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New graduate nurse transitioning: Necessary or nice?

Elaine S. Scott, RN, PhD


4
, Martha Keehner Engelke, RN, PhD, Melvin Swanson, BS, PhD
East Carolina University School of Nursing, Greenville, NC 27858, USA
Received 1 March 2006; revised 19 December 2006; accepted 19 December 2006
Abstract This study investigated the influence of personal factors, orientation, continuing education, and
staffing shortage on the satisfaction, intent to leave their job, and intent to leave the profession of a
random sample of new graduate nurses from varied facilities and geographic locations. It further
examined the influence of personal factors and orientation on turnover rates among new graduate
nurses. The findings indicate that orientation programs are essential to the retention and satisfaction
of new graduate nurses. Given current economic constraints, this study supports nurse executives
ability to advocate for and receive funding for transition-to-work programs as well as the placement
of new graduate nurses in well-staffed units.
D 2008 Elsevier Inc. All rights reserved.
1. Introduction
New graduate nurses recruitment into and retention in
the workplace are fundamental strategies for ensuring that
health care systems have the continued capacity to deliver
patient care (Berliner & Ginzberg, 2002). New graduate
nurses come into the profession through varied educational
avenues and demonstrate a wide range of competence and
confidence levels in their new roles. In addition, todays
new graduates enter a chaotic workplace characterized by
nursing shortages, high patient acuity, and scarce resources.
Nurse executives are challenged to transition these new
graduate nurses in a way that will develop proficiency,
foster satisfaction, and encourage retention.
Although nurse executives know experientially that the
first year of practice influences nurses retention and
professional satisfaction, economic constraints and minimal
research validation often limit their ability to develop and
fund extended nursing internships and orientations. Con-
temporary concerns for high rates of new graduate
turnover and poor beginning technical competencies have
spurred initiatives to develop standardized nursing resi-
dency programs (Johnson & Cleary, 2006). In addition,
studies that have linked patient safety and outcomes to the
quality and quantity of nursing care have resulted in a
litany of new graduate transition recommendations, includ-
ing those from notable sources such as the Institute of
Medicine (2004), the American Hospital Association
Commission on Workforce for Hospitals and Health
Systems (2002), the American Nurses Association [ANA]
(2002), and the American Association of Colleges of
Nursing (2002).
The purpose of this study was to investigate the influence
of anticipatory and organizational socialization variables on
the job and career satisfaction, intent to leave their current
position, turnover, and intent to leave the nursing profession
of a random sample of new graduate nurses from varied
facilities and geographic locations. The results of this
research are of interest to nurse educators and executives.
This study increases understanding of the influence that
various personal and organizational conditions have on new
graduate nurses. Its findings also support nurse executives
ability to advocate for funding to support transition-to-work
programs and validate current national and state initiatives
to determine optimal transition programs.
2. Background
The first year in a profession establishes an individuals
career framework and influences long-term professional
development and satisfaction. In nursing, the first few years
of employment are ideally a critical learning period during
which new graduate nurses enter as novices and receive
ongoing education, experience, and support to socialize
0897-1897/$ see front matter D 2008 Elsevier Inc. All rights reserved.
doi:10.1016/j.apnr.2006.12.002
4 Corresponding author. Tel.: +1 252 744 6383 (work), +1 910 328
2851 (home); fax: +1 252 744 6392.
E-mail address: scottel@ecu.edu (E.S. Scott).
Available online at www.sciencedirect.com
Applied Nursing Research 21 (2008) 7583
www.elsevier.com/locate/apnr
them into the role of a competent and satisfied professional
nurse (Benner, 1984). Orientation programs, internships,
and preceptor relationships all contribute to the develop-
ment of proficiency and self-assurance among new
graduate nurses.
