NURSING GRADUATES: OVERCOMING OBSTACLES DURING THE TRANSITION TO THE WORKFORCE
Nurses play a vital role in healthcare. They work closely with doctors and other medical professionals in all different healthcare settings, from hospitals, clinics, and nursing homes, to community health centers and hospices. Nurses perform a wide variety of tasks, including (but not limited to):
- Performing physical exams
- Administering medications
- Providing wound care
- Interpreting medical information and making critical decisions about patient care/interventions
- Counseling patients and their families
- Supervising and directing other healthcare personnel
- Conducting essential research to improve patient outcomes
Doctors, surgeons, dentists, and other healthcare providers rely heavily on nurses to ensure patients get the care they need-it’s safe to say that most healthcare facilities would simply not be able to function without nurses and the crucial services they provide.
Many nurses are inspired to pursue a career in nursing by a desire to help others. They devote their time, energy, and money into learning the discipline of nursing-many go to school at night while working full time, sacrificing family time and social activities in the process.
Yet, a striking number of nursing graduates leave during their very first year on the job-nearly one in five (17.5%), according to a study published in Policy, Politics & Nursing Practice.1 One in three (33.5%) will leave within two years. These numbers could be as high as 30%-35% in the first year and 50%-57% in the second year, according to Medcom.2
Given the sacrifices aspiring nurses make to prepare for their new career, and the important role nurses play in health care settings, these numbers are alarming.
Why do nurses leave? There are many reasons, including disparities between the training nursing students receive and their real-life on-the-job experience, lack of support, loneliness, and isolation in the first months on the job. We’ll explore these reasons and others in more detail ahead.
REASONS NURSES LEAVE THEIR EMPLOYER OR THE PROFESSION ALTOGETHER
To sum it up generally, the reason nurses leave is because their expectations of what the job would be differ sharply from what they end up experiencing. Common reasons for dissatisfaction among nurses include:
- Heavy workloads
- Undesirable schedules (such as night shift)
- Insufficient time with patients
- Feeling underpaid for the amount of work they do
- Lack of support from mentor/preceptor/manager
- Insecurity about not being able to master skills of the job
- Fear of harming patients
- Lack of autonomous practice
- Feeling bullied by peers
- Lack of acceptance into the group
- Few extrinsic or intrinsic rewards
- Confusion over disparities between methods learned in school versus methods healthcare facility employs
Discontent tends to peak between months four and six, and again near the end of the second year, which helps explain patterns in the nurse turnover during the first and second year.
THE PHASES OF NURSING
Nurses tend to experience the following phases following their debut into the profession:
- Honeymoon : During this phase, which lasts a few weeks to a few months, everything is fresh and new; the nursing graduate may love their unit, preceptor, and patients; they’re excited about learning new things, and their self-esteem is growing.
- Reality shock : Reality sets in, and differences between what the nursing student learned and what is really happening around them become apparent. Nurses are on their own for the first time without the guidance and reassurance of their preceptor or mentor; they realize that nursing is fast-paced, with a constantly changing environment and regulatory requirements to meet. Nurses may be afraid of harming patients and end up dreading coming to work; burnout is common in this phase. Nurses may feel anger, guilt, depression, or anxiety; they are most likely to make medication errors or fail to recognize life-threatening signs in this phase.
- Recovery : In this phase nurses begin to understand the new culture and feel more secure in their abilities; anxiety subsides, and nurses realize there are both positive and negative aspects of nursing, and that no job is perfect.
- Resolution : In this phase nurses develop a sense of perspective and are able to effectively contribute to their environment and handle conflict; support from preceptors and others is important for helping nurses come to the resolution phase, as well as maintaining social and family connections.
NURSING SCHOOL VS. REAL HEALTHCARE SETTINGS
Nursing school immerses students in a world of healthcare theory, but often doesn’t provide sufficient exposure to the real-world experiences they’ll need to learn in order to cope with stress and the daily challenges of nursing.
Clinical time in nursing school is generally short-lived, and when students are in the clinical arena they tend to interact with other students and instructors to a much greater degree than with patients, other nurses, ancillary staff, physicians, consultants, and others.
