Australian new graduate experiences during their transition program in a rural/regional acute care setting

The transition process from student to Registered Nurse has been recognised as an important yet challenging time for newly graduated nurses. Knowledge about this experience from the nurse's perspective, particularly in a rural setting, is limited. This paper reports the findings of a qualitative study of the experiences of newly graduated nurses working in a rural acute care facility in New South Wales. The study examined, from the perspective of the new nurse, the orientation and support which can help to facilitate the transition from student to registered nurse. Four themes emerged which were being supported, being challenged, reflections on being a new graduate, and reflections on a rural new graduate program. These findings contribute to what is know about the transition of new graduates in a rural facility and have implications for program improvements, specifically within the rural acute care environment. The findings are also relevant to students considering rural employment on graduation and for the recruitment and retention of New Graduate Registered Nurses in rural areas.     

The developing role of transition to practice programs for newly graduated mental health nurses

A number of significant challenges face graduate mental health nurses entering the workforce. In response, Transition to Practice programs have been promoted as a potential strategy for improving recruitment and retention within the mental health system. This review explores the experience of transition for mental health nurse graduates and identifies key aspects of Transition to Practice programs that facilitate the transition to practising professional. A comprehensive review of qualitative research, which sought to provide insight into the experience of transition for graduate mental health nurses, was conducted. Nine studies were identified through a search of MEDLINE, CINAHL, PsychINFO, PsychArticles, Psychology, AMED, EMBASE and Health Source: Nursing/academic edition. Findings showed a disparity between undergraduate perceptions of the mental health nurse role and what is actually observed during placement, highlighting the need for the positive contribution of preceptors and mentors within a transitional support model for newly graduated mental health nurses.     

Retention of nurses in the primary and community care workforce after the age of 50 years: database analysis and literature review

Title.  Retention of nurses in the primary and community care workforce after theage of 50 years: database analysis and literature review.
Aim.  This paper is a report of a study conducted to explore strategies for retaining nurses and their implications for the primary and community care nursing workforce.
Background.  An ageing nursing workforce has forced the need for recruitment and retention of nurses to be an important feature of workforce planning in many countries. However, whilst there is a growing awareness of the factors that influence the retention of nurses within secondary care services, little is known about those that influence retention of nurses in primary and community care. Little is known about the age profile of such nurses or the impact of the ageing nursing workforce on individual nursing specialities in the England.
Methods.  Nursing databases were analysed to explore the impact of age on nursing specialities in primary and community care. The nurse retention literature was reviewed from 1995 to 2006.
Findings.  Workforce statistics reveal that primary and community care nurses have a higher age profile than the National Health Service nursing workforce as a whole. However, there are important gaps in the literature in relation to the factors influencing retention of older primary and community care nurses. Specific factors exist for older nurses within primary care that are unique. Implications for their retention are suggested.
Conclusion.  Particular attention needs to be paid to factors influencing retention of older nurses in primary and community care. These factors need to be incorporated into local and national policy planning and development.     

A nurse transition program for orthopaedics: creating a new culture for nurturing graduate nurses

Successful training and initiation of new graduate nurses is a critical concern for the entire healthcare industry. Current literature reports that as many as 80-90% of new graduate nurses will leave their job within the first year of employment (Bradley, 2001). In summer 2001, the inpatient orthopaedic department of a large community hospital in the southeastern United States was faced with significant recruitment and retention issues. In response, a new nurse graduate transition program was developed for the orthopaedic specialty. This program uses an adult learning model and a single dedicated preceptor. In addition to clinical experience, the program provides special attention to the development of professional behavior, relationship building, and critical-thinking skills. During the next 2 years, the program produced eight new orthopaedic nurses with a first-year turnover rate of 0%. In addition, this program has positively influenced other areas of importance for RN recruitment and retention, including quality of care, patient satisfaction, and staff satisfaction.     

