Meeting the Needs of Our New Graduates

By Rose O. Sherman, EdD, RN, FAAN

It is spring and nurse leaders are already interviewing candidates for their nurse residency programs. 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. In many organizations today, it is close to 25%. This is a significant issue when you consider that a growing percentage 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.

What New Graduates Tell Researchers about their Transition Experience

In research conducted by myself and my colleagues, 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

Most but not all healthcare settings now offer some type of residency program for new graduates. While these programs have been demonstrated to result in a higher retention of new graduates, these efforts are not enough. 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 especially months 6-12.
Monitor patient care assignments given to new graduates and follow-up to see if they are appropriate and the new graduate is confident about their abilities to manage their patients. This especially needed if the nurse is assigned to the night tour.
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 M, & Sherman R.O. (2011). Developing the leadership skills of new graduates to influence practice environments: A novice nurse leadership program. Nursing Administration Quarterly,35(4), 312-322.

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.