Abstract
Newly licensed nurses’ retention and job satisfaction are vital for delivering quality healthcare and enhancing healthcare outcomes. Nurse residency programs (NRPs) have been found to enhance newly licensed nurses’ job satisfaction and retention rates. This paper argues that NRPs offer organized assistance and continuous education that help new nurses adjust to their roles and gain confidence in their clinical proficiency.
NRPs also contribute to the quality of patient care and safety. Therefore, this analysis seeks to determine the internal data and evidence that would serve as a base for the research question of the impact of NRPs on nurse retention rates and job satisfaction.
Background
NRP has characteristics that improve career satisfaction for entry-level nurses, positively contributing to retention rates via preparation for difficulties in the workplace. A lack of support for new nurses may lead to discontent on the job and high turnover rates, which could have a detrimental impact on the quality of care provided to patients. According to the findings of several studies, NRPs are connected to higher job satisfaction and retention rates for newly licensed nurses (Chant & Westendorf, 2019). Compared to their counterparts who did not participate in an NRP, nurses who did take part in an NRP reported considerably more significant levels of work satisfaction and reduced turnover rates. In addition, nurses who participated in an NRP said they were more prepared for their positions and had greater confidence in their clinical abilities.
The implementation of NRPs has a beneficial influence on the results of patient care. It was found that nurses who had completed an NRP were happier with their careers and were more likely to remain in their present position. These nurses also reported having a greater sense of self-assurance in their capacity to offer safe and efficient patient care. Putting in place NRPs for newly licensed nurses may be an efficient technique for increasing nurse retention rates and enhancing the sense of fulfillment that comes from one’s nursing job. NRPs may assist new nurses in adjusting to their roles and feeling more confident in their clinical abilities by offering organized assistance and continuous education. This, in turn, will lead to better results for patient care.
PICOT Question
For new nurses, does the implementation of a Nurse Residency Program, compared to no Nurse Residency Program, improve nurse retention rates and career satisfaction within a year of their hire date?
Internal Data
It should be noted that providing high-quality care, ensuring patient safety, and enhancing healthcare outcomes all depend on nurse retention and job satisfaction. Nurse residency programs have been shown to improve retention rates and job satisfaction among new nurses (Sutor & Painter, 2020). The analysis aims to specify the internal data and proof that would inform the research question and where these sources may be obtained within the clinical setting.
Since the PICOT question comprises several components, it is helpful to identify internal data or evidence that could inform each of them. First, nurse turnover rates are a vital source of data and information. The latter is the quantity of nurses who depart the company in a specific time frame, typically a year (CDI Strategies, 2022). Nurse turnover rates can be obtained from the organization’s human resource department. For example, an organization of interest can be contacted with a request for such data within the confidentiality framework.
Additionally, national sources and internet databases can be employed. These rates would provide information on the number of new nurses who leave the organization within a year of their hire date. Comparing the turnover rates of beginner nurses who completed the nurse residency program to those who did not would shed light on the program’s value for retention rates.
Secondly, it is critical to obtain data presented in job satisfaction surveys. Job satisfaction surveys are crucial in assessing nurses’ perceptions of their work environment, job responsibilities, and overall satisfaction. Standardized instruments like the Practice Environment Scale (PES) and the Nursing Work Index (NWI) can be used for surveys (Sanso et al., 2021). Statistical software can be used to examine the findings of these surveys, which can be conducted electronically. To illustrate the program’s impact on job satisfaction, the job satisfaction scores of new nurses who completed the nurse residency program would be compared to those of those who did not.
Thirdly, performance evaluations conducted by organizations of interest can be an outstanding data source. Nurse residency programs typically provide structured learning experiences to develop the new nurse’s skills and competencies (Sutor & Painter, 2020). Performance evaluations provide an opportunity to assess the program’s impact on the new nurse’s performance. Evaluations can be conducted by preceptors or supervisors using standardized tools such as the Clinical Performance Instrument (CPI) or the Objective Structured Clinical Examination (OSCE) (Sutor & Painter, 2020). Performance evaluations can provide insight into the program’s impact on the new nurse’s competence and confidence.
