Nurturing success: Retaining strategies for newly licensed nurses

By Meg Ingram, MSN, RN
Vizient Lead Programmatic Advisor, Nurse Residency Program

The Vizient/American Association of Colleges Nursing (ACCN) Nurse Residency Program^TM (NRP) is a 12-month program that guides newly licensed nurses through transitioning from a student to their professional role as a nurse. While gaining bedside skills in their care settings, nurses attend monthly seminars to increase their knowledge and proficiency and gain support during a difficult transition.

Program data collected at three critical times during the 12-month program reveals newly licensed nurses who leave their jobs in the first year report lower support and lower professional satisfaction. Nurse leaders are now wondering, "What does support look like to a new nurse who earned their license during a pandemic? What kind of professional satisfaction do they look for?"

In a recent focus group of newly licensed nurses, the Vizient/AACN NRP team uncovered themes that contribute to high levels of support and professional satisfaction, most notably providing stable transitions and creating a healthy work environment.

Stable transitions

Stability is crucial to feeling supported. Even as early as the application process, understanding the role and what to expect during the first year can begin to form the foundation of support. When discussing the transition to practice, the group of nurses reflected on the rigid structure of nursing school preparation. Students follow step-by-step skills checklists, attend class on the same day every week, and interact with the same educators and peers. In practice, the inconsistent and dynamic nature of nursing leaves newly licensed nurses feeling unstable. When nurses have a foundation of support, it is easier to be flexible within the field of nursing.

While daily consistency is impossible, nurses identified these factors as contributing to a stable transition:

Transparency: Frequent, transparent conversations with leaders and mentors help new nurses manage expectations, understand challenging situations and participate in problem-solving. Establishing a pattern of open communication during stable times fosters open communication during challenging or uncertain times.

• Consistent feedback: Nurses do not know if they are doing well (or not doing well) unless they receive feedback. The focus group reported that actionable feedback was helpful in furthering their progression. They appreciated scheduled feedback (e.g., a mid-point meeting) and just-in-time or more casual feedback (e.g., debriefing after a shift).
• Nursing is tough: Nurses appreciated the acknowledgment that they have entered a profession where there are challenging situations and shifts. In addition to acknowledgment, it was helpful to connect with their leaders to understand what success looks like and the plan if they are off target.

Consistent preceptorships: As seen in the NRP data, retention rates decrease with every new preceptor a newly licensed nurse trains with. Interviews with nurse residents validated these findings. When nurses have consistent preceptors, they can build upon their existing knowledge and skills instead of having to start over every few shifts. Consistency also fosters a trusting relationship with the preceptor, creating a safe environment for giving and receiving feedback.

Stick to the plan: The nurses discussed how the professional nursing practice looked different from what they expected. Additionally, many mentioned being told important information related to onboarding expectations and timelines only to find out the plan had later changed. Respecting agreed-upon timelines, parameters and opportunities builds trust. When new nurses understand their transition to practice plan, only to find out it has changed, they feel misled, which leads to distrust and disengagement. The nurses also acknowledged that not everything goes according to plan, but transparent communication helps them understand and be more flexible. These are a few areas commonly mentioned:

• Communication of the role up front and in writing
• Length of orientation
• Scheduling
• Progression to other roles following orientation. Within the first year, many new graduates have taken on preceptor or charge nurse roles, as well as additional responsibilities in other areas (e.g., respiratory therapy, physical therapy, nursing assistant). The group expressed that assuming these additional roles earlier than anticipated lowered their confidence in their capabilities. They felt pressure related to a fear that they should be able to complete all of these extra tasks or roles without panic or moral distress and were failing.

Healthy work environment

The group of nurses we spoke with during the focus group used many words to describe a healthy work environment, often mentioning psychological safety and a positive work environment. Examples included:

• In-person: Peer support was absent while completing a notoriously difficult degree program during COVID-19. Nurses mentioned a lack of engagement and support via online communications. They raved about in-person check-ins and in-person learning, stating the sustained physical presence of mentors, leaders and peers plays a role in a healthy environment.
• Respect and validation: Because nursing is a challenging profession, the high competence and knowledge required at entry is a point of pride. Nurses yearn to feel respected and validated for the knowledge they bring. The group found that seasoned nurses expected them to know more, leaving them feeling undervalued; however, feeling respected and receiving validation that they were progressing created a safe environment. Many stated it was as simple as praising a successful patient interaction or giving kudos following a well-constructed shift report.
• Just ask: When asked what support meant to them and what it looked like, one nurse said, "Just ask." Engaging in personal conversations and understanding each person's unique needs helps them feel seen rather than a number in the new graduate count. Today, many new graduates value different things than previous generations, such as flexible staffing, benefits and frequent growth opportunities.

Remember me?

Nurses typically feel supported initially, but after their orientation period ends, many report that the check-ins dropped dramatically in favor of the next group of new graduates. When asked how they would like to be supported following the NRP these ideas were shared:

• Use the career development session at the end of the NRP to highlight ways we can get involved and engaged, and then allow them to choose the direction their engagement goes.
• Offer more education and resources for life skills such as financial and retirement planning, budgeting and taxes.
• Organize short lunch-and-learn-style education sessions in their break rooms on applicable topics.
• Further professional skills training such as communication (e.g., difficult conversations, conflict management), special interest classes and a continued conversation on ethics.

It's not (all) about the money

Surprisingly, very little was mentioned in the focus group about wages. Nurses noted that travel nursing was a lucrative endeavor, with the extra income providing more support and the challenge of working somewhere new increasing their professional satisfaction. Even so, many mentioned that if an organization were willing to invest in them by providing support and professional growth opportunities, they would, in turn, invest in the organization.