Workplace practices with mental health implications impacting on recruitment and retention of overseas nurses in the context of nursing shortages

In response to nursing workforce shortages, health agencies in Australia and elsewhere have sought to meet the demand for nursing services by recruiting nurses internationally. While there is a major focus on recruitment, little attention is given to factors that could enhance retention of overseas qualified nurses. There are a host of factors reported in the literature that impact upon retention of overseas nurses in the workforce, including: impact of re-settlement experiences in the new country; discriminatory practices in accessing employment and negative experiences in the work place. For the benefit of long term retention of overseas nurse graduates in the workforce in Australia and globally, these experiences are major issues needing urgent attention. This discussion paper reviews the literature to explore the impact of aggression and discriminatory practices in nursing as evidence for nurses leaving the profession, and discusses the mental health implications and consequences of such practices relating to overseas nurse graduates.     

Why Mentoring Matters for New Graduates Transitioning to Practice: Implications for Nurse Leaders

Low retention of new nurse graduates in the workplace is directly affecting the current and future nursing workforce. Mentoring is a powerful tool that can be leveraged in both academic programs and in the health care practice setting to foster an environment that supports the successful transition from student, to novice nurse, to experienced nurse. Collaborative knowledge sharing between the mentor and mentee fosters better support, resilience, increased motivation, and overall job satisfaction. These factors result in better retention rates of current students and nurses in practice, contributing to the health of the workforce pipeline and the future health of our communities.     

The graduate nurse experience

Graduate nurses experience stress transitioning from student to practicing professional nurse, moving from a familiar educational environment into the workforce, where expectations are to rapidly function as a competent nurse. This study identified the stresses and challenges experienced by cohorts of graduate nurses working in 6 acute care hospitals, during specific timed data periods, to better understand factors that may influence graduate nurse retention. Results report graduate nurses do not feel skilled, comfortable, and confident for as long as 1 year after being hired, highlighting the need for healthcare organizations to provide extended orientation and support programs to facilitate successful entry into practice.     

The implementation of the UHC/AACN new graduate nurse residency program in a community hospital

Transition into the workforce for the new graduate nurse is affected by many factors. New graduate nurses can benefit from support provided through participation in the UHC/AACN Residency Program. The retention of even one graduate nurse saves the employing institution up to an estimated $80,000 annually. St Joseph's Hospital has improved the retention of new graduate nurses from approximately 40% to 100% with the addition of the UHC/AACN Residency Program alongside other system changes. Data are being monitored at St Joseph's and on a national level through this multisite collaborative aimed at improving patient care and increasing nurse retention.     

Coaching and mentoring new graduates entering perinatal nursing practice

The challenges of the nursing shortage have and continue to impact all aspects of health care today. Specialty areas and critical care areas have created job opportunities and are now providing education programs for both experienced as well as new graduate nurses. Orientation is a critical time for new graduate nurses of differing ages who come from varied personal, educational, and work backgrounds with varied life and job experiences. For the successful completion of orientation, coaching and mentoring are key components in the retention and recruitment of nurses into the profession.     

New graduate transitions: leaving the nest, joining the flight

Aim  This review will explore the lived experience of the transition of new nursing graduates in their first year of practice, the implications to nursing and consequences of status quo, and actions required to support new graduates in their transition to practice.
Background  The new graduate eagerly anticipates their first position in the 'real world' but often experience challenges in their first year of practice.
Evaluation  A literature review highlights the historical inaction and the confirmed lived experiences of new graduate nurses.
Key issues  New graduate transition into the workforce has implications on both an individual and societal level. No longer can one ignore the need to recruit and retain nurses, especially new graduates.
Conclusion  Implemented collaborative and innovative efforts are required to support new graduate nurse transition to practice.
Implications for nursing management  Nurse Managers must question why the disenfranchisement and marginalization of new graduates continues. Persistent inertia impacts recruitment and retention of graduate nurses and patient safety, transforming episodic challenges into chronic systemic issues. This article will contribute to new nursing knowledge by providing a Canadian perspective of demographic trends of the Registered Nurse (RN) and salient actions required to resolve the discourse of new graduate transition into the workplace.     

