Nurse Managers' Views and Expectations of New Graduates Transitioning Into Professional Nursing Practice

Monday, 30 October 2017

Teresa Shellenbarger, PhD
Department of Nursing and Allied Health Professions, Indiana University of Pennsylvania, Indiana, PA, USA
Kristy Chunta, PhD, RN, ACNS, BC
Deparment of Nursing and Allied Health Professions, Indiana University of Pennsylvania, Indiana, PA, USA

New graduates face many challenges as they transition from student to professional nurse. They are confronted by the complex healthcare environment with demands for rapid assimilation into a stressful and often times unwelcoming work environment. These intense job demands frequently result in new nurse stress, dissatisfaction, and even lead to turnover, costing hospitals time and money (Daniels, Mackovjak, Audia, and Richards, 2013). Prior research on new graduate nurse transition suggests an interplay between intrapersonal, interpersonal, and organizational factors that can impact outcomes (Cohen, 2013). A variety of demographic factors as well as workplace environmental factors have been studied but there is limited research that explores nurse managers’ views and expectations of new graduates (Dwyer, & Revell,2016; Laschinger, Wong, Regan, Young-Ritchie, & Bushell, 2013; Phillips, Esterman, Smith, & Kenny, 2013; Pineau Stam, Laschinger, Regan, & Wong, 2015). Given nurse managers’ leadership and influence on the setting, their beliefs about the role and responsibilities of the new graduate may impact the workplace culture which may ultimately trickle down into the success or failure of the new graduate. Given the limited research available, a descriptive qualitative study was conducted to fully understand nurse managers’ views and expectations of new graduates.

A purposive sample of six nurse managers in diverse hospitals in a midAtlantic state were recruited through professional colleagues and personal networking/referrals using purposive sampling. After explaining the study, a member of the research team obtained informed consent. Informants then participated in audiotaped semi-structured interviews which were then transcribed verbatim. Participants were primarily female (n = 5, female; n = 1, male), Caucasian, and between the ages of 41-60. The participants had between 11 and over 30 years working experience and averaged 11 to 15 years’ experience as a nurse manager with one participant having less than five years. All but one manager had a bachelor’s degree in nursing as their highest level of education and the majority worked in hospitals with approximately 301-500 beds. The nurse managers hired between three and greater than nine new graduates within the past three years.

Nurse managers were asked to describe their expectations of recently hired new graduates. Content analysis was used to analyze the transcripts. To ensure data quality peer debriefing and inter-coder verification with multiple coders was used to validate the themes and enhance accuracy, dependability, credibility, and reproducibility. Findings emerging from the interviews with nurse managers revealed three themes. Informants described communication competency and struggles, moving from beginning skills to expanding roles, and mismatched professional work expectations. Nurse managers discussed their expectations for new graduates regarding communication skills. They reported that most recent hires did indeed interact comfortably with patients and families. As expected the new graduates related easily to patients and families and openly communicated with them regarding care. They failed to demonstrate the same ease when interacting with other healthcare providers, particularly physicians, yet were expected to work comfortably with them. They did exceed expectations for using technology for communication activities and were clearly tech savvy. This may represent the demographics of the newly hired nurses who were frequently under age 25 and may have grown up embracing technology.

The second theme emerging from the data analysis revealed new graduates meeting nurse managers’ expectations regarding skill competency. They were comfortable demonstrating basic technical skills such as dressing changes, vital signs, or standardized procedures for the specific unit. They did lack some of the more complex or specialized skill competence such as intravenous (IV) medication administration, probably resulting from a lack of exposure during their prelicensure education. However, nurse managers were understanding of this deficit and encouraged learning and practice of these skills as new graduates expanded their knowledge of the professional nurse role and responsibilities.

The final finding involves a mismatch in professional work expectations. Nurse managers discussed how new graduates were not accustomed to the demanding workload of caring for multiple patients yet as new hires they were expected to assume these responsibilities. They also talked about the disconnect in work schedules with new graduates expecting to have desirable work hours (day shift) and work days (Monday through Friday) and the expectation that new hires will probably not be scheduled for those coveted days and times. These diverging expectations would contribute to the feelings that some new graduates have and could lead to dissatisfaction within the work environment and turnover as new graduates seek alternative scheduling.

Based upon these findings, recommendations for faculty and campus communities can be suggested to advance nursing and assist with new graduate transition into practice. Nursing faculty need to ensure that nursing students graduate from their programs with strong fundamental nursing skills and problem solving ability. They need to be able to use clinical decision making and be willing to look up unfamiliar content or ask for assistance with new skills. These findings also provide useful guidance in the development of orientation needs and approaches that can be implemented to provide new graduates with skills to successfully navigate the health care environment. Providing simulated opportunities to practice delegation, prioritization and communication skills with other health care providers are an important component to ensure work ready new graduates. Additionally, nursing faculty should incorporate multiple patient assignments either in the clinical setting or through simulation activities to realistically prepare students for the demands of clinical practice. Lastly, managers need to be clear to newly hired staff about the work demands, schedules, and expectations so that new graduates can align their expectations with the work environment. This study leads to a beginning understanding of nurse managers’ views and expectations of new graduates but further study is needed to gather a more complete understanding of the situation and then devise evidence-based solutions that can impact actions and advance nursing.