The business literature offers well-substantiated theoret-
ical frameworks for analyzing the transition of students from
the academic world to the world of work. Socialization into
work is described by most organizational theorists as a
multistage process of prework experience, actual work
encounter, and adjustment (Jablin, 1987; Van Maanen &
Schein, 1979). Hinshaw, Smeltzer, and Atwood (1987) were
the first researchers to apply these theories to nursing, and
they discovered that various individual and organizational
factors influence anticipated turnover and satisfaction.
Using a comprehensive review of relevant business and
nursing literature, we designed a conceptual model to
illustrate possible influences on the successful transition of
new graduate nurses into the workplace (Fig. 1).
3. Description of the conceptual framework
3.1. Anticipatory socialization: what happens before work
The period of anticipatory socialization contributes
significantly to the expectations that new graduates bring
into their first job. New graduate nurses enter the profession
through a variety of educational processes and are diverse in
age, marital status, race, and sex. These differences in
personal and educational experiences affect the images that
students develop about what the world of work will be like
after graduation.
3.2. Organizational socialization: what happens when
work begins
New graduate nurses enter the workplace with unique
personal attributes and encounter varied socialization
methods and organizational cultures. Currently, almost all
health care systems use orientation programs to transition
new graduates; however, programs vary in intensity and
dimension, ranging from brief informal programs to
extended formal programs that include preceptors and
mentors during an internship or residency program. Limited
research studies on the effectiveness and outcomes of
orientation exist (Wanous & Reichers, 2000). Because of
the different transition standards in nursing, operational
definitions of orientation also vary. Despite a positive
association between orientation and reduced work anxiety,
more realistic job expectations, and increased organizational
commitment, many organizations have decreased orienta-
tion periods in response to economic pressures (Ellerton &
Gregor, 2003).
Another dimension of organizational socialization is the
work environment. New graduate nurses feel heightened
work stress for a period of up to 1 year (Casey, Fink,
Krugman, & Propst, 2004). Stressors include feeling unable
to set priorities and delegate as well as perform procedures,
poor work environments, nursing supervisors, and physician
Fig. 1. Conceptual model of the transition of new graduate nurses into the workplace.
E.S. Scott et al. / Applied Nursing Research 21 (2008) 7583 76
relations (Casey et al., 2004; Heslop, McIntyre, & Ives,
2001). For nurses, poor working conditions are a primary
cause of work stress and job dissatisfaction (Buerhaus,
Staiger, & Auerbach, 2000; Shader et al., 2001; Steinbrook,
2002; Stordeur et al., 2001; Boychuk-Duchscher, 2001). In a
comprehensive review of nurses work stress, the most often
cited causes were workload, inadequate staffing, and time
pressures (McVicar, 2003). New graduate nurses are a part
of their respective intense workplaces, yet the influence of
specific work stressors on new graduate nurses has had
limited exploration (Chang & Hancock, 2003; Halfer &
Graf, 2006).
3.3. Socialization: outcomes of synergy and dissonance
Anticipatory socialization factors influence new graduate
nurses understanding of and preparation for the real world
of work. Positive work environments and effective organi-
zational transition as well as socialization strategies provide
an initial affirmative experience of the organization; an
introduction to coworkers and managers; an understanding
of the organizational policy, process, and culture; and a solid
framework of competencies for the job. If new graduate
nurses master the realities of practice, they would develop a
sense of work satisfaction and career satisfaction. However,
if there is a high level of dissonance between nurses
expectations and workplace realities, nurses would be more
likely to experience a traumatic transition into the nursing
profession (Kramer, 1974).
Research studies on the association between satisfac-
tion and the anticipatory socialization variables of age,
marital status, race, and educational preparation are
limited and conflicting in their findings. In their early
work, Hinshaw et al. (1987) found an association between
the amount of education in nursing and actual turnover.
Blegen, Vaughn, and Goode (2001) found low correla-
tions between age, educational preparation, and satisfac-
tion, whereas Adams and Bond (2000) found no
association between these variables.
