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Five ways to retain new graduate nurses


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Rebecca Hendren, for HealthLeaders Media, July 5, 2011

Hospitals across the country are welcoming recently graduated nurses to their units and hoping to turn them into competent, confident nurses as quickly as possible.

New nurses have a difficult time bridging the gap from nursing school to practice and hospitals must recognize this difficult transition if they hope to keep the nurses for the long term. Here are five strategies that help new graduates through the transition and ensure that they are engaged, long-term employees.

1. Provide a competency-based orientation.

Once new graduates have completed general, organization-wide orientation, they are sent to their units and start learning how to be a nurse in their new world. Making every new nurse go through the same orientation is a bad idea. It's a waste of time to train nurses how to do something that isn't relevant to their specific job and a waste of resources to send nurses to classes they don't need. Yet many organizations do exactly that.

One-size-fits-all nurse orientation takes longer and is less effective at on-boarding new nurses. Effective orientations are based on competency assessment and personalized to nurses' individual training and development needs. Customizing training and development to graduate nurses' needs creates engaged employees and allows managers to allocate financial resources appropriately, rather than sending every employee to every class.

2. Offer a nurse residency program.

If you don't have a nurse residency program, start one. They are much more than orientation. The best programs run throughout new graduates' first year of practice and support them through the difficult transition shock and various phases of competence. The programs give new nurses the tools to become competent practitioners.

Nursing schools advise students to find organizations with nurse residency programs and hospitals that offer them are able to pick from the best new graduates.

Residency programs require investment in time, people, and resources, but research has shown the initial investment is more than made up by increases in competency and retention. Large hospital systems with significant numbers of new graduate hires can find themselves saving $200,000-$400,000 annually by investing in top quality residency programs. Even small organizations can more than repay the expense of a program.

3. Encourage mentoring.

Mentoring can be formal or informal and both are useful. Many nurse residency programs include mentoring from the program coordinator, nursing professional development specialists who teach classes, or simply through nurses in the programs finding buddies amongst their colleagues.

The best mentoring provides more than just emotional support. Effective mentors guide new nurses through career progression and model how to be good nurses. These mentors are well versed on any number of career challenges and opportunities, whether it's discussing coping with nurse-to-nurse hostility or the benefits of specialty certification for long-term career growth.

If your organization doesn't have a formal program for matching nurses with mentors, start one. The process is just as fulfilling for the mentor as for the mentee and it's a good way to help experienced nurses stay engaged and committed.

4. Ensure good managers.

The old refrain says that employees don't leave organizations, they leave managers. This is especially true in nursing where many nurse managers are promoted because they have excellent clinical skills, but are left on their own to figure out everything from how to balance the unit budget to how to manage their staff.

Investing in leadership training benefits the entire organization. New nurses need managers who set clear behavioral and performance expectations, who create a healthy work environment free from bullying, and who pay attention to staff's continuing education and professional development.

The best managers are inspirational leaders who set expectations, coach, inspire, and nurture new graduates to create the best patient care environment possible. The results will be evident both in staff and patient satisfaction scores.

5. Recognize and support.

If you want commitment, you've got to show commitment. New graduates should be shown you value them and are committed to their long-term career progression. Highlight tuition reimbursement and offer praise and support for nurses who return to school. The IOM's Future of Nursing report is pushing for 80% of RNs to have their BSN by 2020. If your new hires don't have a BSN, help them set a timeframe for doing so-and a manageable path for how to get there. And don't stop at BSN.

Many new nurses burn out and leave because of bullying or a hostile workplace. Don't let new graduates be bullied by other nurses, physicians, or anyone. If you don't have a zero tolerance policy, get one now. If you have one, make sure it's being enforced. Is there a rogue cardiologist, for example, who no one wants to work with, but whose bad behavior is tolerated because he brings in so much revenue? Make a stand now. Let the organization know that bad behavior isn't tolerated from anyone.

New nurses get discouraged and burnout when real-world nursing doesn't resemble what they thought it would be. Help them make a difference and effect change. Encourage them to become involved with shared governance councils that directly influence the practice environment. Get them to enroll in quality improvement initiatives. Make sure they are learning about evidence-based practice. If your hospital doesn't have a journal club, suggest the new graduates start one. Invite enthusiastic new graduates to be part of patient satisfaction and patient experience planning.

With these five key themes addressed, your new graduate nurses will be providing excellent patient care for years to come.

Source: HealthLeaders Media