Evidence-Based Practice Presentation

New Grad 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 (Welding, 2011).
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
the nursing role
Significance to nursing: New graduate nursing programs have a positive impact for new nurses on the
transition into the nursing role. The program is effective because it allows new nurses to experience
real life nursing duties and tasks with the assistance of experienced nurse preceptors. This directly
influences the nursing workforce because it enhances overall nursing competency and provides for
a safer work environment. Confident/experienced nurses lead to better patient health outcomes,
decreased nursing burnout rates and more effective health care for our nation as a whole.

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

efficiency and relevancy of New graduate nursing programs to create our own
NRP. 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: PICOT

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
Goal: Develop a standardized residency program to take the novice learner from new graduate to more competent
have completed the program (AACN, 2016).

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 best practice is having a new grad program for six months or long, is the
best!
Decreases the overall stress levels in new grads
New Grads retention rate is an average 83%, decreasing burnout rates!
There has been an increase nationwide improving the satisfaction in new grads
nurses is around 63%
New Nurses feel confident with practicing skills with a longer working nurse

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

Summary of 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 firstyear 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.

Summary of 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

Summary of strengths and limitations continued

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

Evidence-based nursing recommendations to

support best practice
Tess Graettinger

Application/Implementation to Nursing Practice

Siew Wong
Nurse residency programs - First transitional year
Unit-based orientations
Provide nonthreatening environment through clinical simulation
Communicating with physicians, patients, and family members
Knowing what to do for dying patients
Delegating tasks to nursing assistant
Prioritizing patient care
Being supported by other nurses on the unit
Having opportunities to practice skills
Managing time
Feeling prepared to complete job responsibilities
Weekly/monthly assessment by manager, preceptor, or educator
(Friday, Zoller, Hollerbach, Jones, & Knofczynski, 2015)

Cost analysis
Alexus Milobar
An 18 week medical surgical new graduate nursing program costs the hospital $21,571 per resident in Florida. A 22 week intensive care new
graduate nursing program costs the hospital $36,960 per resident.
A medical surgical residency for 20 new graduate nurses in Florida cost the hospital $535,424 for non productive time and outsourced residency.
With the use of new graduate nursing programs the contract labor dollars were reduced from $3.04 million to $797,000 in a 12 month post
residency time.
Should be valued as an investment as an investment as opposed to an expense.
Even if a hospital undergoes budgeting issues and decreases reimbursements orientation programs should be a budget priority.
Talk about improving the retention rate because it is worth the cost
Trepanier, S., Early, S., Ulrich, B., & Cherry, B. (2012). New graduate nurse residency program: A cost-benefit analysis based on turnover and contract labor usage. Nursing Economics, 30(4), 207-14.
Retrieved from
http://ezproxy.library.arizona.edu/login?url=http://search.proquest.com.ezproxy2.library.arizona.edu/docview/1037800871?accountid=8360
Welding, N. M. (2011). Creating a nursing residency: Decrease turnover and increase clinical competence. Medsurg nursing, 20(1), 37.

Risks vs Benefits
Victoria Chavez
Risk for the institution:

Benefits for the institution:

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

(Kowalski & Cross, 2010)

2. Introduces new graduates to the key persons and

resources needed to execute the routines of the
institutions.
2. Personal growth, employee motivation, improved job
performance and retention rates, and career
advancement.
(Bliech, 2012)

Risks vs Benefits
Risks for the nurses:
1.

2.

3.

Traditional orientation programs

a.

6 weeks to 3 months

b.

too brief to achieve expected levels of clinical

competency and professional confidence.

Lack of clinical experience and organizational skills,

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

(Kowalski & Cross, 2010)

Benefits for the nurses:

1.

Mentoring projects:
a.

2.

improved study skills, critical thinking skills,

understanding of content, clinical time
management skills, confidence levels, and overall
clinical performance.

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:

a. self confidence
b. nursing and health team satisfaction

Risks vs Benefits
Risks for the patent:
1.

2.

Nursing turnover:
a.

Disrupts health care teams

b.

Impacts the delivery of quality care to their

patients.

Benefits for the patient:

1.

a.
2.

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.

Increased patient safety and communication.

First 6 months
a.

New graduate nurses:

a.

Participation in New Graduate programs:

Focus on internal issues

i.

clinical practice

ii.

personal identity

iii. coping strategies

3.

Second 6 months
a.

Focus on external issues

i.

patients

Implementation
Nursing Residency Program
Cunningham-Spinks Hospital
30 new graduate RN
30 RN preceptors (2 year minimum nursing experience)
Present to Administration Board (estimate 3 months to approve and initiate)
Program layout
Estimated cost analysis
Incentives
Benefits

12 month Nursing Residency Program

Block 1 (1 month)
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)

Evaluation
Post 6 months and 1 year
Retention rates
Job satisfaction
Burnout
Recommendation on how to improve/change the NRP to be more effective

Evaluation
Alexus Milobar

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.
3. After completion of the 1-year NRP, the new graduate nurse will demonstrate
effective decision-making skills related to clinical judgement and time
management when delivering patient care.

Summary
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.

Summary
-New graduate programs are effective to increase nursing competency, decrease burnout rates and 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.
-The Best practice is to participate in a NPR program because it directly influences patient safety, increases confidence and
many more positive implications.
-Our 12 month new graduate program is a holistic program that has been created for 30 students. Run by 2 nurse
educators, it takes the students through 12 months of education, hands on care, skills practice and training that prepare
them to confidently work on their own.
-The cost analysis is effective. At a total cost of $1,800,000, this an affordable budget for the Cunningham-Spinks Hospital.
Compared to other NRP programs nationwide.
- The benefits of this program far outweigh the total risks. The risk of nurses dropping out, turnover rates increasing and
dissatisfaction with the program are less likely compared to to the benefits of the program that include for instance: a low
budget, the program increases nurses confidence, provides valuable experiences, and it positively influences patient safety.
-

References:
Trepanier, S., Early, S., Ulrich, B., & Cherry, B. (2012). New graduate nurse residency program: A cost-benefit analysis based on
turnover and contract labor usage. Nursing Economics, 30(4), 207-14. Retrieved from
http://ezproxy.library.arizona.edu/login?url=http://search.proquest.com.ezproxy2.library.arizona.edu/docview/1037800871?acco
untid=8360
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),
151-157.
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.
Scott, E. S., Engelke, M. K., & Swanson, M. (2008). New graduate nurse transitioning: necessary or nice?. Applied Nursing
Research, 21(2), 75-83.
Bleich, M. (2012). In praise of nursing residency programs. American nurse today, 7(5), 47-49.
Wulf, L. S. (2011). Benefits of mentoring for retention of new graduate nurses (Doctoral dissertation, Ball State University).