Yamashita (1995) found increased satisfaction among
nurses who were married or older. Marital status was also
found to be related to satisfaction by Yaktin, Azoury, and
Doumit (2003) as well as Cimete, Gencalp, and Keskin
(2003), with the married nurses in their studies being
more satisfied.
Winter-Collins and MacDaniel (2000) found no differ-
ence between the satisfaction levels of new ADN (Associate
Degree in Nursing) graduates and those of new BSN
(Bachelor of Science in Nursing) graduates. However,
Rambur, Palumbo, McIntosh, and Mongeon (2003) found
that nurses educational preparation was associated with
their intent to leave their job and that BSN nurses were more
satisfied and less likely to leave.
With the exception of preceptorships, the influence of
organizational transition methods on new graduates career
satisfaction and job satisfaction, intent to leave, and turnover
has primarily been descriptive in nature (Casey et al., 2004).
Research studies on new graduate nurses orientation are
most often limited to anecdotal accounts of successes based
on one hospitals experiences. No study has examined the
association between attendance at specific continuing
education (CE) programs and socialization outcomes;
however, the literature frequently cites lack of experience
with delegation as a cause of frustration and worry among
new graduate nurses (Ross & Clifford, 2002). Early (e.g.,
Hinshaw et al, 1987) and contemporary (e.g., McVicar,
2003) work have linked inadequate staffing and time
pressures to nurses work stress and job dissatisfaction.
Limiting new graduate stressors and fostering positive work
environments are essential satisfaction strategies; however,
the influence of transitional methods and environmental
factors on new graduate nurses remains relatively unex-
plored (Bowles & Candela, 2005).
4. Methods
This study was a secondary analysis of data collected by
the North Carolina Center for Nursing (NCCN). The sample
was drawn from among nurses who were actively employed
and newly licensed by the North Carolina Board of Nursing
for a period not shorter than 6 months and not longer than
2 years. The participants were identified through random
stratified sampling of new graduate nurses included in the
North Carolina Board of Nursing database. Permission was
obtained to deidentify and use the sample of 329 nurses for
analysis. Before implementing the study, we obtained
approval from the East Carolina University Institutional
Review Board.
The NCCN researchers developed a survey instrument to
gather information about new graduate nurses. This tool was
reviewed by a panel of experts to establish its content validity
and included questions successfully used in previous nursing
studies by the center. Embedded in the survey tool were seven
questions measuring job satisfaction and career satisfaction.
The internal consistency and reliability of these satisfaction
items were confirmed in a previous study on general staff
nurses (Shaver & Lacey, 2003).
Although many anticipatory and organizational sociali-
zation factors have been found to influence satisfaction,
intent to leave, and turnover (Fig. 1), only 12 variables
collected from the NCCN survey were coded and used in
this study; these items were age (in actual years), race
(White or non-White), marital status (married/widowed or
single/divorced), education (ADN/Diploma or BSN), the
quantity of orientation (number of weeks), the quality of
orientation (met needs or did not meet needs), the frequency
of staffing shortages (daily or weekly or more frequently),
level of job satisfaction (satisfied or dissatisfied), level of
career satisfaction (satisfied or dissatisfied), intent to leave
current position ( z3 or b3 years), intent to leave nursing
( z3 or b3 years), and turnover (one position and employer
or more than one position and employer). Descriptive data
collected by the NCCN were used to characterize the
E.S. Scott et al. / Applied Nursing Research 21 (2008) 7583 77
sample. These data included each new graduate nurses
current employment status, position type, work setting,
number of positions and employers, hours worked per week,
and average patient caseload per day.
The turnover history of the participants was self-
reported at the same time other data were collected for the
survey. This limited the analysis of independent variables
that might influence turnover, allowing only those that
preceded turnover (age, race, marital status, and educational
preparation) to be used as anticipatory socialization items
and only quantity and quality of orientation, which
specifically referred to the participants first job position,
to be used as organizational socialization factors. For other
items related to organizational socialization, it was impos-
sible to determine if respondents who had turned over were
referring to their current or previous job; therefore, the lack
of clarity in temporal sequence precluded analysis of these
influences on turnover.
