Newly Licensed Registered Nurses Research Articles

Impact of Nurse Residency Programs on Retention and Job Satisfaction: An Integrative Review

Objects: Retention of new nurses is vital within the context of the nursing shortage Canada is currently facing. Nurse residency programs (NRP) need to be explored to better understand their role in combating the nursing shortage. The aim of this study is to explore current nurse residency programs and their impacts on retention and job satisfaction with the aim to inform development of similar programs in Canada. Methods: The study utilized Whittemore and Knafl’s integrative review methodology to review current literature on nurse residency programs in The United States of America with focuses on retention rates, job satisfaction and intent to leave. Overall, this article drew on seven distinct research studies. Findings: The literature review found that Nurse Residency Programs (NRP) can improve retention rates however, this may be due to contracts signed upon beginning of NRP. Job satisfaction for newly licensed registered nurses (NLRNs) participating in NRP also showed improvements but their impact on reducing turnover intention is unclear and needs further study. Conclusion: The impact of nurse residency programs on retention and job satisfaction has some positive effects, but the strength of this relationship remains unclear and would benefit from further research.

Fostering Resilience and Well-Being Among New Graduate Nurses.

Nearly one third of the U.S. nursing workforce is considering leaving their current job, with millennials new to the role most likely to leave. Newly licensed registered nurses (NLRNs) often feel unprepared and overwhelmed, contributing to the risk of turnover in this workforce segment and amplifying unstable healthcare environments. This evidence-based quality improvement project integrated a resilience and well-being program into a nurse residency program, improving resilience and well-being in NLRNs transitioning to professional practice.

Work Readiness of Newly Licensed RNs.

The aim of this study was to examine the work readiness of newly licensed RNs (NLRNs) based on demographics, education, and work experiences. Work readiness is the extent to which new graduates possess qualities and competencies associated with workplace success. Work readiness of NLRNs complements their clinical knowledge and skills and has been shown to predict job satisfaction and work engagement. Two hundred ninety-seven NLRNs participating in the nurse residency program of a health system in the southeast region of the United States were surveyed using the Work Readiness Scale-Graduate Nurse. Scores on all readiness dimensions were high. Analysis revealed unexpected differences in readiness dimensions based on race, nursing degree, and completion of a nurse externship program. Work readiness adds to our understanding of factors that can affect the transition of NLRNs into the work setting. Further research is needed to understand how work readiness develops over time, factors that predict work readiness, and its relationship to NLRN retention and other outcomes.

The Implementation of a Perianesthesia Nursing Orientation for the Newly Licensed Registered Nurse

<h3>Background Information</h3> Historically, nurses were required to have critical care experience prior to transitioning into the perianesthesia areas of practice. Due to complexity of patient care and critical thinking demands of perianesthesia, new graduates are not often recruited. Throughout the United States, there is limited opportunity for new graduate nurses to work in specialty areas, such as perianesthesia, when there is no formal nursing orientation for the newly licensed registered nurses (NLRNs). Perianesthesia nursing encompasses a unique subset of nursing that combines the acute and critical care skills with a comprehensive surgical and anesthesia knowledge base. A perianesthesia specialty nursing orientation for the newly licensed registered nurse could establish a strong nursing foundation and evolve these novice nurses into competent, perceptive, and collaborative perianesthesia nurses. <h3>Objectives of Project</h3> The objective of this project was to create a perianesthesia nursing orientation for the NLRN. <h3>Process of Implementation</h3> An integrative review of the literature was done to synthesize the evidence and understand the impact of nurse residency programs on healthcare organizations. The project leaders then sought out subject matter experts through ASPAN to gain a better understanding of how to operationalize this project. The project leaders then created an orientation plan and business proposal and submitted it to executive leadership, nursing leadership, and perioperative leadership. The business proposal was accepted and the first perianesthesia nurse residency program was started in January 2021. <h3>Statement of Successful Practice</h3> The first cohort was comprised of 2 NLRNs. The two nurses were selected from a candidate pool of almost 100 applicants. The two NLRNs proceeded through a comprehensive orientation plan for 6 months and successfully finished by July 2021. Due to the success of the pilot group, the project leaders were able to successfully justify and recruit for another group of NLRNs, who started in January 2022. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> The establishment of a specialty nursing orientation for the NLRN now gives new graduate nurses the opportunity to transition successfully into the perianesthesia setting as a new to practice nurse.