Development of a mentorship programme for new graduate nurses in mental health

A university and three area mental health services collaborated in developing a mentorship programme for new graduate nurses in mental health. The programme evolved from initiatives identified by the New South Wales Government to address recruitment and retention problems impacting on the mental health nursing workforce. This mentorship programme was identified as a strategy to potentially contribute to retention of novice nurses within the local mental health nursing workforce. New graduate nurses entering the mental health field were provided the opportunity to engage in a temporary supportive professional mentoring relationship. The present paper describes the background of the programme and provides an overview of how it was developed. It serves as a starting point for others contemplating developing similar programmes. Evaluation of the programme is incomplete, therefore, formal results will be presented in a subsequent paper.     

Attracting and retaining nurses in primary care

There is increasing demand for nurses to work in primary care. This is driven in part by the need to retain current levels but also by the modernisation plans for primary care services, which require new roles for nurses, new ways of working and more nurses in primary care settings. While campaigns for increased recruitment of hospital nurses and doctors has been largely successful in recent years, primary care has still to see the impact. This article reports on a Department of Health (England) funded project that aimed to identify strategies and exemplars to assist primary care trusts (PCTs) and the workforce development confederations (WDCs) in strategic health authorities in attracting and retaining nurses to primary care at registered nurse level. It reports on the range of initiatives identified, the perceived benefits and challenges. It concludes by proposing a strategic model for planning for the recruitment and retention of primary care nurses.     

Review of small rural health services in Victoria: how does the nursing‐medical division of labour affect access to emergency care?

Aims. This paper is based on a review of the Australian and International literature relating to the nursing‐medical division of labour. It also explores how the division of labour affects patient access to emergency care in small rural health services in Victoria, Australia. Background. The paper describes the future Australian health workforce and the implications for rural Victoria. The concept of division of labour and how it relates to nursing and medicine is critically reviewed. Two forms of division of labour emerge – traditional and negotiated division of labour. Key themes are drawn from the literature that describes the impact of a traditional form of division of labour in a rural context. Methods. This paper is based on a review of the Australian and international literature, including grey literature, on the subject of rural emergency services, professional boundaries and roles, division of labour, professional relationships and power and the Australian health workforce. Results. In Australia, the contracting workforce means that traditional divisions of labour between health professionals cannot be sustained without reducing access to emergency care in rural Victoria. A traditional division of labour results in rural health services that are vulnerable to slight shifts in the medical workforce, unsafe services and recruitment and retention problems. A negotiated form of division of labour provides a practical alternative. Conclusion. A division of labour that is negotiated between doctors and nurses and supported by a legal and clinical governance framework, is needed to support rural emergency services. The published evidence suggests that this situation currently does not exist in Victoria. Strategies are offered for creating and supporting a negotiated division of labour. Relevance to clinical practice. This paper offers some strategies for establishing a negotiated division of labour between doctors and nurses in rural emergency care.     

The dual roles of rural midwives: the potential for role conflict and impact on retention

Nurses and midwives continue to make up the largest proportion of the health workforce. As a result, shortages of nurses and midwives have a significant impact on the delivery of effective health care. Shortages of nurses and midwives are known to be more pronounced in rural and remote areas where recruitment and retention remain problematic. However, rural nurses are often required to be multi-skilled, which has led to expectations that nurses who are also midwives, are required to work across areas of the hospital to help to address shortages. For midwives this issue is even more problematic as they may actually end up spending a very small percentage of their working day involved in the delivery of maternity care. This workforce strategy has the potential to seriously erode the skills of the midwives. Situations such as this are implicated in attrition of midwives because of the role stress that results when they are required to work in models of care where they experience the constant pull to work between departments and across roles. This paper addresses the requirement for midwives in some rural facilities to work across roles of general nurse and midwife and outlines the issues that arise as a result. In particular, the paper links the concepts of Role Theory to the requirement for midwives to work in dual roles and the potential for role stress to develop.     