Simple descriptive analysis provided an overview of the
sample, including the presence of missing data and outliers.
Using v
2
analysis, we examined the associations between
categorical independent variables and the outcome variables
of nurses turnover, job satisfaction, career satisfaction,
intent to leave their current position, and intent to leave the
nursing profession. A p value of .05 or lower was used
to determine statistical significance in all analyses. Those
items that did not evidence significance with the use of v
2
analysis were excluded from the binary logistic regression
analyses used to examine the relationship of independent
variables to the outcome variables of nurses job satisfac-
tion, career satisfaction, and intent to leave their
current position.
Table 1 shows the univariate analysis results for the
predictor variables that were statistically significant. A test
of the full model for job satisfaction using the five
Table 1
Univariate analysis of predictor variables related to the participants job
satisfaction, career satisfaction, and intent to leave their current position in
less than 3 years ( p b .025)
Variable Satisfied
[n (%)]
Not satisfied
[n (%)]
Statistics
v
2
p
Job satisfaction
Marital status
Single/Divorced/
Separated
92 (51.7) 86 (48.3) 5.848 .016
Married/Widowed 98 (64.9) 53 (35.1)
Race
White 135 (47.9) 147 (52.1) 5.197 .023
Non-White 10 (27.8) 27 (72.2)
Quality of orientation
Completely met needs 70 (58.8) 49 (41.2) 15.137 b.001
Somewhat/
Not at all
70 (36.3) 123 (63.7)
Frequency of short staffing
Daily 16 (20.3) 63 (79.7) 27.219 b.001
Weekly or more
frequently
133 (53.8) 114 (46.2)
Career satisfaction
Satisfied 128 (54.9) 105 (45.1) 27.459 b.001
Not satisfied 22 (23.2) 73 (76.8)
Career satisfaction
Marital status
Single/Divorced/
Separated
87 (62.6) 52 (37.4) 8.365 .004
Married/Widowed 146 (77.2) 43 (22.8)
Age
b25 years 78 (66.1) 40 (33.9) 2.182 .140
z25 years 155 (73.8) 55 (26.2)
Degree
ADN/Diploma 124 (80.5) 30 (19.5) 12.970 b.001
BSN 102 (62.2) 62 (37.8)
Quality of orientation
Completely
met needs
95 (79.8) 24 (20.2) 6.736 .009
Somewhat/
Not at all
127 (66.1) 65 (33.9)
Frequency of short staffing
Daily 45 (57.0) 34 (43.0) 10.115 .001
Weekly or
more frequently
186 (75.6) 60 (24.4)
Job satisfaction
Satisfied 128 (85.3) 22 (14.7) 27.459 b.001
Not satisfied 105 (59.0) 73 (41.0)
Variable Intent to leave current position Statistics
b3 years
[n (%)]
z3 years
[n (%)]
v
2
p
Marital status
Single/Divorced/
Separated
76 (55.1) 62 (44.9) 10.757 .001
Married/Widowed 70 (36.8) 120 (63.2)
Race
White 120 (42.7) 161 (57.3) 5.784 .016
Non-White 23 (63.9) 13 (36.1)
Quality of orientation
Completely
met needs
41 (34.7) 77 (65.3) 6.237 .013
Somewhat/
Not at all
95 (49.2) 98 (50.8)
Table 1 (continued)
Variable Intent to leave current position Statistics
b3 years
[n (%)]
z3 years
[n (%)]
v
2
p
CE on delegation
Yes 108 (41.2) 154 (58.8) 5.709 .017
No 38 (57.6) 28 (42.4)
CE on conflict management
Yes 110 (42.8) 147 (57.2) 1.407 .236
No 36 (50.7) 35 (49.3)
Frequency of short staffing
Daily 49 (62.0) 30 (38.0) 12.803 b.001
Weekly or more
frequently
96 (39.0) 150 (61.0)
Job satisfaction
Satisfied 40 (26.7) 110 (73.3) 35.639 b.001
Not satisfied 106 (59.6) 72 (40.4)
Career satisfaction
