How Nurse Leaders Can Support New Nurses’ Transition Into Practice

Nursing graduates are entering a rapidly changing and demanding environment with patients that have complex needs and larger patient-to-nurse ratios than in years past. The transition period — from academia to clinical practice — is critical for nurses to develop the necessary skills.

Nurse residency programs are a structured option that achieves far more than a traditional nursing orientation. These programs can help meet graduate nurses’ educational, informational, and mental needs. Let’s examine how nurse residency programs improve patient outcomes and nurse retention, which helps hospitals save money, and how nurse leaders can advocate for transition-to-practice programs.

New graduate nurses must move from a theoretical-based academic environment into clinical practice, transitioning everything they learned in the classroom and during supervised clinical experiences to independently caring for patients.

In previous years, researchers have noted that new nurses have higher medication and practice errors than experienced nurses, contributing to stress levels and significantly impacting patient safety.

New nurses care for more complex patients in an increasingly elaborate, technologically advanced healthcare setting. Roughly 25% of new graduate nurses leave their first position within the first year. This can significantly impact hospitals that spend thousands of dollars hiring and preparing new graduates for practice.

A 2022 review of the literature found that the costs related to training and orienting new nurses comprised one of the largest expenses of nursing turnover. Some studies recorded the cost ranging upward of $62,000, and the cost of replacing a nurse may be as high as $82,000.

One study revealed that a nurse residency program improved readiness for practice and indicated those nurses may be less likely to leave the institution. They concluded that nurse residency programs helped improve nurse retention and readiness for practice while increasing job satisfaction compared to a standard orientation program.

Another study by the National Council of State Boards of Nursing (NCSBN) examined how transition-to-practice programs affect nurses in hospitals, community public health, and home health settings. During Phase 1 of the study, researchers evaluated the results of a nurse residency transition to practice program in a hospital and found significantly better outcomes.

The researchers measured the new nurses’ reported competence, self-reported errors, work stress, job satisfaction, and nurse retention levels. The data showed that transition-to-practice programs with the best results were formalized programs supported by the hospital administration, 9-12 months long, and included a floor preceptor educated in the role.

Nurse residency programs with the greatest success centered on clinical reasoning, communication, patient safety, teamwork, quality improvement, informatics, and evidence-based practice. The programs gave new graduates time to absorb and apply the information in a clinical setting.

New graduates were given time to share their reflections and get feedback from their preceptors. The researchers also found transition-to-practice programs were more successful when the content was customized so new graduates learned information based on the unit where they were working.

During Phase 2, the researchers looked at the feasibility of the same types of programs in a non-hospital setting, such as home health care or a nursing home. The data was not as conclusive, and further study is planned.

Accreditation of these programs is the next step to establishing standards of practice and ensuring evidence-based plans are incorporated in the process. For example, a rapid review found multiple inconsistencies in transition-to-practice programs. These inconsistencies included preceptorships, mentoring, duration of the program, and the length of formalized study.

Inconsistencies make it impossible for researchers to determine the effectiveness of transition-to-practice programs across multiple hospitals and to generalize research findings. Using an accredited framework increases the value to the hospital and new nurses, ensuring an evidence-based framework is used to meet goals, decrease nursing turnover, and improve nursing job satisfaction and patient outcomes.

The Accreditation Commission for Education in Nursing (ACEN) offers a transition-to-practice program accreditation, which allows for program flexibility to meet the needs of the organization and the community while ensuring the nurses and hospital are following program quality standards.

ACEN processes are guided by current practice and outcomes, following data that suggests successful transition-to-practice programs improve the nursing care quality and patient safety.

Strong nursing leaders are vital to ensuring the profession successfully navigates the growing technological healthcare evolution while protecting nurses. Nurse leaders do more than develop an annual budget, monitor productivity, and represent their nursing staff. They are also role models and influence the organization at all levels.

Because nursing leaders take a broad view of how daily activities impact healthcare organizations’ goals, leaders must adapt to changing environments and help motivate their staff to achieve positive patient outcomes.

One of these roles is investing the appropriate resources to help new graduate nurses transition into the nursing profession. One way that has proven effective across multiple organizational structures is by implementing a nurse residency program.

Developing an accredited nurse transition-to-practice program helps foster a healthy work environment that retains staff and improves quality nursing care. Ultimately, these measurements improve patient outcomes and reduce hospital costs.

Promoting the investment and implementation of a transition to practice nursing program is one strategy that helps to support nurses’ mental health and lower the burnout rate. Nursing leaders can help ensure a supportive workplace where nurses feel safe to share their concerns and frustrations.

The workplace environment and culture are dictated by management and leadership. Nursing leaders can also help promote programs within the institution that reduce nursing burnout and protect mental health.

Nursing leadership also plays a role in patient education to help build stronger patient outcomes. In turn, this helps support nursing staff, especially new nursing graduates, faced with learning new skills and ensuring their patients receive appropriate education that influences long-term outcomes.