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HealthJanuary 04, 2021

Improving nurse retention by restructuring nurse orientation

By: Sarah Handzel, BSN, RN
Registered nursing positions are expected to grow by 7% through the next decade, with over three million nurses needed by 2029.1 Many factors play into this need, including a greater number of nurses retiring and an increasingly older patient population with more complex health needs. But employers continue to struggle to retain nurses, especially those that are new to the profession.

High turnover continues to contribute to nursing shortages—factors like burnout, family obligations, and violence in the healthcare setting all influence a nurse’s decision to remain in the workforce. The problem is especially prominent among younger nurses. Up to 33% of nurses leave the profession within the first two years of practice2, leading to problems like lower quality patient care, higher morbidity, and increased mortality rates.3 Additionally, it’s estimated that turnover costs range from $62,000 to $67,000 on average.4

Orientation plays a crucial role in nurse retention, especially among new graduates, but many orientation programs fall short of employee needs. A new study in The Health Care Manager4 reviews examples of orientation practices that work to retain more employees.

Successful orientation programs: what works

While there is no one-size-fits-all approach to nurse orientation, certain practices do help healthcare organizations retain new staff members. Programs should not simply be about training new nurses; instead, orientation must take both the nurses’ and the organizations’ needs into account as nurses prepare to deliver high-quality patient care.

Successful orientation programs are more likely to have a structured approach, taking the level of each new nurse into account as they are trained in organizational policies and procedures. One hospital chose a four-track approach to orientation, training novices, advanced beginners, competent, and proficient to expert nurses in separate sessions to accommodate their particular learning needs. Another facility, a pediatric academic medical center Magnet hospital, used an internship-based transition program based on the education theories of Benner’s Novice to Expert research, Knowles’ adult learning principles, and Kramer’s research on reality shock.4 This program extended beyond the typical orientation period to include continuing online education, discussion groups, and mentorship.

Other programs pair novice nurses with experienced nurses, with the novices first watching seasoned nurses go about their duties. As time goes on, the experienced nurses switch with the novices, watching them work and checking off specific procedures as completed when the novice is competent. Preceptor support seems to be crucial to novice nurse success, with the majority of effective orientation programs implementing this strategy.

Some facilities create new nursing roles to help retention—chief retention offices for nursing help collect feedback regarding the goals and aspirations of new nurses. Using turnover statistics, these officers developed marketing campaigns for nurse recruitment.

Nurse leaders should not expect to simply “tweak” existing orientation programs to better serve new nurses and improve retention rates. Instead, new ways of doing business must be explored. Organizational involvement, coupled with consideration of internal and external factors specific to each new nurse greatly improves the likelihood of retention among new employees, leading to better patient care and outcomes.

Sarah Handzel, BSN, RN
Freelance Health and Medical Content Writer, Wolters Kluwer Health
Sarah has over nine years’ experience in various clinical areas, including surgery, endocrinology, family practice, and pharmaceuticals. She began writing professionally in 2016 as a way to use her medical knowledge beyond the bedside to help educate and inform healthcare consumers and providers.
  1. “Registered Nurses: Occupational Outlook Handbook.” U.S. Bureau of Labor Statistics, U.S. Bureau of Labor Statistics, 1 Sept. 2020, bls.gov/ooh/healthcare/registered-nurses.htm.
  2. “Why New Nurses Are Leaving the Profession.” Registered Nursing.org, RegisteredNursing.org, 20 Aug. 2020, registerednursing.org/why-new-nurses-leaving-profession/.
  3. Haddad, Lisa M. “Nursing Shortage.” StatPearls [Internet]., U.S. National Library of Medicine, 16 Nov. 2020, ncbi.nlm.nih.gov/books/NBK493175/.
  4. Kiel, Joan M. PhD, CHPS. “An Analysis of Restructuring Orientation to Enhance Nurse Retention.” NursingCenter, 2020, nursingcenter.com/journalarticle?Article_ID=5683104.
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