Looking Out for Our New Nurse Grads

Laura A. Stokowski, RN, MS


June 17, 2011

In This Article

The Future Prospects for New Grads

Nursing employment patterns have always been relatively elastic, expanding and contracting as nurses increase or decrease their working hours according to their financial need.[8] As the economy improves, nurses who have put off retirement or avoided reducing their work hours are expected to return to their original plans. This should open up opportunities for new graduates.

It's hard to tell if it's fact or wishful thinking, but many experts are saying that the job prospects for new graduates are going to improve in the near future. This prediction seems to hinge on the economy, at least in the short term. Large numbers of baby boomer nurses may have put off retirement temporarily, but this situation can't last forever. Eventually, these nurses will retire, easing the job crunch for newly licensed nurses.

In fact, many experts warn that it is not only short-sighted, but dangerous to assume that the nursing shortage is over. Although the recession may have given a temporary reprieve, "that bandage is about to be yanked off."[16] Reducing the number of nurses in the training pipeline or slowing their assimilation into the workforce could be catastrophic.

If hospitals aren't careful, they could find themselves going from not hiring any new graduates, to having to hire all new graduates following the inevitable mass exodus of retiring nurses. Peter Buerhaus, director of Vanderbilt University's Center for Interdisciplinary Health Workforce Studies, cautions that if we don't find ways to integrate our current new graduates into the workforce, projected nursing shortages will become even worse and solving them more costly.[17]

Transition-to-Practice Programs

One solution is to boost the number of internships as community-based transition-to-practice programs for new graduates. The National Council of State Boards of Nursing has launched a multistate (Illinois, Ohio, and North Carolina) study to evaluate safety and quality outcomes of nurse transition to practice programs.[18] Newly licensed nurses hired to work in hospital settings will be followed during their first year of employment, during which they will participate in interactive, online transition to practice modules, work one-on-one with a preceptor, and receive institutional support from the hospital. Patient outcomes will be included in the analysis. The program includes training for preceptors. Data collection is scheduled to begin in July 2011.

Transition-to-practice programs aren't designed to repeat what is learned during the basic nursing education. Instead, these programs aim to help newly licensed nurses acquire skills that are essential to nursing but are difficult to acquire as a student nurse: providing care for a full patient load, supervising care provided by others, delegating, time management and prioritization, interaction with physicians, decision-making, synthesizing data from multiple sources, and appropriately applying research findings to practice.

New Entry to Practice Settings

In an era when much healthcare is shifting into ambulatory settings, and only the sickest patients remain in the hospital, it is no longer feasible to require or even encourage new graduates to work "a year or two" on a medical-surgical unit before branching out into areas such as home health, intensive care, or mental health.

Researchers have begun to look at programs for integrating new graduate nurses into healthcare settings that have not traditionally been seen as entry into practice settings. Meadows described a pilot project that successfully integrated new graduate nurses into home healthcare, skipping over the usual prerequisite for a year's acute care experience.[19]

Proulx and Bourcier redesigned an orientation program specifically to accommodate new graduate nurses who enter practice in critical care. Some hospitals have even opened up internships in areas that have previously been considered too challenging for new graduates, such as psychiatry and the operating room.[20]

Keeping the Momentum

The inability to find jobs after graduation has been a rude awakening for the newest members of our profession. Still, it is imperative that we find ways to continue the pipeline of new nurses. The shortage of nurses may have been stalled temporarily, but it could reach crisis mode again if the anticipated mass exodus of older nurses comes to fruition in an improved economy. Innovative programs such as transition-to-practice and orienting new graduates to nontraditional entry to practice positions offer some hope for integrating new graduates into the workforce even when jobs are scarce, but these efforts are not sufficiently widespread to get all of our new grads doing what they hoped to do after graduation: working!


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