The Effectiveness of Simulation Use in Transition to Practice Nurse Residency Programs: A Review of Literature From 2009 to 2018.

Representatives of three international associations reviewed literature published from 2009 to 2018 to ascertain the effectiveness of simulation use in transition to practice programs for newly licensed registered nurses (NLRNs). A review of nine quantitative studies demonstrated that simulation positively influences NLRN self-perception of skills, competence, readiness for practice, and confidence. However, evidence of objective measures of NLRN competence and the impact of simulation on patient and organizational outcomes was lacking.

Hospital-Based Simulation.

This chapter discusses the current state of hospital-based simulation, including the unprecedented events of 2020's global COVID-19 pandemic. Hospital-based simulation training requires a new approach. The realities of social distancing and the operational demands of hospital staffing ratios warrant creative adaptations of traditional simulation training methods. Hospitals used simulation to improve patient outcomes by training healthcare staff and students through telesimulation, and tested systems and equipment using in situ simulation (ISS). Latent safety threats (LSTs) were identified and corrected to improve patient outcomes. Hospital-based simulation has been incorporated into newly licensed registered nurses (NLRNs) residency programs to prepare them for competent practice. Simulations are also used for preparing staff for low-incidence, high-risk medical emergencies or disasters, such as active shooter events. Hospital-based simulation training adds value to healthcare systems, but requires more evidence of its quantitative and qualitative impacts.

Effect of a brief cognitive behavioral program on depressive symptoms among newly licensed registered nurses: An observational study.

Depressive symptoms are a serious problem in workplaces. Hospital staff members, such as newly licensed registered nurses (NLRNs), are at particularly increased risk of these symptoms owing to their limited experience. Previous studies have shown that a brief program-based cognitive behavioral therapy program (CBP) can offer effective treatment. Here, we conducted a longitudinal observational study of 683 NLRNs (CBP group, n = 522; no-CBP group, n = 181) over a period of 1 year (six times surveys were done during this period). Outcomes were assessed on the basis of surveys that covered the Beck Depression Inventory-I (BDI). The independent variables were CBP attendance (CBP was conducted 3 months after starting work), personality traits, personal stressful life events, workplace adversity, and pre-CBP change in BDI in the 3 months before CBP (ΔBDIpre-CBP). All factors were included in Cox proportional hazards models with time-dependent covariates for depressive symptoms (BDI ≥10), and we reported hazard ratios (HRs). Based on this analysis, we detected that CBP was significantly associated with benefit for depressive symptoms in all NLRNs (Puncorrected = 0.0137, HR = 0.902). To identify who benefitted most from CBP, we conducted a subgroup analysis based on the change in BDI before CBP (ΔBDIpre-CBP). The strongest association was when BDI scores were low after starting work and increased before CBP (Puncorrected = 0.00627, HR = 0.616). These results are consistent with previous findings, and indicate that CBP may benefit the mental health of NLRNs. Furthermore, selective prevention based on the pattern of BDI change over time may be important in identifying who should be offered CBP first. Although CBP is generally effective for all nurses, such a selective approach may be most appropriate where cost-effectiveness is a prominent concern.

The MINDBODYSTRONG Intervention for New Nurse Residents: 6-Month Effects on Mental Health Outcomes, Healthy Lifestyle Behaviors, and Job Satisfaction.

In 2017, the National Academy of Medicine convened its Action Collaborative for Clinician Well-being and Resilience in an effort to stem the epidemic levels of burnout, depression, and suicide among healthcare clinicians. Nurses report higher rates of substance abuse, depression, and suicide than the national average. Newly licensed registered nurses (NLRNs) report high levels of burnout and stress. Suboptimal health in nurses is linked to medical errors. Few studies address the mental health and lifestyle behaviors of NLRNs or provide evidence-based solutions to improve these outcomes. This study evaluated the 6-month effects of the MINDBODYSTRONG for Healthcare Professionals program on the mental health, healthy lifestyle behaviors, and job satisfaction of NLRNs participating in a nurse residency program. A two-group randomized controlled trial was conducted with 89 NLRNs at a large, Midwestern academic medical center. The intervention group received eight 30- to 35-min weekly sessions as part of the MINDBODYSTRONG program, a cognitive behavioral skill-building program incorporating strategies to improve mental and physical health. The control group acted as the attention control group receiving eight weekly 30- to 35-min debriefing sessions as part of the normal nurse residency program. Data were collected at baseline, immediately postintervention, 3months postintervention, and 6months postintervention. The intervention group scored better on mental health outcomes, healthy lifestyle behaviors, and job satisfaction at 6months postintervention than the control group. Significant improvements were found for depressive symptoms and job satisfaction; there were moderate to large positive effects for the MINDBODYSTRONG program on all variables. The MINDBODYSTRONG program sustained its positive effects across time and has excellent potential as an evidence-based intervention for improving the mental health, healthy lifestyle behaviors, and job satisfaction in NLRNs.

