Evidence-Based Practice Presentation

New Graduate Nursing Programs

Group F
Madilynn Will
Ivan Urbieta
Victoria Chavez
Michelle Tamayo
Tess Graettinger
Alexus Milobar
Siew Wong
Sean Chester

Introduction
New graduate nurses represent 10% of the nursing workforce
Largest source of registered nurses available for nurses
Expected to transition into professional practice straight from school,
with many students having little experience
Many hospitals with new graduate nurses experienced high turnover
rates, decreased retention and disatisfaction with their jobs
New graduate programs were created to provide new nurses with
extra training and help transition into

Significance to nursing: New graduate nursing programs have a

positive impact on decreasing anxiety during transition into the
workforce. In addition, they lower turnover rates and increase
retention and nursing competency overall.

(Welding, 2011)

As a group we have researched the evidence based nursing practice of

the efficiency and relevancy of New graduate nursing programs. We
highlight the benefit of these programs on increasing nursing
competence, leadership, job satisfaction, retention rates and
ultimately decreasing turnover in new graduates during their first year
of working.
In addition, our research provides valuable information to our peers, who
are soon to be new graduates nurses, for deciding if new graduate
programs will be helpful for their transition into the nursing profession.
Enjoy

Significance of the Clinical Question

Tess Graettinger

What is the best practice for new graduate nurses transitioning out of
nursing school into the workforce?

What is the effect on new graduate nurses (P) who participate in hospitals with new
graduate nursing programs (I) compared to hospitals that do not offer these programs
(C), when considering burnout and retention rates (O) within their first year (T) of
working?

Population

New graduate nurses

Intervention

Hospitals offering new graduate program

Comparison

Hospitals without new graduate programs

Outcome

To improve new graduate nurse retention rates and to decrease burnout rates

Time

Within the first year of work

Summary of Current Practice: Local Hospitals With or Without a New

Graduate Program
Michelle Tamayo

Local results:
Hospitals in Tucson that have a New Grad Program
Banner UMC, Tucson Medical Center, Carondalet
There is no standardized new graduate program in Tucson
Hospitals in Tucson/near Tucson that do not have a New Grad Program
Northwest Medical Center
Oro Valley hospital
Green Valley hospital

New Graduate Program Current Practice In

Local Hospital: Tucson Medical Center
Goal: minimizing stress and maximizing the confidence of the RN after 1 year program
(Murphy, E., 2016)

Phase 1: General Clinical and Hospital Orientation

-One month orientation
-To make sure new graduates understand Tucson Medical Centers benefits and
responsibilities
-Classes/review on major nursing topics
-Skills competency check offs (Murphy, E., 2016)
Phase 2: Taking part in shifts
-Weekly forums & skills labs
-Interdisciplinary experience and orientation specific to department
-Meeting preceptor to guide you to the rest of unit orientation
-3, 8-hour shifts every week for 1 month
-Full time shifts with assigned preceptor (Murphy, E., 2016)
Phase 3:
-Applying learned skills into practice
-Full transition into the TMC nursing community
-Once a month 4 hour required forums (Murphy, E., 2016)

New Graduate Program Current Practice in Arizona

State results: Hospitals in Arizona are not required to have a New Graduate Nursing
Program
Example of an accredited hospital with a New Graduate Nursing Program: Mayo-clinic: (1
year)

Goal: To provide new nurses with education and support in developing decision-making
abilities and knowledge, while enhancing technical skills (Mayo Foundation, 2016).

Comprehensive Curriculum: Variety of educational styles

-Presentations
-Lectures
-Guided hands-on skills training
-High-fidelity patient simulations
(Attendance is mandatory for all) (Mayo Foundation, 2016).

One-on-one Preceptor:
-Length of time with preceptors varies by specific unit and each individuals learning needs
(Mayo Foundation, 2016).

Offers NCLEX review (for payment)

-Increase the amount of nurses that pass before residency program (Mayo Foundation, 2016).

New Graduate Program Current Practice in the United States

National: Hospitals in the United States are not required to have a New Graduate Nursing Program and do
not have a standard program

Example: The University Healthsystem Consortium & American Association of Colleges of Nursing
(The national voice for baccalaureate and graduate nursing education)
187 practice sites in 32 states offer the year-long residency program, with average retention rates at 95%. More than 40,000 nurses have
completed the program (AACN, 2016).
Goal: Develop a standardized residency program to take the novice learner from new graduate to more competent provider.
Framework: Formal curriculum of year long residencies, including:
-In depth development of leadership skills
-Analysis of evidence through reviews of literature
-Application of outcome data to improve patient care
-Professional development
(Structured informal sessions lead by Resident Facilitator)
-End of the year Evidence Based Project (AACN, 2016).
Critical Thinking Development using Case Scenarios
-Based on actual scenarios that have occurred at participating hospitals
-Professional reflection
-Comparing scenarios with other scenarios, personal experiences, different symptoms/diagnoses, alternative approaches
-Assessment tools by HESI/Elsevier (AACN, 2016).