Students are generally not assigned complex or unstable patients during training; instead they may only be able to observe such patients. Additionally, students may only have a few days of exposure to the ICU, emergency room, or pediatrics unit, and then may only be observers. To a large degree this is because hospitals can only accommodate so many students at once. As a result, many students may not get the exposure they need to feel confident once on the job.
CAN CARING TOO MUCH HURT NURSES?
Most people have an expectation that nurses are and should be caring and compassionate. Yet survey data by researchers at the University of Akron shows that those who pursue a career in nursing primarily out of a desire to help others are more prone to burnout.3 By contrast, those who pursue nursing for the enjoyment of the work or for the lifestyle it provides have a lower likelihood of burnout.
The increased incidence of burnout in those who pursue nursing to help others may result from a higher emotional investment in patient outcomes among these individuals.
Symptoms of burnout include:
| Fatigue | Mood swings |
| Physical complaints | Anxiety |
| Over or undereating | Depression |
| Sleep troubles | Anger and/or guilt |
Managing stress is especially important for these nurses. They must embrace the idea of self-care first-after all, it is impossible to provide care for others over the long-term when caregivers are stressed, physically exhausted, and emotionally fatigued.
BULLYING AND INCIVILITY IN NURSING
There is a common saying that “nurses eat their young,” a reference to the problem of hazing, bullying, or incivility new nurses sometimes experience at the hands of more experienced nurses. While these behaviors aren’t limited to the field of nursing, it can nevertheless seem strange for hostility and abuse to arise in a segment of the healthcare industry that is so focused on compassion and caring.
New nurses can manage incivility and bullying coming from fellow nurses by:
- Conveying confidence (but not arrogance) when interacting with others
- Rehearsing different scenarios of conflict with their instructor ahead of time
- Being assertive in their communication with others
- Encouraging cooperation among team members
NURSING TURNOVER: A COSTLY PROBLEM
Not only is it tremendously disappointing for new nurses to leave the profession early due to burnout, it also creates strain on the health care system. Turnover is costly in any industry, and nursing is no exception. Facilities spend anywhere between $44,000 and $88,000 for every nurse that must be replaced, according to Medcom.4
It’s clear that adequately preparing the nurses for the real world of health care is not only important, but necessary. Let’s look at some ways that can be done.
SOLUTIONS: EASING THE TRANSITION AND AVOIDING BURNOUT
The following can help prevent burnout and reduce subsequent abandonment of the profession by new nurses.
- Nurse mentoring programs can be an effective strategy in helping future nurses cope with the realities of their job. Nurses who are paired with a compatible mentor with at least two years of clinical experience tend to have better experiences once on their own. Mentors should coach new nurses on effective communication, stress management, and how to best work autonomously.
- Transitional learning involving coursework, practice using mannequins, and role playing can help fill in the gaps of real-world experience that nursing students frequently miss out on.
- Internships and residency programs help nurse grads transition to the workplace and typically last 5-15 months. These structured programs are focused on evidence-based curriculum and clinical experience, and they provide grads with information and training on anatomy, physiology, pathologies, pharmacology, procedures and treatments, and more through the use of nursing videos, live lectures, and small group discussions. Internships and residency programs that provide guided clinical experience with preceptors and mentors can be a tremendous help in reducing turnover.
- Preceptors can help ease the transition into the new work environment for new nurses by creating clear teaching plans with goals and clearly defined expectations. Preceptors should introduce new hires to the policies and procedures of the unit, and guide and correct new hires as needed. Preceptors can also help minimize anxiety among new hires by carefully choosing patients that the new hire will work with.
- Mentors have more long-term relationships with nurse graduates than preceptors, since the latter have a time-limited association with grads. Mentors provide support, coaching, and encouragement to help nurse graduates improve their performance and reach their goals. They help with conflict resolution and advise the new grads about the importance of self-care, limiting overtime, and talking about stressful situations.
Burnout and turnover are significant problems not only for nurses, and the facilities where they work, but, ultimately, for patients-the recipients of care. Taking steps to adequately prepare nurses for real-world encounters using preceptors, mentors, internships, residencies, and transitional learning programs that incorporate live lectures, nursing medical videos, coursework, and group discussions can help ease the transition of newly graduated nurses to the workforce.
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