Satisfied 81 (34.8) 152 (65.2) 32.043 b.001
Not satisfied 65 (69.1) 29 (30.9)
E.S. Scott et al. / Applied Nursing Research 21 (2008) 7583 78
determined predictors against a constant-only model was
statistically reliable, v
2
(5, n = 285) = 69.15, p b .001. This
was also true for the predictors of career satisfaction,
v
2
(6, n = 298) = 56.39, p b .001, suggesting that the
predictors, as a set, reliably distinguished between new
graduate nurses who were satisfied with their job and career
and those who were not. The levels of variance in
satisfaction accounted for by the model were 27.8% for
job satisfaction and 24.7% for career satisfaction. Partic-
ipants who were satisfied with their job were predicted
64.1% of the time, whereas those who were dissatisfied with
their job were predicted 75.3% of the time, resulting in an
overall success rate of 70%. The model successfully
predicted 91.1% of participants who were satisfied with
their career but only 37.6% of those who were dissatisfied,
resulting in an overall prediction rate of 75.8%.
In the analysis of the participants intent to leave their
current job, job satisfaction and career satisfaction were
added as independent variables based on the original work
of Hinshaw (1987), which suggested that they were separate
elements associated with anticipated turnover. A test of the
full model with eight predictors against a constant-only
model was statistically reliable, v
2
(8, n = 296) = 58.99,
p b .001, indicating that the predictors, as a set, reliably
distinguished between new nurses who said they would
leave their current job in less than 3 years and those who
said they would not. The level of variance in intent to leave
accounted for by the model was 24.2%. Participants
intending to stay longer than 3 years were successfully
predicted 78% of the time, whereas those intending to leave
within 3 years were successfully predicted 59.8% of the
time, resulting in an overall prediction success rate of 70%.
Table 2 shows regression coefficients, Wald statistics,
p values, odds ratios, and 95% confidence intervals for the
predictors of job satisfaction and career satisfaction as well
as nurses intent to leave their current job. The Hosmer
Lemeshow goodness-of-fit v
2
analysis outcomes for job
satisfaction ( p = .793) and nurses intent to leave their job
( p = .59) were not significant, showing good fit between
observed and predicted values. The v
2
analysis outcome for
career satisfaction was significant ( p = .05), indicating poor
fit between observed and predicted values. This poor fit was
probably caused by the small number of participants
reporting career dissatisfaction.
The analysis of intent to leave the nursing profession was
limited because only 6% of the sample intended to leave
within 3 years. This precluded a multivariate analysis with
logistic regression; however, univariate analysis of the
associations of job satisfaction, career satisfaction, and
nurses intent to leave their current position in less than
3 years with the intent to leave nursing in less than 3 years
found that only career satisfaction ( p V .001) and nurses
intent to leave their current job ( p V .001) were
significantly associated with intent to leave nursing in less
than 3 years.