Synopsis of Current Literature Research Findings related to

New Grad Programs
Ivan Urbieta

The turnover rate for new graduate nurses is 63%

38% of New graduate nurse leave their first job
After two years 78%,new graduate leave

6% of new graduate leave the nursing profession

Factors involving nurses to leave
Increased stress
Feelings of Inability of effective patient safety
Heavy work load

Strengths and Limitations

Madilynn Will

Increased job satisfaction as well as nursing retention and competence rates.

New licensed registered nurses that attended RN orientation, had the lowest
first-year turnover.
NRPs had a positive impact in nurse-physician and patient and family
communication, support from preceptors, leadership skills, clinical
competency, technical skills, confidence, and stress levels.
Many of the respondents who participated in the studies, were still actively
employed, full-time registered nurses.

Strengths and Limitations

Madilynn Will

Strengths:

Large sample size

Strong response rate among former nurses who participated in
residency programs and are still employed at the same hospital
Anonymous online survey
Large variety of positive and negative comments in the open-ended
questions
Results compare favorably to rates reported in prior literature
Demographics show a more racially diverse group, with equal
representatives of males and females

(Rosenfeld, Glassman, & Capobianco, 2015)

Strengths and Limitations

Madilynn Will

Limitations:

Some studies were conducted in one institution, limiting

generalization
Findings may not apply to smaller institutions
Lack of a true comparison, RNs who did not benefit from the NRP
Experimental or quasi-experimental studies will better analyze the
impact NRPs have on the nursing workforce
Culture could influence outcomes of this study

(Rosenfeld, Glassman, & Capobianco, 2015)

Evidence-based Recommendations
Siew Wong

To support best practice, new graduate nurses

Should participate in new graduate programs for 6 months or
longer (Scott, Engelke, & Swanson, 2008)
Should work with experienced nurses (Scott, Engelke, & Swanson,
2008)
Should work 8-hour shifts to prevent burnout (Kenny, Reeve, &
Hall, 2016)
Should participate in weekly forums each week
Should be placed in a well-organized unit
Should NOT be placed in an already understaffed unit
High-stress environment leads to high turnover (Scott, Engelke, &
Swanson, 2008)

Implementation
Nursing Residency Program
Alexus Milobar

Cunningham-Spinks Hospital
30 new graduate RN
30 RN preceptors (2 year minimum nursing experience)

Present to Administration Board (Est. 3 months to approve & initiate)

Program layout
Estimated cost analysis
Incentives
Benefits

12-month Nursing Residency Program

Block 1 (1 month: with fellow New Grad)
Four 9-hour shifts/week
Orientation
Hospital policies, benefits, retirement, education lectures, competency
skills, review of certifications
Guest speakers
Dieticians, PT, OT, ST, diabetic educator, social work

Leadership skills

Block 2 (1 month: with Preceptor)

Three 8-hour shifts/week prevent burnout
Plus two 6 hour forums/week 1: skills, 1: lecture
Introduce to unit and preceptor

12-month Nursing Residency Program

Block 3 (3 months: with Preceptor)
Three 12-hour shifts/week
Follow up with nurse educator at the end of each week

Block 4 (7 months: Independent)

Three 12-hour shifts/week
With one 2 hour forum/month

Mock code, updated policies

New graduate peer support

Coping strategies, time management, self progress

Evaluation
Program, preceptor, self evaluation

Cost Analysis
2 Nursing Educators
Average salary: $78,000/year
Total= $156,000/program
30 New Graduate RN
Average New Grad salary: $30/hour
Total per New Grad= $56,160/year
Total= $1,684,800/ program
Total Program Cost
$ 1,840,800
Contingency: $20,000
GRAND TOTAL= $1,860,800

Cost Analysis: Current NRP rates

18 week Medical Surgical NRP in Florida
$21,571 per resident
Total=$431,420

22 week Intensive Care NRP in Florida

20 new graduate RNs
$36,960 per resident
Total=$739,200

(Trepanier, Early, Ulrich, & Cherry, 2012)

(Welding, 2011)

Risks vs. Benefits for institution

Victoria Chavez

RISKS

BENEFITS

1.

Hospitals are faced with budget challenges

1.

1.

Limited resources

Formal and informal set of learning

opportunities that focus on helping nurses
learn the institutions policies, procedures,
and standards of care.

1.

Partnering the new graduates with their

fitting mentors.

2.

1.

Appropriate unit placement

Introduces new graduates to the key

persons and resources needed to execute
the routines of the institutions.

3.

Personal growth, employee motivation,

improved job performance and retention
rates, and career advancement.

(Kowalski & Cross, 2010)

(Bliech, 2012)

Risks vs. Benefits for the Nurse

Victoria Chavez

RISKS

BENEFITS

1. Traditional orientation programs

a.
b.

6 weeks to 3 months
too brief to achieve expected levels of
clinical competency and professional
confidence.

