When new nurse graduates enter the workforce, it's often trial by fire.
New hires must master clinical and critical thinking skills rapidly. And when new nurses have inadequate nursing orientation, this can lead to high turnover rates. To avoid this, nurse leaders must take a hard look at the nursing competencies needed to ensure that new nurse grads succeed.
Areas for improvement
The increasing number of new graduate nurses in the hospital setting directly affects patient care. Nursing vacancies that are created by a number of variables are most likely to be filled with new graduate nurses, and the Health Care Advisory Board projects that 42% of hires in a hospital setting consist of new graduate nurses. New hires are expected to display nursing competence in a variety of areas, but these nurses often have little clinical experience, which can create stress and stretch the available resources of the organization.
To improve the transition from new graduate to skilled practicing nurse, most healthcare organizations use nurse orientation programs or nurse residency programs. The main goal of these nurse residency programs is to ensure that new graduates are both confident and competent.
By identifying areas in which new graduate nurses need further development, nurse educators can structure their curriculum to adapt to the needs of the new nurses and assist them in providing competent nursing care.
Traditionally, nursing orientation programs and nurse residency programs have focused on skill attainment and policies specific to that organization. Nursing competence is not only a professional standard described by the American Nurses Association (ANA), but also a Joint Commission requirement.
Competence is defined as "the ability to perform according to defined expectations." But educators are starting to realize that nursing competencies extend beyond skills and policies. Other elements of nursing competence include values, attitudes, general nursing knowledge, and clinical skills. In current nurse residency programs, clinical nurse educators are showing broader focus by including competencies to further develop a new nurse's critical thinking abilities.
Implications for nurse leaders
The behavior and actions of nurse leaders affect both the organization and the new nurse orientees. Nurse residency programs have consistently shown to be beneficial to the organization by cutting long-term costs while providing new graduates with support and guidance.
Traditionally, most resources for new graduates are available during the day. But organizations are more likely to hire a new graduate for a night shift position, when there is less access to training resources. To address this problem, nurse leaders can designate part of their education budget to provide additional support, such as online resources and a help desk, for off-shift preceptors and orientees.
Nurse leaders should also consider preceptor-based orientation when implementing a nurse residency program. This type of orientation has been correlated with improved nurse retention, including reduced turnover rates and cost savings for the organization.
Nurse residency programs are more efficient if they span the new graduate's first year of experience. It's recommended that executives provide funding for a year-long program with adequate support for this entire time, instead of the traditional six to 12 weeks.