Unexpected And Interrupted Transitions Among Newly Licensed Registered Nurses: Perspectives Of Nurse Managers And Preceptors
Abstract
Successful retention of newly licensed registered nurses (NLRNs) into practice is critical to ensure the nursing workforce required to meet current and future health care demands. NLRN turnover rates result in loss of revenue due to high orientation costs and further hinder the development of a stable workforce. For nurse educators and administrators to effectively address early attrition among NLRNs, they must have a clear understanding of the factors that contribute to NLRNs leaving employment. The aim of this qualitative descriptive research was to explore NLRN transition to professional practice from the experiences and perspectives of nurse managers and preceptors who worked with NLRNs who left employment from their unit within two years of graduation. Data collection strategies included audio-recorded, in-depth, individual semi-structured interviews with a sample of seven managers and seven preceptors who met study inclusion criteria. Data analysis involved a qualitative thematic content approach (Saldaña, 2011; Sandelowski, 2000). Transitions Theory provided the framework for analysis and presentation of the results (Meleis, Sawyer, Im, Messias, & Schumacher, 2000). Chapter 2 entitled A Review of Theoretical Frameworks on the Transition to Professional Nursing Practice is an examination and critique of four theoretical frameworks related to the student to professional nurse transition. This literature review set the stage for the dissertation research.
Chapters 3 and 4 contain the findings of the research, which are presented in the form of two manuscripts prepared for submission to peer-reviewed journals. The article in Chapter 3, entitled Nurse Managers’ Reflections on Newly Licensed Registered Nurses’ Interrupted Individual and Organization Transitions to Professional Practice, examines the participating managers’ reflections on NLRNs’ interrupted individual and organizational transitions to professional practice. The analysis and interpretation of the 22 cases of NLRN attrition discussed resulted in the identification of five patterns of interrupted NLRN transitions: resignation, in-house transfer, probationary dismissal, resignation after discipline, and termination. Chapter 4 contains the manuscript entitled Nurse Managers’ and Preceptors’ Advice to Newly Licensed Registered Nurses in which I present and discuss the research participants’ advice and recommendations for NLRNs. These included that NLRNs should ask questions and show initiative in seeking information and assistance from other RNs and unit staff. The helpful hints participants shared were pragmatic and aimed to assist the NLRN in the transition to practice (i.e., be on time for work; seek out opportunities; listen, be flexible, prioritize). Managers and preceptors also identified pre-professional socialization, including nursing students’ experience in the formal workforce, both within and outside healthcare settings, as a facilitator of the transition to the formal workplace. Another theme focused on encouraging NLRNs to identify what they envision as their professional goals and to realize they have choices. These findings indicated that managers’ and preceptors’ are invested in facilitating smooth transitions for NLRNs.
These findings suggest opportunities for further theoretical refinement and the need for more research on the NLRN transition to professional practice. These include further examination of interruption as a pattern of response within Transitions Theory, in reference to individual and organizational transitions, development and testing of new models of collaboration between nursing and business to address transition within a professional environment, and the effectiveness of mandatory preceptor orientation programs based on evidence. Nurse educators should seek out the perspectives of nurse managers and preceptors and incorporate their input into nursing curricula to better prepare students for workplace expectations and employer selection.