2. Lack of clinical experience and

organizational skills, resulted in decreased
self-confidence.
1. Increased workload and responsibilities,
new situations, unfamiliar surroundings
and procedures, and new work
relationships increased the stress of the
new graduates.

1. Mentoring projects:
a. improved study skills, critical
thinking skills, understanding of
content, clinical time management
skills, confidence levels, and overall
clinical performance.

2. Mentees receive:
a. more promotions, have higher
salaries, exert greater influence, and
are more satisfied with their jobs
and careers compared to nonmentees.

3. One on one mentoring increased:

a. self confidence
b. nursing and health team satisfaction
c. improved quality of care.
(Kowalski & Cross, 2010)

(Bliech, 2012)

Risks vs. Benefits for the Patient

Victoria Chavez

RISKS
1. Nursing turnover
a. Disrupts health care teams
b. Impacts the delivery of quality care
to their patients.

2. New graduate nurses

a. Do not possess the clinical
judgement of an experienced nurse
b. May not recognize the early signs of
patient deterioration
c. May create the possibility of
increased morbidity and mortality
amongst their patients.

BENEFITS
1. Participation in New Graduate
programs:
a. Increased patient safety and
communication.

2. First 6 months
a. Focus on internal issues
i. clinical practice
ii. personal identity
iii. coping strategies

3. Second 6 months
a. Focus on external issues
i. patients
ii. the healthcare team
iii. extending their learning

(Scott, Engelke, & Swanson, 2008)

(Kowalski & Cross, 2010)

Evaluation/Outcomes
Tess Graettinger

Evaluate new graduates at 6 months and 1 year post NRP:

1.
2.
3.
4.

Retention rates
Job satisfaction
Burnout
Recommendation on how to improve/change the NRP to be more
effective

Outcome:
1. The new graduate nurse will work at the same institution where
he or she completed the NRP for at least one year post program.
2. Throughout the duration of the 1-year NRP, the new graduate
nurse will verbalize and demonstrate three strategies he or she
can use when experiencing increased stress and excessive
fatigue to reduce the likelihood of burnout.

Summary
Sean

New graduate programs

The issues involved include that 6% of new graduate nurses lead the nursing
workforce. Nurses also experience stress and increased workload without help
transitioning from school.
Best practice

Our 12 month new graduate program

Cost analysis is effective

Benefits of this program far outweigh the total risks

increase nursing competency

decrease burnout rates
increase overall nurse satisfaction.

participate in a NPR program

directly influences patient safety
increases confidence and many more positive implications.

holistic program for 30 students

2 nurse educators
12 months of education: hands on care, skills practice and training that prepare them to
confidently work on their own.

total cost of $1,800,000, this an affordable budget for the Cunningham-Spinks Hospital.
Compared to other NRP programs nationwide.

Program increases nurses confidence

Provides valuable experiences
Positively influences patient safety.

Thank you
Sean Chester

New nursing graduate programs are no way a quick solution for nursing
turnover and retention rates. However, evidence from the many
sources obtained in this presentation for example support our
question that in fact, new graduate nursing programs do have a
profound impact on new graduate nurses. They directly reduce
burnout rates within the first year of working and the programs meet
individual needs that help to increase retention rates in the hospital
care setting.
Now, many hospitals and facilities across the country are increasing
budget costs in order to implement new graduate nursing and
residency programs to increase nursing leadership and satisfaction
among this population.

References
Bleich, M. (2012). In praise of nursing residency programs. American nurse today, 7(5), 47-49.

Friday, L., Zoller, J. S., Hollerbach, A. D., Jones, K., & Knofczynski, G. (2015). The Effects of a Prelicensure Extern Program and Nurse
Residency Program on New Graduate Outcomes and Retention. Journal for Nurses in Professional Development, 31(3), 151157.
Kenny, P., Reeve, R., & Hall, J. (2016). Satisfaction with nursing education, job satisfaction, and work intentions of new
graduate nurses. Nurse education today, 36, 230-235.

Kowalski, S., & Cross, C. L. (2010). Preliminary outcomes of a local residency programme for new graduate registered nurses. Journal
of Nursing Management, 18(1), 96-104.

Introducing the UHN/AACN Nurse Residency Program Marketing Tool Kit Available. (February 2016). American Association of
Colleges of Nursing. Retrieved from: http://www.aacn.nche.edu/education-resources/nurse-residency-program
New Grads and New Beginnings at TMC. (12 June 2014). Tucson Medical Center. Retrieved from: http://tmcaznews.com

/2014/06/12/new-grads-and-new-beginnings-at-tmc/

Rosenfeld, P., Glassman, K., & Capobianco, E. (2015). Evaluating the short and long-term outcomes of a post-BSN residency
program: Findings of a retrospective study of nurse residents, 2005-2012. The Journal of Nursing Administration, 45(6), 331-338.
doi: 10.1097/NNA.0000000000000211