5. Results
The study sample was predominantly White and female;
the mean age of the participants was 29 years. Educational
preparation was equally divided between BSN and ADN/
Diploma; most of the participants had received an orienta-
tion to their first job (94.8%) and had attended CE programs
(81.5%). The hospital was the predominant work setting
Table 2
Logistic regression analysis of variables predicting participants job satisfaction, career satisfaction, and intent to leave their current position et al. in less than 3 years
Variable B Wald statistic p Odds ratio (95% confidence interval)
Job satisfaction
Quality of orientation 0.883 10.469 .001 2.419 (1.4174.130)
Marital status 0.534 3.889 .049 1.716 (1.0032.900)
Frequency of short staffing 1.755 22.280 b.001 5.784 (2.79111.986)
Race 0.736 2.654 .103 2.088 (0.8615.062)
Career satisfaction 1.206 13.926 b.001 3.339 (1.7736.290)
Career satisfaction
Quality of orientation 0.393 1.597 .206 1.482 (0.8052.728)
Marital status 0.437 2.322 .128 1.548 (0.8822.716)
Age 0.011 0.001 .971 0.989 (0.5491.784)
Frequency of short staffing 0.619 3.781 .052 1.857 (0.9953.464)
Educational preparation 1.117 13.383 b.001 3.055 (1.6795.556)
Job satisfaction 1.432 18.714 b.001 4.188 (2.1898.013)
Intent to leave current position in b3 years
Quality of orientation 0.224 0.649 .420 1.251 (0.7252.157)
Marital status 0.540 2.871 .090 1.574 (0.9312.659)
Frequency of short staffing 0.550 2.926 .087 1.733 (0.9233.254)
CE on delegation 0.771 4.875 .027 2.162 (1.0904.285)
CE on conflict management 0.045 0.016 .899 0.956 (0.4801.906)
Race 0.787 3.442 .064 2.197 (0.9575.048)
Job satisfaction 0.785 7.632 .006 2.192 (1.2563.825)
Career satisfaction 1.097 13.359 b.001 2.996 (1.6635.395)
E.S. Scott et al. / Applied Nursing Research 21 (2008) 7583 79
(81.1%), with most of the participants holding staff or
general duty positions (71.1%). Among the new graduate
nurses surveyed, 54.1% were dissatisfied with their current
job and 55.0% had already left their first job but 70.8% were
satisfied with the career of nursing. In this study, 58.7% of
the respondents felt that the orientation they received had
not completely met their needs. New graduate nurses
reported extreme differences in the amount of orientation
received, ranging from as little as half a week to as much as
1 year. Most of the new nurses reported staffing shortages as
a work reality, with 24% stating they experienced daily
staffing shortages within their work units. Additional
demographic and statistical data are shown in Table 3.
Only the predictor variables of quantity and quality of
orientation were significantly associated with new graduate
nurses turnover. The orientation length for new graduate
nurses who turned over in their first nursing job (M = 7.8,
SD = 6.35) averaged almost 2 weeks less as compared with
the orientation length for those who did not turn over (M =
9.7, SD = 6.39), t(313) = 2.65, p = .008. The turnover rate
for those who felt that their orientation completely met their
needs was 45%, whereas the turnover rate for those who
noted that their orientation had not completely met their
needs was 60%, v
2
(1) = 6.44, p = .01.
New graduate nurses who evidenced satisfaction with
their job were 2.4 times more likely to also report being
completely satisfied with their orientation. In addition,
these nurses were 3.3 times more likely to be satisfied
with nursing as a career. New graduates who were
satisfied with their job were also 1.7 times more likely
to be married or widowed and 5.2 times more likely to be
White. The strongest predictor of job satisfaction was
Table 3
Descriptive statistics of study variables
Characteristic Frequency
(valid %)
Range M (SD)
Frequency of short staffing
Not more than weekly 247 (75.1)
Daily 79 (24.0)
Missing 3 (0.9)
Type of setting
Hospital 267 (81.1)
Nursing home/
Rehabilitation facility
10 (3.0)
Community 52 (15.9)
Missing 0
Orientation in first position
Yes 310 (94.2)
No 12 (3.7)
Missing 7 (2.1)
No. of weeks of orientation 0.652 8.6 (6.43)
Orientation met needs
Completely 119 (36.2)
Somewhat/Not at all 193 (58.7)
Missing 17 (5.1)
Job satisfaction
Satisfied 151 (45.9)
Not satisfied 178 (54.1)
Missing 0
Career satisfaction
Satisfied 233 (70.8)
