This Doctor of Nursing (DNP) practice project is being conducted at a 629-bed pediatric medical center located in an urban area of the midwestern United States in the float pool unit. The intervention in this project is the use of a concerted management support toolkit over a six-month period by members of the nursing management team with 17 new graduate nurses hired into the float pool between June and August of 2017. The purpose of the toolkit is to provide members of the nursing management team with interventions they can use to support new graduate nurses. Before implementation of the project in early September 2017, a training session around the concerted management support toolkit for the six members of the management team in the float pool occurred. Tools were distributed to the members of the management team for them to use during their individual meetings with each of the new graduate RNs hired between June and August of 2017. These tools included a guide to debriefing/reflecting with the new graduates, a reminder around what is important to ensure a professional practice environment for new graduate nurses, and suggestions of ways to provide for professional development. Additionally, a tool highlighting the important leadership behaviors to support new graduate nurses, including authentic leadership, emotional intelligence, structural empowerment, and transformational leadership was discussed.
The debriefing/reflecting piece of the concerted management support toolkit includes information around the debriefing and reflecting processing. Debriefing occurs during confidential meetings where new graduate nurses reflect on their clinical experiences while sharing their thoughts, and can provide the new graduate with stress management and coping skills, as well as for an emotional outlet. Questions that can be used for debriefing/reflecting around a specific clinical experience can include: were you satisfied with your ability to work through the clinical situation; how could you have handled the situation differently; and how did this experience make you feel? If there is not a specific clinical experience to discuss, potential topics may include self-care, reality shock, effective communication, transitioning to night shift, grief management, and disruptive behaviors in the workplace.
The supportive professional practice environment piece of the concerted management support toolkit involves information around providing for a professional practice environment for new graduate nurses. This includes ensuring that the concept of structural empowerment, which is the degree of access to workplace conditions that provide information, support, resources, and opportunities to learn and grow, exists in the workplace. Employees who have access to these empowerment structures are more likely to be motivated and more committed to and engaged with the organization, are more effective on the job, and are able to accomplish their work in meaningful ways. Also important to providing for a professional practice environment for new graduate nurses includes staffing and resource adequacy, nursing participation for organizational and unit-based affairs, nurse-physician collaboration, and nurse manager ability, leadership, and support of nurses.
The professional development piece of the toolkit includes information around the use of a personal professional development plan that allows each new graduate RN to set professional developmental goals. Use of the personal professional development plan is driven by the new graduate RN, and is very broad, beyond the care each new graduate provides at the bedside. It focuses on not only development goals for the year, but also long-term goals that they would like to work on. Activities to meet the goals, both short and long-term, are identified, and timelines decided upon. Time is also spent determining how the member of the management team can help with setting up a plan to meet the goals.
The piece of the toolkit around important leadership behaviors of the management team involves ideas focusing on how important it is for leaders to create work environments that promote the retention of new graduate nurses. Specific behaviors leaders should demonstrate include authentic leadership which focuses on relationships, self-awareness, honesty, optimism, transparency, trust, and consistency. Authentic leaders encourage employees to accomplish their work goals, and they demonstrate a sense of genuine caring for employees. Also important is emotional intelligence, which includes self-awareness, the ability to manage relationships, self-management, and social awareness, as well as the ability to motivate, manage conflict, and communicate. Finally, transformational leadership should be present, and includes intellectual stimulation, charisma, inspirational motivation, confidence, optimism, resilience, and having a strong emotional connection. Transformational leadership motivates new graduates by appealing to their higher ideals and moral values, and gives meaning to jobs by energizing them about the importance of their work.
Formal evaluation of the project will take place six months after implementation of the concerted management support toolkit, in March of 2018. Retention rates will be measured at that point to determine how many of the new graduate nurses who started between June and August of 2017 and were recipients of the concerted management support toolkit, remain in the department. In order to evaluate the effect of the concerted management support toolkit, retention rates of new graduate nurses hired into the float pool between June and August of 2016 (who did not receive the concerted management support intervention) will be gathered and compared against the retention rates of the new graduates in the float pool hired between June and August of 2017 who had the concerted management support intervention.
One of the three strongest predictors of job satisfaction in newly graduated nurses is support from their supervisor. Support in general, and especially from the management team, positively impacts the confidence and competence, as well as the professional development of new graduate nurses. One way to retain new graduate nurses is via a concerted support effort from the nursing management team. As the literature and this DNP project has demonstrated thus far, the use of concerted management support strategies increase retention and commitment to stay, as well as decrease turnover in new graduate nurses. Overall, having nursing management that provides support is a valuable retention strategy. Supportive nursing managers and educators are key, as well as the crucial piece, in the transition, acclimation, and retention of newly graduated nurses.