What New Graduates Need from their Nurse Leaders

By Rose O. Sherman, EdD, RN, FAAN

It may not surprise you to learn that the highest turnover in most nursing organizations occurs with new graduates in their first year of nursing practice. The National Council of State Boards of Nursing (2011) in the United States reports that this turnover is 25 percent a year. This is a significant issue when you consider that 10% of the current nursing workforce in acute care settings are new graduates. While some of this turnover may be inevitable, many of these losses could definitely be prevented if nurse leaders better understood the needs of new graduates and supported them more effectively during their transition into the profession.

New Graduate Transition Today – What is Different?

Many of you reading this blog may have recently graduated. Although the phenomena of reality shock has been acknowledged as part of new graduate transition for decades, there is good evidence to suggest that the problems with transition into nursing practice are more serious today. Many current nurse leaders entered nursing practice before 1994 when computerized licensure testing began. Prior to this time, licensure exams were only given twice each year and most new graduates entered practice with provisional licenses working with experienced nurses for extended periods of time. New graduates today take their exam shortly after graduation and the license is generally required for employment. The health care world they enter is also very different. Today’s hospital patients are more acutely ill and have shorter lengths of stay than in the past. An unintended consequence to this change is that there has been a rapid deployment of new graduates into clinical settings where they assume responsibilities that are potentially beyond their capabilities. Some health care agencies have responded by having well structured orientations and new graduate support but this is not true in all settings.

What New Graduates Tell Researchers about their Transition Experience

In research conducted by one of my colleagues, Dr. Susan Dyess, new graduates reported beginning practice feeling a combination of fear and confidence. They understood their strengths and limitations and hope that organizations will provide them the support they need to be successful. New graduates talked about the less than ideal communication in health care agencies between nurses, physicians and other members of the team. The lack of professional confidence they feel is often heightened when another professional uses a gruff tone or expresses disgust with their lack of knowledge. New graduates also expressed concern about their ability to supervise and delegate care to assistive personnel especially when their requests were ignored. New graduates in this study also reported frequent experiences with horizontal violence or bullying from other colleagues in the work setting. They expressed dismay that some of these behaviors were tolerated on units with no intervention from the nurse leader. New graduates also spoke about feelings of professional isolation when they feel overwhelmed and everyone is too busy to help them. In today’s environment, they are working with complex patients often in specialty areas whose care requires high critical thinking. Decisions need to be made quickly and opportunities for reflection on practice are rare. New graduates sometimes feel unprepared or unable to meet the challenges they confront. New nurses have many questions when they enter practice and seek the advice of their colleagues. They reported in this research that they often receive contradictory advice from colleagues which was very confusing to them. The organizational policies and procedures they rely on for guidance were not always quickly accessible. Many of the new graduates in the study worked night shifts and had limited interaction with their nurse managers after orientation. Preceptor selection is critical and this relationship is extremely important in the successful transition of new graduates. This study supported work done by Duchscher (2008) that suggested that new graduates move through three stages (doing, knowing and being) during their first 12 months and need support during each phase.

How Nursing Leaders can make a Difference

At some point in the near future if the National Council of State Boards of Nursing are successful with their legislative efforts, structured transition programs will become a licensure requirement for nursing graduates. Nurse leaders at all levels from charge to manager can be proactive today in their own settings by taking some or all of the following steps:

Select preceptors who are supportive and enjoy working with new graduates.
Observe for signs of bullying of new graduates by other staff and establishing a zero tolerance culture.
Check in frequently with new graduates throughout their first year of practice.
Monitor patient care assignments given to new graduates and followup to see if they are appropriate and the new graduate is confident about their abilities to manage their patients.
Help new graduates with their communications with physicians and other departments by observing for signs of disrespect or the new graduate’s lack of confidence.
Maintain an open door policy and encouraging the new graduate to check in with any problems or concerns.
Ensure that the new graduate attends all the orientation and other support classes offered by the agency.

Read to Lead

Dyess, S. & Sherman, R.O (2009). The first year of practice: New graduate learning needs and transition experiences. Journal of Continuing Education in Nursing. 40(9), 403-409.

Duchscher, J. B. (2008). A process of becoming: The stages of new nursing graduate professional role transition. The Journal of Continuing Education in Nursing, 39(10), 441– 450.

National Council of State Boards of Nursing. (2011). Transition into Practice. Click Here for Study and More Information.