Not satisfied 95 (28.9)
Missing 1 (0.3)
Intent to leave current position
b3 years 146 (44.5)
z3 years 182 (55.5)
Missing 1
Intent to leave nursing
b3 years 20 (6.1)
z3 years 308 (93.9)
Missing 1
Turnover
Turnover 181 (55.0)
No turnover 148 (45.0)
Missing 0
Age
b25 years 118 (35.8)
2530 years 117 (35.6) 2149 29.1 (6.66)
N30 years 94 (28.6)
Missing 0
Race
White 282 (86.5)
Non-White 37 (13.5)
Missing 0
Marital status
Single/Divorced 139 (42.2)
Married/Widowed 190 (57.8)
Missing 0
Sex
Female 307 (93.3)
Male 17 (5.2)
Missing 5 (1.5)
Educational preparation
Diploma/ADN 164 (49.8)
BSN 165 (50.2)
Missing 0
Table 3 (continued)
Characteristic Frequency
(valid %)
Range M (SD)
Age (years) by educational preparation
Diploma/ADN 164 (49.8) 2148 30.9 (7.04)
BSN 165 (50.2) 2249 27.5 (5.88)
Missing 0
No. of employers
1 267 (81.2)
z2 59 (17.9) 08 1.6 (0.969)
Missing 3 (0.9)
No. of positions
1 143 (43.5) 18 1.8 (1.01)
z2 172 (52.3)
Missing 14 (4.2)
Type of position
Staff/General Duty Nurse 234 (71.2)
Home/Office/School Nurse 31 (9.4)
Case Manager/Utilization
Review Nurse/Clinical
Nurse Specialist
7 (2.1)
Team Leader/Unit Manager 51 (15.5)
Other 4 (1.2)
Missing 2 (0.6)
E.S. Scott et al. / Applied Nursing Research 21 (2008) 7583 80
frequency of staffing shortage. New graduate nurses
satisfied with their job were 5.8 times more likely than
other graduate nurses to report staffing shortages that
occurred weekly or not at all rather than daily. New
graduate nurses experiencing daily staffing shortages were
also more dissatisfied with nursing as a career, with the
relationship between staffing shortage and dissatisfaction
approaching significance ( p = .052).
The best predictors of career satisfaction were educa-
tional preparation and job satisfaction. The ADN nurses
were 3.1 times more likely than the BSN nurses to be
satisfied with nursing as a career. New graduate nurses who
reported a high degree of satisfaction with their current job
were 4.2 times more likely to also report a high degree of
satisfaction with the career of nursing.
The participants intent to leave their current position
was predicted by job satisfaction and career satisfaction and
by attendance at a CE program on delegation. New graduate
nurses who intended to leave their current position within
3 years were 2.2 times as likely as others to be dissatisfied
with their job and 2.9 times as likely to be dissatisfied with
the career of nursing. New graduate nurses who had
attended a CE program on delegation were 2.2 times as
likely as peers to leave their job within 3 years.
Intent to leave the nursing profession in less than 3 years
was reported by 20 new graduate nurses and was only
associated with career satisfaction. Nurses who did not like
being a nurse were more likely to report a desire to leave
the profession.
6. Summary and conclusions
One of the most significant findings of this study is the
critical role that orientation in the first job plays in
promoting new graduate nurses job satisfaction and
retention. Although the duration and quality of orientation
reduced turnover of new graduates, regardless of whether
the new nurses remained in their first position or changed
jobs, those who experienced a longer orientation that met all
of their needs were more satisfied with their current job.
This suggests that the first nursing orientation experience
might have an influence on job satisfaction over the initial
1- to 2-year period of transition from school to work. The
study on competence development by Benner (1984)
indicated that nurses need 2 to 3 years to become competent
practitioners, and new graduate nurses often cite the
development of confidence and competence as essential
for feeling good about their job. Future research efforts
should evaluate if the development of confidence and
competence as well as job satisfaction in new graduates
who remain in their first job for at least 1 year are greater
than those in new graduates who change units or organ-
izations. Part of competence development involves attend-
ing relevant CE programs. Many new nurses struggle with
the ability to delegate, and this research showed an
association between nurses attendance at an educational
program on delegation and their intent to leave their job.
