Retaining newly Registered Nurses in the profession.

Abstract

Newly qualified nurses (NQNs) are one group at risk of early exit from the workforce. There is a need to reinforce the 'flaky bridge' (Health Education England [HEE] 2018) and ease 'transition shock' to facilitate NQN retention. (1) establish the current state of the art in the UK for nurse retention and transition from student to Registered Nurse; (2) provide UK healthcare organisations, higher education institutions and individual nurses with an evidence-based approach to plan for successful transition; (3) develop an evidence-based toolkit that enables NQNs and their employers to identify, implement and evaluate an individualised approach to transition. A rapid evidence assessment (REA) of NQN transition and retention was undertaken followed by 40 interviews with final year nursing students, NQNs, clinical leaders and academics and 113 written reflections from final year nursing students captured qualitative data on transition. A 'transition toolkit' was developed and used with one group of students (n=75) and data on retention and employment captured to determine impact on the number of nurses retained at the end of 12 months. A variety of formal and informal approaches that enhance and support transition were identified by the REA including having a formal orientation period; the initial placement; satisfaction with the unit and clinical supervision; empowerment; pre-registration employment; and low stress levels having had previous experience in the unit. Preceptorship was found to significantly increase NQNs competence, though no firm conclusions could be reached regarding the impact on retention. Qualitative data suggested that NQNs still experience transition shock and support during the transition period was important. Quantitative data indicated that most NQNs were employed full-time and working in local NHS hospitals. Most had undertaken employment during their programme and when qualified had not changed employer or role and did not plan to change. In the post-intervention group, most had engaged with the STaR project material and had accessed their place of first employment through the project. There were no statistically significant differences between cohorts, and no statistically significant relationships among the data. A supportive framework incorporating supernumerary status, preceptorship or equivalent, peer and organisational culture of support can help to ensure a smooth, seamless and comfortable transition. The link between NQN support and retention remains poorly evidenced.