Fourthly, nurse engagement surveys are helpful as complementary data sources to performance evaluations. Nurse engagement surveys measure nurses’ commitment to work, willingness to go above and beyond, and loyalty to the organization (CDI Strategies, 2022). These surveys can be conducted using standardized tools such as the Gallup Q12 survey (Gallup, Inc., 2023). An understanding of the program’s effect on engagement could be gained by comparing the engagement scores of new nurses who completed the nurse residency program to those who did not.
Fifthly, internal data and evidence can also be obtained from sources within the clinical setting. These sources include Electronic Health Record (EHR) systems, which can provide data on nurse turnover percentage, job satisfaction inquiries, and performance assessments (Sanso et al., 2021). It is possible to program these devices to provide reports that statistical software can examine. Human resource departments can also provide a wealth of information for PICOT question analysis. The human resource department maintains personnel records, including turnover rates (Aburumman et al., 2020). The department can provide access to job satisfaction surveys and performance evaluations.
Sixthly, specific professionals within the healthcare and clinical environments can be utilized as valuable data sources. For example, nurse managers and supervisors can be contacted to obtain the necessary data relevant to the PICOT question. It should be mentioned that conducting performance reviews and giving new nurses feedback are the responsibilities of nurse managers and supervisors (Aburumman et al., 2020). They can provide information on engagement levels and turnover rates as well.
Coordinators of nurse residency programs can also offer details on the goals, organization, and content of the program. They can gather and collect data on program outcomes, including retention rates, job satisfaction, and performance evaluations (Sanso et al., 2021). Therefore, these professionals are of prime interest in ensuring that the critical pieces of evidence are obtained for the analysis.
Several sources include internal data and evidence that would inform the research question on nurse residency programs’ impact on retention rates and job satisfaction. These, as shown below, include nurse turnover rates, job satisfaction questionaries, performance evaluations, and nurse engagement surveys. The data can be obtained from various sources within the clinical setting, including electronic health record systems, the human resource management department, nurse supervisors and managers, and coordinators of the nurse residency program.
Internal Sources of Data
Nurse Turnover Rates
Source: Human resource department.
Special considerations: Challenges may emerge regarding the confidentiality of data collection. If this issue indeed appears, it will be needed to complete the nurse turnover rates independently, which will take more time.
Job Satisfaction
Source: Nurse staff.
Special considerations: The Practice Environment Scale and the Nursing Work Index (PES-NWI) are convenient tools for systemizing obtained answers (Sanso et al., 2021). However, it may not reflect the peculiarities of problems associated with nurse turnover. Moreover, one should consider that some nursing staff members might deliberately choose positive answers for a range of reasons. For example, the absence of alternative employment options in case of job dissatisfaction can force a nurse to select answers based on the ‘not-to-do-worse’ principle.
On the other hand, the nurse may be affected by negative leadership styles, such as authoritarian or bureaucratic ones, which impede honest answers. In this case, interviews are also needed to obtain and track specific insights concerning a job satisfaction level.
The findings on interpretability demonstrated that a threshold score of less than 12 effectively identifies challenges in nurses’ working conditions, indicating poor practice environments (Sanso et al., 2021). On the other hand, a threshold score of more than 15 was suggested and proved successful in recognizing superior practice environments (Sanso et al., 2021). These benchmarks were valuable in pinpointing nurses experiencing high burnout levels and job satisfaction issues, particularly those exhibiting subpar practice environments.
Nurse Leadership Surveys and Interviews
Source: Nurse managers, supervisors, and nurse staff.
Special considerations: Job dissatisfaction and a high turnover rate may be a result of inappropriate leadership. For instance, nurse managers may be demanding or create an unhealthy and toxic environment by comparing nurses and their performance. In this stance, questionnaires for nurse leaders should be utilized to identify the most frequently applied leadership style. Furthermore, interviews with nurse staff members should also be conducted to evaluate their perceptions regarding the leadership practices and approaches they encounter.
