Introduction
Close to 60% of all new graduate nurses who are employed at health care institutions, leave those places within the first year of employment (Pine & Tart, 2007). The cumulative effect of this high turnover has staggering losses. A 2004 economic analysis of this issue reported that the dollar cost of turnover per Registered Nurse (RN) in a 6000-bed acute care hospital is more than $60,000 (Ponyton et al, 2007). Nurse turnover negatively affects the ability of the patient care team thereby compromising the quality of care given in that hospital. In addition it results in personal losses to the graduate nurse. There is need to address this problem and to that end health care institutions have been implementing various measures in order to prevent high graduate nurse turnover. Understanding the human elements behind the high turnover helps leaders to design suitable interventions and invest resources to solve problematic areas.
Handling the high rate of new graduate nurse turnover
In order to establish effective measures to curb high rate of new graduate nurse turnover it is important to establish some compliance criteria. Nurses who exhibit the least chances to leave a hospital show or must be availed with the following seven issues; professional respect, access to career development, flexible work schedules, access to information, competence, work management skills and are capable of becoming part of a team (Sullivan & Decker, 2005). Any healthcare institution that addresses all these concerns among its new graduate nurses is bound to enjoy high staff retention, significant improvement in the quality of healthcare that the institution offers and reduced costs of operation.
The high rate of new graduate nurse turnover is due to a high degree of stress new nurses encounter. This stress is related to a lack of clinical situational experience and transitional issues as the new graduate begins to practice as a Registered Nurse. One solution to this problem is to have hospitals establish nurse residency programs. These programs will orientate nurses to their clinical surroundings; offer new Registered Nurses the opportunity to gain further clinical experience and knowledge (Goode, Lynn, Krsek & Bednash, 2009). According to Ulrich, et al (2010) the program offers new nurses a chance to meet, bond and form work relationships with other nurses and hospital staff which can prove very beneficial in the establishment of multidisciplinary teams. Residency programs will lessen the stress of new graduate nurses by allowing them to transition into the RN role, in turn decreasing new graduate nurse turnover rate.
Researchers into new graduate nurse turnover issues have identified job stress as the strongest predictor of job satisfaction. The researchers found a strong relationship between total job satisfaction and a sense of belonging (supportive co-worker relationships). Many graduate nurses are usually most satisfied with their co-workers and least satisfied by the professional opportunities (Halfer & Graf, 2006). As such, it would be prudent for hospital managements to try and check out for compatibility of staff and in particular that of new graduate nurses. They should offer the nurses competitive salaries that are marked by constant increments commensurate with economic demands. Halfer and Graf, (2006) asserts that the more the new nurses are able to blend in and find comfort working with other experienced nurses, the more the turnover is reduced.
In orientation, new graduate nurses also express stress which ultimately leads many of them to leave their work. In order of their ranking the issues that stress graduate nurses are lack of experience, interactions with doctors, lack of organizational skills and new situations (Goode et al, 2009). If the following issues are worked on during the orientation period the current high turnover can be reduced; real nurse work (practice role) transitional processes (learning opportunities and organization), guidance (by preceptor), personal dynamics and institutional context (policies and routines) (Sullivan & Decker, 2005).
Graduate nurses are also concerned by the lack of power to make decisions and effective changes. Specific areas of concern for the nurses include perceived lack of opportunities for career development, dissatisfaction with the salaries offered as well as the work schedules.
There have been successful cases of Nurse Residency programs. These include the Houston-based Methodist Hospital’s UHC Baccalaureate Nurse Residency Program. It is a 1-year program which focuses on helping new nurses acclimatize to the hospital setting and thereby reducing the nurse turnover rates at the Methodist Hospital. New nurses are trained based on the Patricia Benner’s theoretical framework on transition to professional practice; From novice to expert: Excellence and power in clinical practice (Pine & Tart, 2007).
The program is anchored on understanding the needs of new graduate nurses using the given model. This model is very suitable for application by other healthcare institutions because it is simple and has very clear and relevant deliverables. Firstly, it assists the new nurses to graduate in transitioning from the role of advanced beginners to competent nursing roles and meet the demands. Secondly the program provides support and training to help nurses understand the organizational and bureaucratic structure of the medical environment in which they serve. Pine and Tart, (2007) noted that the program has had immense success; prior to implementation of the program the Methodist Hospital experienced turnover of between 30 to 60%. After implementing the program for one year the hospital recorded a 13% turnover rate which was quite impressive.
