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'Onboard' new graduate nurses to prevent them jumping ship


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Rebecca Hendren, for HealthLeaders Media, September 7th, 2010

I’ve been thinking about new graduate nurses a lot recently. In my conversations with managers and educators, we talk about ways they are training new grads at their organizations and their greatest concerns. Their two top priorities are to ensure new nurse competency and to “onboard” the new staff to their organization.

Onboarding is a business management term that describes the process of assimilating new employees into an organization. More than simply orientation, onboarding is the process of embedding new employees into the culture and ensuring they not only become productive employees, but they become emotionally invested in the organization.

After all, organizations spend large amounts of time, effort, and resources on training new grads; the last thing they want is for those new grads to up and leave for somewhere else, which research shows they all too frequently do.

The onboarding process is crucial for new graduate nurses who face an enormous change process as they transition from student nurse to independent RNs. In my conversations with managers and educators at hospitals, they talk about the reality shock every new graduate nurse experiences and the importance of recognizing the stages new graduates go through:

Honeymoon phase: The first phase is the initial glow of their first job. They are excited to have completed school, passed the NCLEX, and be practicing in their chosen profession. They tend to view nursing through rose-colored glasses and have a positive view of their coworkers and the work environment.

Shock phase: This is the most dangerous period. After the honeymoon phase has worn off, new graduate nurses are overwhelmed with their clinical responsibilities and perceive the realities of the work environment, including stressed out staff, difficult patients, regulatory burdens, and too few resources. They have likely been exposed to nurse-to-nurse hostility, whether as witnesses or as victims. They may have witnessed or endured a situation with a rude or demeaning physician.

Recovery phase: In this phase, new nurses become more used to the environment and can see both its positives and negatives. They are becoming more competent in their practice.

Resolution phase: The final stage is resolution, where new nurses reach the point of fitting into the environment. They may adopt the beliefs and values of their coworkers as a way to fit in, which can be problematic if their fellow nurses display negative behavior such as horizontal hostility, gossip, or poor communication skills.

During the period from honeymoon to resolution, new graduate nurses need experienced preceptors and mentors to help them understand what they are going through, provide guidance and answers to questions, and generally deal with the transition. It’s a make or break period when new graduate nurses are most vulnerable to your organization’s culture. Entrenched nurse-to-nurse hostility or the one physician who everyone dreads can be the turning point for already overwhelmed new nurses to acquiesce and follow the herd, or jump ship to a better environment at the earliest opportunity.

Last week, I wrote about the value of nurse residency programs, which provide a year-long training period for new nurses. These programs are valuable, but organizations need experienced preceptors and mentors guiding new nurses from day one.

Too many nurses are assigned to become preceptors without adequate training. They are competent nurses and a year or two out of school, so it’s assumed they will relate to new grads and that is about all the need. Unless they receive training in the phases of reality shock, what new graduates need, how to role model behavior and expectations, and how to provide feedback and criticism, they are being set up to fail.

Preceptors and mentors are a crucial part of the onboarding process. They have the power and influence to help new nurses plot the right course to become committed, successful employees. To help newer nurses get with the program, preceptors need to be adequately trained and fully 'onboard' themselves.

Source: HealthLeaders Media