Use of Survival Analysis to Determine Risk Points for New Graduate Nurse Retention

Thursday, 16 July 2009: 10:50 AM

Janet Houser, PhD, RN
Rueckert Hartman College for Health Profession, Regis University, Denver, CO
Cynthia A. Oster, PhD, MBA, RN
Cardiovascular Services, Porter Adventist Hospital, Denver, CO

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

Learning Objective 2: Discuss potential nursing education strategies focused on evidence-based risk points to enhance retention of new graduate nurses

Purpose: The purpose of this investigation was to use survival analysis to determine the risk points for loss of new graduate nurses.  A secondary purpose was to compare orientation approaches relative to 1- and 2-year retention.
Methods: Termination data were collected for 159 new graduate nurses in an acute care hospital for seven years. Retention of new graduates who participated in one of three orientation strategies was also collected for 2006 and 2007.  The three strategies were experience on a dedicated education unit; unit orientation only; and new graduate classes. 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 new graduate group and for each program. Hazard curves were generated. The log-rank test was used to determine if differences in retention by program were statistically significant.
Results: Retention for new graduates over the 7 year period was 66.7%. 25.2% terminated within the first two years, of which 17% terminated in year 1. Risk points for termination were highest during year 1, with at least one termination in each month.  Hazard analysis demonstrated highest risk of termination at months 7, 14, between 22 and 26 months, and between 40 and 42 months.  There were no statistically significant differences between types of orientation programming in survival probability, but this analysis had limited power due to the restriction of time range.
Conclusion: Intensive efforts toward retention of new graduates are warranted in the first year of employment, as risk of termination is distributed throughout the initial year of employment. Specific preventive strategies may be helpful if targeted at risk points identified by survival. Comparison of hazard curves for different orientation programs can inform educators and administrators about the efforts that have the greatest impact on retention.