In addition, one must consider the possibility of untruthful answers because of the reasons mentioned in the Job Satisfaction field. A qualitative analysis of interviews with 36 academic, clinical, and administrative healthcare leaders revealed that insufficient support and work-life balance challenges were obstacles to women’s leadership in Greek and Maltese healthcare environments (Hughes et al., 2022). The primary hurdles faced by women in healthcare leadership in Greece and Malta included maintaining a balance between work and personal life, inadequate family support, a gender gap, gender-based prejudice, and limited social support.
Performance Evaluation
Source: Preceptors or supervisors.
Special considerations: The Clinical Performance Instrument (CPI) and Objective Structured Clinical Examination (OSCE) are sufficient and adequate tools to evaluate performance (Sutor & Painter, 2020). Nevertheless, it is crucial to perform this assessment before the implementation of the nurse residency program (NRP) and in the post-implementation period to see precise results and identify areas for improvement. Participants in the study were selected from four separate units and evaluated on multiple criteria, including gender and educational background (Chen et al., 2021). There was a total of 55 participants consisting of males and females. The number of females was 50, and 5 were men aged 20 to 29. Most test-takers held college degrees (74.5%, n=41), and about half were employed in medical or surgical departments, representing the 50.9%, n=28 variables (Chen et al., 2021).
Nurse Engagement Score
Source: Preceptors or supervisors.
Special considerations: Although nurse engagement comprises specific components, namely willingness to strive above, work commitment, and loyalty to the organization, some other elements may emerge because of the particular and unique nature of the organization. The Gallup Q12 survey can be used as a standardized measurement tool, but one should also consider how to involve more precise indicators (Gallup, Inc., 2023). For example, time spent addressing patient complaints can be used to assess nurses’ readiness to handle extreme cases immediately.
The same time indicator assessment can also be applied to patient falls. Selecting precise indicators is vital since patient complaints and falls lead to the poor financial performance of the healthcare organization, which is inevitably associated with nurse performance and engagement. Finally, the latter two depend on the availability of decent working conditions and motivation reflected in job satisfaction levels, thus highlighting the tight connection between the mentioned indicators.
Electronic Health Records (EHRs)
Source: Human resource department.
Special considerations: EHRs can be used as a complementary tool to the nurse engagement evaluation. The records contain information on patient condition dynamics, implying how nurses maintain patient conditions.
Nurse management perceptions and expectations regarding the nurse residency program (NRP)
Source: Nurse managers and supervisors.
Special considerations: This portion of data is needed to identify the most problematic domains that should be addressed with the help of NRP. Moreover, it enables the comparison of the nurse staff’s perceptions of job satisfaction with the analysis of nurse leadership to determine the objective goals of the NRP.
Nurse Turnover Cost
Source: Financial department.
Special considerations: The consideration of nurse turnover cost is the most critical as it impacts both the job satisfaction level and the implementation of the NRP. One of the recommendations is to pay attention to nurses’ specializations as they imply various needs. For instance, Shaffer and Curtin (2020) state that bedside nurse turnover was 17.2% in 2020, which suggests that turnover rates can vary among bedside nurses and emergency nurses. Moreover, it is necessary to make allowance for the time needed to fill a nurse position (Shaffer & Curtin, 2020). The lack of personnel leads to an overload faced by the currently employed nurses, which can affect job satisfaction levels.
NRP Curriculum
Source: Nurse managers, preceptors, and supervisors.
Special considerations: The NRP must be adapted to the needs and requirements of a particular healthcare facility. Although the program should be multi-domain, it is unacceptable to include irrelevant objectives or training practices. One can rely on component categories introduced by Chant and Westendorf (2019), which include a strong foundation, structured program, and assessment process. Each of these groups comprises a range of dimensions, and one should focus on the most relevant and pertaining to the organization. For instance, the strong foundation category requires a healthy environment and authentic leadership.
If the preliminary evaluation and analysis of job satisfaction and nurse leadership reveal negative results, it can cause problems with the structured program category that envisages professional mentors and experienced preceptors. The NRP implementation cannot be performed with existing mentors and preceptors if they apply inappropriate and toxic practices. Therefore, one should contemplate the involvement of independent mentors. In addition, there is a need to determine the program length to avoid burdening nurses with additional training activities.
References
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