During the course of study, students learn and grow to become proficient in the delivery of quality healthcare (AACN, 2008). However, according to the Joint Commission (2010), many new graduate nurses are clinically unprepared for the practice environment and lack the expertise to ensure patient safety (Letourneau & Fater, 2015). The first few months when new graduates work as registered nurses have been reported to be the most stressful time period, as they struggle with their role expectations, seek emotional support, and develop their professional communication (Cheng, Liou, Tsai, & Chang, 2015). Traditional orientation programs require a new graduate nurse to work with a designated preceptor over a period of several months; the new graduate nurse relies on her preceptor in her progression as a professional nurse and healthcare role model. Unfortunately, a lack of adequate training can have severe consequences on retention rates among new graduates. The National Council of State Boards of Nursing (2015) estimated that approximately 25% of new nurses leave their initial place of employment within one year of hire. One method utilized by hospitals to combat the revolving door of nurses is the development of hospital-based nurse residency programs, which are increasingly evolving as a means of transition into the nursing role. Nurse residency programs allow new graduate nurses the opportunity to develop and establish nursing skills, adapt to the professional environment, and encourage the new graduate to assume greater responsibility in a structured setting (Letourneau & Fater, 2015). Therefore, the purpose of this study is to explore the differences between participation in a nurse residency program versus a traditional orientation program and the effect they may have on new graduate nurses’ professional self-concept.
Methods:
This study is a non-experimental cross-sectional quantitative research design that used an online survey method. The participants were asked to complete a demographic informational questionnaire, which includes a question related to involvement in a hospital-based nursing residency program. In addition to the demographic information, the participants were asked to complete the Professional Self-Concept Nurses Instrument (PSCNI), a 27-item based survey measuring professional practice, job satisfaction, and communication. The questionnaire takes an estimated 15 to 20 minutes for completion, and the range of possible scores is 27-108 (Arthur, 1995). Cronbach’s Alpha for this study was 0.81.
A convenience sample of new graduate nurses in the state of New Jersey (N = 199) was invited to participate in this study. An email list serve from the New Jersey Board of Nursing with new graduate nurses’ email information was used to recruit participants; a new graduate nurse was defined as a successful NCLEX test taker between May 2014 and April 2015. Descriptive statistics were used to characterize the demographics of the sample. Outcome measures were studied using non-parametric analysis: Mann-Whitney U test. SPSS version 23 was used to manage the data. Power Analysis indicated that a minimum of 87 participants were needed in order to determine statistical significance with an Alpha = .05, Power = .80, and Effect size at .20.
Results:
One hundred twenty-four (124) new graduate nurses participated in this study. The majority of participants were female (n = 109, 88.6%), single (n = 84, 68%), and baccalaureate-prepared (n = 87, 71%). Most nurses worked in an acute care environment; the unit of employment varied from a general medical-surgical floor (n = 45, 39%) to a pediatric unit (n = 7, 6%). More than half of the nurses had been employed for over 5 months (63%) and were oriented using a traditional program (n = 83, 78%) versus a residency program (n = 23, 22%).
The scores on the PSCNI ranged from 61-108 with an average score of 78 (SD = 8.0). To address the purpose of this study, a Mann-Whitney U test was conducted to explore the correlation between orientation methods and levels of professional self-concept. There were no significant differences in levels of professional self-concept between nurses who participated in a traditional orientation program and those who were involved in a residency program. There were also no significant differences in levels of professional practice, job satisfaction, and communication based on the type of orientation.
Conclusion:
The study explored the impact of nurse residency programs versus traditional orientation programs on new graduate nurses’ professional self-concept during their first year of employment. Data analysis revealed that many new graduate nurses were employed in a hospital-based environment, with the greatest percentage working on a medical-surgical unit. Many nurses reported a high level of professional self-concept. Although this study did not find significant differences between orientation methods in improving new graduate nurses’ self-concept, the literature shows that nurses involved in residency programs have higher retention rates than those who do not participate (Bérubé et al., 2012). Perhaps an alternate strategy to address levels of self-concept and retention rates may not be the type of the orientation program but the quality of educational and clinical training. There are many intrinsic and extrinsic factors that influence self-concept, performance, and job satisfaction of a new graduate nurse, including the nurse’s learning style and the type of unit on which he or she works. Therefore, the individualization of education and orientation may better prepare new graduate nurses for the nursing role and its many responsibilities.