Intervention Effects of the MINDBODYSTRONG Cognitive Behavioral Skills Building Program on Newly Licensed Registered Nurses' Mental Health, Healthy Lifestyle Behaviors, and Job Satisfaction.

The purpose of this study was to evaluate the effects of the MINDBODYSTRONG for Healthcare Professionals Program on stress, anxiety, depressive symptoms, healthy lifestyle behaviors, and job satisfaction on newly licensed RNs (NLRNs) participating in a nurse residency program. The constellation of burnout, depression, and suicide in clinicians is a public health epidemic that affects the quality and safety of healthcare. The National Academy of Medicine's Action Collaborative on Clinician Well-being and Resilience has called for an increase in evidence-based interventions to combat this alarming problem. The MINDBODYSTRONG Program is a novel adaptation of an evidence-based cognitive behavioral skills-building intervention that provides a theory-based approach to improve the mental health, healthy lifestyle beliefs and behaviors, and job satisfaction of NLRNs. A 2-group, cluster randomized controlled trial was used with 89 new nurses participating in a new-graduate nurse residency program. The experimental intervention, MINDBODYSTRONG, consisted of 8 manualized weekly 45-minute sessions. Data were collected at baseline, immediately following, and 3 months after intervention that measured stress, depressive symptoms, anxiety, healthy lifestyle beliefs and behaviors, and job satisfaction. Repeated-measures analysis of variance was used for data analysis. The intervention group scored significantly better with moderate to large positive effects on the mental health variables as well as healthy lifestyle beliefs and healthy lifestyle behaviors at both follow-up time points compared with the attention control group. Moderate to large positive effects also were found for job satisfaction. The MINDBODYSTRONG Program has excellent potential as an evidence-based intervention for improving the mental health, healthy lifestyle beliefs and behaviors, and job satisfaction, in NLRNs.

The Effect of Transition to Practice Programs on the Self-Assessment of Newly Licensed Registered Nurses' Confidence in Quality and Safety Competency Attainment.

The aim of the study was to evaluate effectiveness of transition to practice programs (TPPs) on self-assessment of quality and safety competency development in newly licensed registered nurses (NLRNs). TPPs are innovative strategies to promote quality and safety competencies. Hospital-based TPPs support and facilitate transition to practice. A pretest-posttest design was used to determine if NLRNs' self-assessment of quality and safety knowledge, skills, and attitudes changed significantly over time and by TPP type as measured by the Nursing Quality and Safety Self-Inventory. Sixty-four NLRNs from three TPPs participated. A statistically significant increase in confidence in knowledge and skills was found with no significant changes in confidence attitudes. No significant changes were found based on TPP type or prelicensure program. The Nursing Quality and Safety Self-Inventory was a valid and reliable instrument for measuring changes in quality and safety knowledge, skills, and attitudes in NLRNs. TPPs are effective strategies to advance confidence in quality and safety competencies.

Workplace Bullying and Newly Licensed Registered Nurses: An Evolutionary Concept Analysis.

Workplace bullying (WPB) among nurses, especially newly licensed registered nurses (NLRNs), negatively affects nurse, patient, and organizational outcomes. Despite empirical evidence addressing the prevalence and impact of WPB, the behavior continues to persist within nursing work environments. Increased conceptual clarity of WPB is needed for interventions to be developed, executed, and evaluated. The purposes of this concept analysis, in which we used Rodgers' evolutionary method, were to obtain a clearer understanding of WPB, to differentiate the concept from other forms of workplace violence, and to describe a definition of WPB consistently used in the literature. Three attributes specific to WPB included negative behaviors directed toward an individual who perceives themselves to be a target, a time frame of experiencing these negative behaviors (e.g., daily or weekly) for a prolonged period (e.g., several weeks), and the inclusion of a power gradient or hierarchy between the bully and target. Antecedents identified for WPB included a scarcity of resources and poor leadership and management. Consequences associated with WPB included adverse nurse, patient, and health care organizational outcomes. WPB was conceptually defined as any negative behavior, exhibited by a nurse of either perceived or actual power, that was repeatedly (i.e., daily or weekly) and persistently directed toward NLRNs who have difficulty defending themselves against the behavior. Implications for researchers, health care organizations, nurse leaders, and nurses are included.

