How to Retain New Graduate Nurses for Beyond the First Year: A Scoping Review

Hannah Churchill lives in Hanover, Ontario, is a mother of 9-year-old twin boys Bennett and Sawyer and a dog mom to their mini-golden doodle puppy Jessi. In her spare time, she enjoys working out, taking walks, playing board games, reading, watching movies, and relaxing on the beach.

Hannah has been a nurse for almost twenty years and throughout her experience has witnessed firsthand how new graduate nurses are thrown into a workplace with minimal orientation, training and little to no support from their nurse manager. I have consoled many novice nurses crying in bathroom stalls, saying they are overwhelmed and questioning why they went to school to be a nurse. Transitioning from the classroom to the workforce is a critical time for new nurses. Senior healthcare leaders need to be more aware of this transition and ensure that appropriate systematic interventions are in place to help onboard, support, and guide new graduate nurses in their nursing careers.

Introduction

The shift from student to professional nurse is a critical phase that presents significant challenges for new graduates. This transition, characterized by changes in roles, responsibilities, and the application of knowledge, often leads to high turnover rates during the first year of employment if not properly supported. This paper explores the factors contributing to turnover and highlights strategies for enhancing retention, underscoring the importance of supportive structures based on Dr. Duchscher’s Transition Stages Model.

Significance of Retention

In light of intensified nursing shortages stemming from the COVID-19 pandemic, retaining new graduate nurses has become a critical priority. These new graduates are vital for sustaining staffing levels in healthcare settings. Many resign due to unmet needs, highlighting the necessity for targeted interventions and mentorship programs that assist their transition into the professional environment, ultimately benefiting the broader healthcare system.

Findings: Key Themes in Turnover

The review synthesizes insights from twenty-three studies using Arksey and O’Malley’s framework and reveals three central themes contributing to the resignation of new graduate nurses: support, stress/burnout, and training/mentoring.

Support: A prevalent issue is the stigmatization of new graduates, who are frequently viewed as incompetent. This stigma intensifies feelings of inadequacy. The absence of emotional and professional support from supervisors, along with an unfavourable work environment, further contributes to high turnover rates.

Stress/Burnout: Many new nurses experience burnout due to high job demands and pressure to meet unrealistic expectations. This stress is often compounded by a lack of work-life balance and an unsupportive workplace culture, which has been exacerbated by the recent pandemic.

Training/Mentoring: Deficiencies in mentorship and guidance, along with poorly structured orientation programs, are major factors contributing to early resignation. Inconsistent or inadequate mentorship does not provide new nurses with the essential skills and confidence they need.

Strategies to Prevent Turnover

Healthcare leaders can help prevent new graduate nurses’ resignation rates by establishing structured support systems that promote a positive workplace culture, implementing interventions that reduce stress and burnout, and ensuring adequate training and mentoring.

Enhancing Support: It is crucial to create an environment where questions are encouraged and stigmatization is minimized. Recognizing and celebrating hard work enhances morale and investment in the organization. Leadership support, involving open communication and empowerment, should be emphasized.

Reducing Stress/Burnout: Initiatives promoting work-life balance, like flexible schedules, are essential. Regular check-ins and emotional support from leadership can alleviate stress. Building supportive peer networks and zero-tolerance policies for bullying further enhance the workplace atmosphere.

Improving Training/Mentoring: It is vital to establish structured orientation and residency programs tailored to individual competencies. Formal mentorship programs should pair new graduates with experienced nurses to guide and support their development. Continuous professional development opportunities and technology-based training tools can further enhance learning and adaptation.

Understanding Transitional Stages

Dr. Duchscher’s Transitional Stages Model elucidates the stages new graduates undergo post-orientation: Doing, Being, and Knowing. Recognizing these stages helps organizations provide more targeted support. During the initial "Doing" stage, graduates often feel overwhelmed by the gap between their education and practical realities, leading to a task-oriented focus that can hinder development without proper support. In the "Being" stage, nurses question workplace practices and career choices, underscoring the need for supportive leadership. Finally, the "Knowing" stage involves seeking growth and balance, anchoring professional identity with ideals of nursing.

Conclusion and Recommendations

This review highlights the necessity for healthcare organizations to create comprehensive strategies aimed at retaining new graduate nurses. Initiatives should concentrate on structured mentorship, emotional resilience, ongoing professional development, and cultivating a supportive workplace culture. Nursing leaders must thoroughly grasp the transitional stages to effectively tackle the unique challenges faced by new graduates. Ultimately, improved retention positively impacts the healthcare system through enhanced patient outcomes, reduced turnover costs, and the recruitment of future nursing talent.