Nursing first year of practice, past, present and future: documenting the journey in New Zealand

Aim  Documenting the journey of graduate nurse support in New Zealand from local programmes to a nationally consistent framework.
Background  Education of nurses in New Zealand has changed over the decades, from apprenticeship-style hospital-based training to academically prepared registered nurses. Newly graduated nurses require time to become confident within the clinical setting. To achieve this, a well-supported graduate nurse programme is required.
Evaluation  The authors utilized historical reviews of nursing education within New Zealand and current work being undertaken by a national working party to implement a nationally consistent graduate nurse programme.
Key issues  Disparity between locally delivered graduate programmes. Lack of funding to provide a well-structured programme and the impact on the recruitment and retention of new nurses.
Conclusions  It was identified that there was a strong need to ensure graduate nurse programmes were consistent across New Zealand in order to support graduate nurses and retain them in the workforce.
Implications for nursing management  The first year of practice remains a challenging transition time with a need for a well-structured and supported programme. Key needs include learning activities grounded in practice experience, robust programme coordination, skilled clinical educators, preceptors, and a structured learning framework.     

"I'm a different kind of nurse": advice from nurses in rural and remote Canada

The sustainability of the rural and remote nursing workforce in Canada is increasingly at issue as the country becomes more urbanized and the nursing workforce ages. In order to support the retention of nurses in rural and remote communities and the recruitment of nurses to these communities, we require a better understanding of what is important to rural and remote nurses themselves. As part of the in-depth interviews conducted within The Nature of Nursing Practice in Rural and Remote Canada, a national research project, registered nurses (RNs) were asked what advice they would have for new nurses, educators, administrators and policy makers. This is the first of two papers describing that advice. It focuses on RNs in acute care, long-term care, home care, community health/public health and primary care roles in rural and remote communities across the country. The RNs were generous with their advice and gave many rich examples. While they were enthusiastic about their nursing practice and encouraging of other nurses to work in rural settings, they were intent that improvements be made in several key areas: education available to new practitioners and themselves, working conditions for rural and remote nurses, leadership, organizational supports and policies that better support rural and remote practice and communities.     

Transition to mental health nursing through specialist graduate nurse programs in mental health: a review of the literature

Specialist graduate nurse programs (GNPs) in psychiatric/mental health nursing have been widely implemented across public healthcare services throughout Victoria, Australia. Broadly, these programs aim to assist newly graduated nurses during the transition from nursing student to registered nurse. This paper presents a review of the literature relevant to GNPs; specifically focusing on graduate transition. An adequate orientation to clinical areas and ongoing support throughout the transition process were identified as significant determinants of new graduates" satisfaction with the initial post-qualification period. However, the literature suggests that the inadequacy of psychiatric/mental health nursing content in undergraduate nursing courses creates additional difficulties within this specialty area of practice. Moreover, the current literature review emphasises the need for further research to evaluate the effectiveness of GNPs for nursing in general and for psychiatric/mental health nursing in particular.     

Australia’s first Transition to Professional Practice in Primary Care Program: Qualitative findings from a mixed-method evaluation

Background

In Australia, there is an increasing demand for registered nurses in primary health care. Registered nurses graduating from university typically enter the workforce via supported transition to professional practice programs in acute-care hospital settings. A prospective strategy to create a sustainable primary health care workforce is to develop comparable transition programs in primary health care settings, such as general practice. We developed, implemented, and evaluated Australia’s first transition to professional practice in primary care program.

Nursing recruitment and retention in New York state: a qualitative workforce needs assessment

This study's objective is to determine major barriers to nursing recruitment and retention as a basis for the New York State Area Health Education Center (NYS AHEC) System's strategic plan for its nursing recruitment and retention initiative, using qualitative assessment with maximum variation purposeful sample. Nine focus groups were conducted in eight rural and urban regions. Three analysts evaluated data following a theory-driven immersion-crystallization approach. Fifty-six practicing nurses, nurse managers, nursing educators, and health care administrators participated. Participants identified workforce recruitment challenges, including labor market dynamics, professional image in the media, and workforce education and training. Workforce retention challenges were also identified, including working conditions, workforce compensation, and barriers to continuing education. Findings confirm documented national and state nursing workforce issues, identify rural-urban distinctions not evidenced in previous research, and provide priorities for the NYS AHEC System pertaining to access to formal and continuing education, faculty shortages, work-place best practices, and recruitment.