The Impact of Supplemental Simulation on Newly Licensed Registered Nurses

BackgroundChallenges exist for nursing students as they transition to their role as newly licensed registered nurses (NLRNs) due to a mismatch between their perceived readiness and role competency and the demands of the practice environment. Simulations with debriefing may be one strategy to better prepare students for the role of a NLRN. The purpose of this study was to explore whether supplementing traditional clinical experiences with simulation versus substituting simulation for traditional clinical experiences had an impact on NLRNs' perception of competence, work stress, and job satisfaction. SampleA convenience sample of 115 NLRNs from two successive graduating classes in a Midwestern traditional baccalaureate nursing program who participated in the same curriculum with different uses of simulation were recruited. MethodsA quasi-experimental design was used to compare the two groups of NLRNs at six months of practice. ResultsThe NLRNs with supplemented simulation had higher job satisfaction. ConclusionThese results suggest that programs that use simulation to supplement traditional clinical experiences may lead to increased job satisfaction in NLRNs.

Factors Influencing Organizational Commitment and Turnover in Nurse Residents.

Newly licensed RNs (NLRNs) are at risk for leaving employment in the first year. Nurse residency programs have demonstrated success for NLRN retention, yet other variables remain to be explored. A retrospective correlational approach was used to determine the effect of autonomy, competence, group cohesion, structural empowerment, and job satisfaction on organizational commitment, turnover intent, and actual job turnover using secondary data of 1,498 nurse residents. At 1 year post-residency, turnover intent was low. The turnover rate at year 2 was 8.3% (n = 125). Group cohesion, job satisfaction, and structural empowerment had a significant effect on organizational commitment. Organizational commitment had a significant effect on turnover intent. As part of the global NLRN population, findings based on the U.S. residency programs provide nursing professional development with information to foster the needs of NLRNs and nursing administrators with information to support the development and effectiveness of nurse residency programs in the organization. J Contin Educ Nurs. 2018;49(10):482-488.

Determinants of Workplace Injuries and Violence Among Newly Licensed RNs.

Workplace injuries, such as musculoskeletal injuries, needlestick injuries, and emotional and physical violence, remain an issue in U.S. hospitals. To develop meaningful safety programs, it is important to identify workplace factors that contribute to injuries. This study explored factors that affect injuries in a sample of newly licensed registered nurses (NLRNs) in Florida. Regressions were run on models in which the dependent variable was the degree to which the respondent had experienced needlesticks, work-related musculoskeletal injuries, cuts or lacerations, contusions, verbal violence, physical violence, and other occupational injuries. A higher probability of these injuries was associated with greater length of employment, working evening or night shifts, working overtime, and reporting job difficulties and pressures. A lower probability was associated with working in a teaching hospital and working more hours. Study findings suggest that work environment issues must be addressed for safety programs to be effective.

Newly Licensed RN Retention: Hospital and Nurse Characteristics.

The aims of this study were to examine the relationship between 1-year retention of newly licensed RNs (NLRNs) employed in hospitals and personal and hospital characteristics, and determine which characteristics had the most influence. A secondary analysis of data collected in a study of transition to practice was used to describe the retention of 1464 NLRNs employed by 97 hospitals in 3 states. Hospitals varied in size, location (urban and rural), Magnet® designation, and university affiliation. The NLRNs also varied in education, age, race, gender, and experience. The overall retention rate at 1 year was 83%. Retention of NLRNs was higher in urban areas and in Magnet hospitals. The only personal characteristic that affected retention was age, with younger nurses more likely to stay. Hospital characteristics had a larger effect on NLRN retention than personal characteristics. Hospitals in rural areas have a particular challenge in retaining NLRNs.

The Role of Preceptorship and Group Cohesion on Newly Licensed Registered Nurses' Satisfaction and Intent to Stay.

