Running head: LITERATURE REVIEW
This literature review will discuss and critique five articles addressing new graduate nurse retention, in relation to my research question of, “For new graduate nursing students hired into INOVA Fairfax ED, does the use of a buddy program for the first year of employment reduce the future risk of turnover compared with no post-orientation intervention?”.
Retention of new graduate nurses in all nursing specialties is imperative. Not only is it cost effective to increase the rate of retention of new graduates, the decrease in turnover will improve staffing ratios and patient outcomes. There is a need for research on post-orientation interventions such as a buddy program to decrease turnover of new graduate nurses. Building relationship between new and experienced staff members in crucial, because we are already experiencing a shortage of nurses. Therefore, we need to find a way to stop new nurses form leaving their positions within the first year, and further decrease the likelihood they will leave the profession altogether.
The first study reviewed was a phenomenological study seeking to understand the experiences of graduate nurses and their transition into professional practice (Kelly & McAllister, 2013). A two-year study in which fourteen out of sixty-five senior nursing students from an Australian university participated. The subjects varied in age and background. The preceptors had minimal training received by the hospital that would affect the reliability of this study. Data was collected through semi-structured interviews and journals kept by the participants. The data was collected and inputted into NVivo, an analysis tool, to generate themes throughout the data. There was consistency of data collection and the analysis tools used were appropriate for this study.
The size of this study was limited, which could affect generalizability of the findings. However, the details provided by the participants will aid in the understanding barriers and facilitators of quality learning through clinical preceptors (Kelly & McAllister, 2013). The information obtained through this study expresses a deep need for relationship building between the preceptor and the student to enhance the learning process and build confidence as a new nurse.
The second study, a phenomenological study, followed seven new graduate nurses. All of which varied in age, degrees (i.e. associates or bachelor’s), hospitals, and department. The inclusion criteria consisted of being a new graduate nurse and participation in a new grad residency program. Data collection was obtained through audio recorded interviews performed by the primary researcher. Each interview lasted forty-five to sixty minutes in a setting selected by the participant, which shows consistency in the collection of the data. Great consideration and rigor was taken into account concerning credibility, transferability, dependability, and confirmability of the data (Moore & Cagle, 2012). Two experienced researchers individually collectively analyzed this data to confirm emerging themes. Some limitations to this research was concerning the background and history of the participants had including prior patient care experience.
The third study reviewed was a convergent mixed methods study which was a part of a larger project. The larger project was evaluating the effectiveness of clinical supervision for new graduate nurses that were working in an acute care setting (Hussein, Everett, Ramjan, & Salamonson, 2017). The sample size was one hundred-forty new graduate nurses which were enrolled in a twelve-month long transition program at a Sydney hospital. The Manchester Clinical Supervision Scale (MCSS-26) was used to assess the new graduate nurse’s perception of the quality of clinical supervision. In addition, the Practice Environment Scale -Australia (PES-AUS) was used to assess satisfaction with the clinical environment. These tools allowed for consistency in the collection of the data. Other factors were also taken into consideration such as age, gender, and prior experience in the healthcare profession (Hussein, Everett, Ramjan, & Salamonson, 2017). The quantitative data was analyzed using a statistical software package (IBM SPSS Statistics Version 22), and “continuous variables were assessed for normality using the Kolmogorov-Smirnov test, and expressed as median and range” (Hussein, Everett, Ramjan, & Salamonson, 2017, p.4). This form of data collection and analysis was appropriate for this study, and tools have been proven to be reliable. Although there are limitations to this study, which include the study being conducted at only one facility. Additionally, the self-repot methods used for the qualitative portion of this survey were not very reliable.