The Nurse Residency program such as the one implemented by the Methodist Hospital also has a significant return on investment. As noted earlier, high nurse turnover rates bring about massive financial losses. Reversing the turnover stands to bring about significant Return On Investment (ROI). Methodist hospital managed to save $823,680 by reducing the turnover from 50% to 13%. The following is a breakdown of the expenditure on the program over I-year period (2004 to 2005) (Pine & Tart, 2007)
(Pine & Tart, 2007)
Besides the ROI, the program is a fast way of helping nurses to not only fit in to the rigors of the workplace but also to transform them into nursing leaders.
In order to make the Nurse Resident programs more successful and by extension reduce new graduate nurse turnover, the following measures are necessary. The first is establishment of effective communication where feedbacks and responses can be exchanged at ease between the graduate nurses and the program coordinators (Sullivan & Decker, 2005). Periodic assessments say on a monthly basis are suitable to allow residents identify learning needs that are directly applicable to their practice. In other words regular review of the program helps to tailor the programs to the exact needs of the nurses. Some of the issues that the nurses might recommend to be included in their program are stress management strategies, relaxation methods such as yoga and their applications to nursing practice, financial management, and team building exercises.
It would be particularly important for all hospital to consider cultural orientation programs in order to accommodate nurses that may not have come from the immediate culture. All new nurses should be given adequate briefings on how to handle managers, co-workers and patients from the most prominent cultures in the locality. If need be the hospital management should access the potential for language barrier between the new graduate nurses and the other stakeholders (Sullivan & Decker, 2005). When new nurses are compatible with the language and the culture of their new workplace, chances that the nurse will leave due to culture shock and incompatibility are greatly reduced.
Conclusion
It is appalling that about 60% of all new graduate nurses leave their work within one year. This very high turnover yields financial losses to affected healthcare institutions as well as personal losses to the nurses. In order to curb this healthcare institutions need to establish mechanisms that will instill professionalism to the nurses, offer then access to career development and information, come up with flexible work schedules, ensure that they recruit competent nurses and that they train nurses on the importance of teamwork. All programs to curb high staff turnover should satisfy these criteria. Nurse Residency programs such as the one implemented by Methodist Hospital in Houston, Texas have proved to be very effective in reducing staff turnover rates and the associated financial losses. The Methodist hospital managed to reduce its staff turnover from 50% to 13% within one year which reduced the financial expenditure by $823,680. In addition is vital for healthcare institutional leaders to increase job satisfaction by competitive salaries, compatible pairing or grouping with other healthcare professionals and an opportunity to learn about other cultures served in that hospital. When all these things are effectively done, the job satisfaction goes up significantly thereby reducing staff turnover. This in turn translates to reduced expenditures and great opportunities for healthcare institutions to improve their services.
References
Goode, C., Lynn, M., Krsek. C., & Bednash, G. (2009) Nurse Residency Programs: An Essential Requirement for Nursing. Vol. 27 No.3 Retrieved 25 November 2013 from https://www.nursingeconomics.net/ce/2011/article27142159.pdf
Halfer, D. & Graf, E. (2006) Graduate Nurse Perceptions of the Work Place. Vol. 24 No. Retrieved 25 November 2013 from http://www.fchs.ac.ae/fchs/uploads/Files/Garduate%20Nurse%20Perceptions%20of%20the%20Work%20Experience.pdf
Pine, T & Tart, K. (2007) Return on Investment: Benefits and Challenges of a Baccalaureate Nurse Residency program. Vol. 25, No. 1. Retrieved 25 November 2013 from http://www.nursingeconomics.net/ce/2009/article021319.pdf
Ponyton, M., Madden, C., Bowers, R., Keefe, M., & Peery L. (2007). Nurse residency program implementation: the Utahexperience. (n.d.). Nurse residency program implementation: the Utahexperience. Retrieved November 24, 2013, from http://www.biomedsearch.com/article/Nurse-residency-program-implementation-Utah/172010510.html
Sullivan, E. J., & Decker, P. J., (2005). Effective leadership and management in nursing (6th Ed.). Upper Saddle River, N.J.: Pearson/Prentice Hall.
Ulrich, B. Et al (2010) Improving Retention, Confidence, And Competence of New Graduate Nurses: Results from a 10-Year Longitudinal Database Vol. 28 No. 6. Retrieved 25 Nov. 13 from http://www.ndcenterfornursing.org/linked/versant_10_year_article_nec_2010.pdf