Thirteen percent of newly licensed registered nurses (NLRNs) vacate their first job after 1 year, and 37% report that they feel ready to change jobs. Turnover can lead to consistent and detrimental nursing shortages in nursing units, as well as increased costs for health care systems. A descriptive, prospective, cross-sectional design was used to understand how preceptor role effectiveness and group cohesion affect NLRNs' satisfaction and intent to stay. NLRNs reported high levels of perceived preceptor role effectiveness, group cohesion, and job satisfaction, with only moderate levels of intent to stay. Statistically significant relationships were found among preceptor role effectiveness, job satisfaction, and intent to stay, as well as among group cohesion, job satisfaction, and intent to stay. Preceptor role effectiveness and group cohesion are predictors of NLRNs' level of job satisfaction. Job satisfaction is a predictor of NLRNs' intent to stay. Effective preceptors and positive group cohesion are factors that are important to NLRNs' job satisfaction and intent to stay.

Work-Family Conflict Among Newly Licensed Registered Nurses: A Structural Equation Model of Antecedents and Outcomes

Conflict between work and family is a human resource management issue that is particularly relevant for nurses. Nursing is a demanding profession, and a high proportion of nurses are women, who tend to have greater family responsibilities than men. Little is known regarding work-family conflict among nurses, and even less is known about how this affects newly licensed registered nurses (NLRNs), who can be stressed from their new jobs and careers. This study empirically tests a model of antecedents and outcomes of work-family and family-work conflict among a sample of NLRNs. We developed a model of the relationships between personal and work environment characteristics, work-family and family-work conflicts, job satisfaction, and intent to leave the job and profession. We used structural equation modeling (Amos, IBM SPSS) to test the model with data from.a survey of NLRNs. We examined a number of latent variables, as well as direct and mediating relationships. The measurement models for all latent variables were validated. The final model indicated that age, health, and family responsibilities are antecedents of family-work conflict; job demands lead to work-family conflict; family-work conflict contributes to job difficulties, which lowers job satisfaction, which, in turn, increases the intent to leave the job and profession; and work-family conflict increases the intent to leave the job and profession (but does not directly affect job satisfaction). Policies to help NLRNs with family responsibilities could reduce family-work conflict, which might reduce job difficulties and improve satisfaction and retention. In addition, policies to reduce job demands could reduce work-family conflict and improve retention.

Original Research

Recent changes in U.S. health care and economics may influence the demand for nurses and the work choices of newly licensed RNs (NLRNs). We sought to compare the work lives of two cohorts of NLRNs licensed six years apart. Data were collected from two groups of NLRNs in 14 states via mailed surveys. The first group consisted of a subset of NLRNs surveyed for a larger study in 2004-05; the second group was surveyed by similar methods in 2010-11. Responses were weighted to adjust for differences in response rates according to geographic area. Response rates were 58% and 47%, respectively, for the 2004-05 cohort (N = 774) and the 2010-11 cohort (N = 1,613). The NLRNs in the later cohort were less likely to work in hospitals, special-care units, and direct care and more likely to work as managers, be enrolled in formal education programs, and view their work environments positively, resulting in more commitment to the organization. Also, those in the later cohort reported fewer local job opportunities, and a greater number held a second job : These findings indicate a shift from the traditional work patterns of NLRNs, who often began their careers in hospitals. Employers' heightened awareness of such changing trends among NLRNs may help them in planning for RN recruitment and retention.

Original Research

The future of nursing depends on newly licensed RNs (NLRNs), who often need help in transitioning from an academic to a clinical setting. This study sought to describe the NLRN's orientation experience and to identify ways of enhancing it.Using qualitative methods, a convenience sample of NLRNs was recruited and 21 were interviewed; audio recordings of the interviews were transcribed and validated for accuracy. Interpretative analysis of the transcripts sought to identify major patterns and themes.Four patterns and 10 themes emerged from the data analysis: preceptor variability (with themes of satisfactory and unsatisfactory preceptorship), professional growth and confidence changing with time (with themes of learning through experience, learning to manage time, and learning to communicate), a sense of being nurtured (with themes of support through the program, the preceptor, and peers), and enhancing the transition (with themes of orientation enhancements and human resource enhancements).These qualitative findings provide insight into the NLRN's transition from student to professional and suggest ways institutions might enhance orientation. Further study is warranted.

Registered Nurse Perceptions After Implementation of a Nurse Residency Program

Nurse residency programs (NRPs) are an effective mechanism for transitioning newly licensed registered nurses (NLRNs) to practice. No studies have investigated how experienced nurses view NLRN performance after NRPs. The purpose of this quality initiative was to identify experienced nurses' satisfaction with NLRN proficiency before and after implementation of an NRP using the Nursing Practice Readiness Tool. Findings indicate that experienced nurses are more satisfied with the performance of NLRNs after the new nurse participated in an NRP.