Retention of New Graduate Nurses A Survival Analysis of Five On-Boarding Strategies

Saturday, 16 November 2013: 3:55 PM

Cynthia A. Oster, PhD, MBA, RN
Performance Practice and Innovation, Porter Adventist Hospital, Denver, CO
Mary Siegrist, MS, RHIA
Information Management and Statistical Analysis Consulting, Aurora, CO
Janet Houser, PhD, RN
Rueckert Hartman College for Health Profession, Regis University, Denver, CO

Learning Objective 1: Describe the application of survival analysis to determine risk points for retention of new graduate nurses.

Learning Objective 2: Identify retention and risk points of termination of new graduate nurses.

A 30% turnover rate among graduate nurses in year one of practice may climb to 57% in year two (Halfer, 2011). 

The study purpose was to estimate retention of new graduate nurses experiencing five different on-boarding strategies and determine risk points for loss.  Four year retention of graduates who participated in one of five on-boarding strategies was collected between 2001 and 2012.  Data collected were start dates, termination dates, and program type. Termination time in months was calculated.

Kaplan-Meier analysis was used to model survival for the overall group and each program. Probability of survival and survival curves were generated. The log-rank test determined significant differences in retention by program. Power was calculated to be 0.859 with eta equaling 0.770.

41 graduates oriented through general classes with unit orientation, 13 through the Dedicated Education Unit, 18 through unit orientation only, 46 through graduate classes with unit orientation and 81 through the graduate residency program. Differences in termination rates were statistically different (X2 = 26.70, p < .0001). Residency program survival probability was significantly different (log rank X2 = 42.453, p < .0001). Risk points for termination were 8 and 12 months for the residency program while the four other strategies had multiple risk points.

Longitudinal analysis revealed the residency program significantly improves the survival of new graduate nurses. Identified risk points provide actionable information to plan intensive preventive interventions to prevent loss in the first four years of employment. Comparison of hazard curves for different on-boarding programs can inform administrators about efforts having the greatest impact on retention.