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: Mayoclinic: (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
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:
Development of leadership skills
Analysis of evidence
Application of outcome data to improve patient care
Professional development
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
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 (Scott, Engelke, &
Swanson, 2008)

Should NOT be placed in an already understaffed unit

High-stress environment leads to high turnover (Scott,
Engelke, & Swanson, 2008)

OUR PLAN:

Nursing Residency Program

at Cunningham-Spinks Hospital

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. Formal and informal set of learning

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

2. Limited resources
3. Partnering the new graduates with
their fitting mentors.
4. Appropriate unit placement

2. 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.

6 weeks to 3 months

b.

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.
3. 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 non-mentees.

3. One on one mentoring

increased:
(Kowalski & Cross, 2010)

a. self confidence
b. nursing and health team

(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.

(Scott, Engelke, & Swanson, 2008)

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
(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
New graduate programs

increase nursing competency

decrease burnout rates
increase overall nurse satisfaction.

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

participate in a NPR program

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

Summary
Our 12 month new graduate program

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.

Cost analysis is effective

total cost of $1,800,000, this an affordable budget for the

Cunningham-Spinks Hospital.
Compared to other NRP programs nationwide.

Benefits of this program far outweigh the total risks

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.

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