, 21, 75-83.

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