The fourth study reviewed was a retrospective descriptive evaluative design, which looked at retention between two groups of graduate RNs in the critical care units of Cohen Children’s Medical Center (CCMC) before and after the initiation of the Pediatric Fellowship Program (PNFP) (Friedman, Delaney, Schmidt, Quinn, & Macyk, 2013). A nonprobability convenience sample was used for this study. The sample in this study consists of new graduate RNs hired to begin nursing orientation during March 2005 to August 2007, prior to the initiation of the PNFP, and September 2007 to March 2010, after the initiation of PNFP (Friedman, Delaney, Schmidt, Quinn, & Macyk, 2013). The collection of data regarding retention of both groups was retrieved through the CCMC’s HR department. The data for both groups was measured longitudinally at four different points after the commencement of the new graduate’s program. There was consistency in the collection of data, as well as reliability in the source of the data. The tool used to measure all data was made specifically for this study, appropriate for this data analysis. Limitations in this study are concerned with the retrospective design. Other variables that may have affected new graduate nurse retention are those that the researchers were unable to detect. There was a significant increase in the new graduate nurse retention once the PNFP was implemented (Friedman, Delaney, Schmidt, Quinn, & Macyk, 2013).
The last study which I reviewed was a qualitative study aimed to reveal the experiences and perceptions of nurses regarding turnover to identify strategies to improve retention, job satisfaction, and performance (Dawson, Stasa, Roche, Homer, & Duffield, 2014). The sample consisted of three hundred and sixty-two nurses working on a medical and surgical unit from three of Australia’s states/territories. This study was part of a larger project which examined the relationship between turnover and patient, organizational, and staff outcomes. The study distributed a survey with an open-ended question at the end, which allowed the participants to elaborate on needs and concerns of turnover. Statements were then analyzed using NVivo a qualitative data analysis tool, and themes emerged from this analysis. There was consistency in the collection of the data, and reliability of the instruments used. Out of this data three themes emerged. One which relates to the given research question about the factors that directly affect turnover. Factors listed under this theme include limited career options, poor staff support, poor recognition, and poor staff attitudes, all of which contributes to turnover. This study showed the importance of the relationships between the staff members to reduce the rate of turnover. limitations to this study such as only twenty-two percent of the sample from the larger survey answered the open question. Due to the limited response this may potentially affect the data quality, because this may not be the typical nurse’s perspective.
After reviewing the research that could be found on new graduate nurse retention and mentoring programs I have found there is little research on programs after the orientation phase of the transition from student to being in the workforce. Throughout the research there is a trend of relationship building among staff, bridging the gap between new and experienced nurses. In many of the reviewed literature during interviews, new graduates consistently expressed a lack of support, especially after the orientation phase. Moving forward research needs to be addressed to evaluate if a buddy program for new nurses is effective in increasing retention and decreasing turnover.
Dawson, A. J., Stasa, H., Roche, M. A., Homer, C. S. E., & Duffield, C. (2014). Nursing churn and turnover in Australian hospitals: Nurses perceptions and suggestions for supportive strategies. BMC Nursing, 13, 11. doi:http://dx.doi.org.prx-stratford.lirn.net/10.1186/1472-6955-13-11
Friedman, M. I., Delaney, M. M., Schmidt, K., Quinn, C., & Macyk, I. (2013). Specialized new graduate RN pediatric orientation: A strategy for nursing retention and its financial impact. Nursing Economics, 31(4), 162.
Hussein, R., Everett, B., Ramjan, L. M., Hu, W., & Salamonson, Y. (2017). New graduate nurses’ experiences in a clinical specialty: a follow up study of newcomer perceptions of transitional support. BMC nursing, 16(1), 42.
Kelly, J., & McAllister, M. (2013). Lessons students and new graduates could teach: a phenomenological study that reveals insights on the essence of building a supportive learning culture through preceptorship. Contemporary nurse, 44(2), 170-177.
Moore, Penny, PhD, R.N., C.N.L., & Cagle, Carolyn Spence, PhD., R.N.C. (2012). The lived experience of new nurses: Importance of the clinical preceptor. The Journal of Continuing Education in Nursing, 43(12), 555-565. doi:http://dx.doi.org.prx-stratford.lirn.net/10.3928/00220124-20120904-29