This might indicate that these nurses were struggling with
this issue.
Nursings Agenda for the Future (ANA, 2002) promoted
innovation in recruitment and retention as a primary focus
for nurse leaders. Within this domain, a specific recom-
mendation was made to badvocate for standardized intern-
ships and residencies through partnerships between schools
of nursing, professional organizations and practice sitesQ
(ANA, 2002, p. 17). This study supports how essential it is
to standardize and implement transition-to-work programs.
The current initiatives to develop and research these
programs already hold promise, with increased retention
and competence development being preliminarily affirmed
in American projects (Krsek, 2006). While the evidence
from these large demonstration projects are gathered and
orientation programs are developed, the strong association
found in this study between orientation, job satisfaction, and
turnover supports the need for health care systems to
recognize the value of orientation for new graduates.
Despite budget constraints and reimbursement reductions,
nurse executives need to advocate for orientation as a
budget priority. Nurse executives also need to examine new
graduate nurses perceptions of the quality and duration of
orientation experiences, gather feedback about these per-
ceptions usefulness during nurses first year of practice,
and correlate these findings with job satisfaction, career
satisfaction, and turnover.
Another noteworthy study finding is the association
between staffing shortage and job as well as career
dissatisfaction in new graduates. Nurse leaders often recruit
new graduates to work in understaffed units rather than
placing experienced nurses in these areas to stabilize and
alter the culture. Experienced nurses are more competent in
handling multiple priorities and larger caseloads, yet often
new graduate nurses have to begin practice in these at-risk
environments. Health care organizations and nurse leaders
need to buffer the work stress experienced by new graduate
nurses by placing them in units with adequate staffing and
expert nurse mentors. In this study, the new graduate nurses
career satisfaction and job satisfaction were also strong
predictors of their intent to leave their current job and to
leave nursing within 3 years. Previous research studies have
linked intent to leave a job with turnover, suggesting that
placing new graduate nurses in poorly staffed units might
result in increased turnover.
The finding that ADN nurses had higher degrees of
career satisfaction could indicate a difference in the
expectation and fulfillment needs of baccalaureate nurses.
Current recommendations call for an increase in the ratio of
BSN to ADN nurses to ensure patient safety and quality
outcomes (NCCN, 2002). However, although a higher
percentage of BSN graduates in a unit might lead to
improved patient safety, this study suggests that BSN
graduates may be less tolerant of adverse work conditions
and more likely to seek employment in other fields as
E.S. Scott et al. / Applied Nursing Research 21 (2008) 7583 81
compared with ADN graduates. This study supports
monitoring the factors that satisfy and those that dissatisfy
new graduate nurses from orientation through the first
2 years of their practice and evaluating differences based on
educational preparation. These findings should be used to
structure relevant incentives, educational support, and
practice environments that meet the needs of BSN and
ADN nurses. A higher level of career satisfaction among
White nurses also raises concern that the needs of non-
White nurses are not being met and should be further
explored by nurse leaders and researchers.
Nursing executives must continue to find funding for
adequate orientation and transition-to-work programs for
new graduate nurses. Leaders must also promote the
placement of these new nurses in well-staffed units where
they can gain competence and confidence rather than be
overwhelmed by daily workloads. Current efforts to
construct, standardize, and even mandate nursing residen-
cies and internships within the profession should be
promoted because there is a clear relationship between the
quality as well as quantity of new graduate nurses
orientation and the satisfaction as well as retention of these
novice professionals. This research reiterates the importance
of the work that the nursing profession is doing through
transition-to-work demonstration projects and supports the
interim needs of nursing executives who are battling with
budgets to provide an adequate orientation for new
graduate nurses.
Acknowledgments
We thank the NCCN, Dr. Brenda Cleary, and Linda
Lacey for their assistance in obtaining the data used in
this study.
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