Nurse leaders strive to ensure nurses — from newly licensed to experienced — have the resources and support to excel in their practice. Yet, 50%¹ of novice nurses commit errors in care and nurse turnover rates are rising, especially among new RNs (23.9%² ) who often lack professional skills, competence, and engagement to deliver optimal patient care.

Having started my career as a nurse before transitioning into health informatics, I understand there is a lot to tackle to ensure newly licensed nurses receive the right education and support to make the important transition to practice. With the experience-complexity gap at its widest at the start of the nursing journey, clinical leaders can enable the success of their new nurses by helping to close that gap.

With this goal in mind, organizations often offer new nurses a combination of orientation and residency programs as well as professional development and peer mentoring. I had the pleasure of joining a panel of experts at the ANPD Annual Convention to delve deeper into how organizations are addressing these issues. Excerpts and insights from that session are shared below.

Elizabeth Fritz, MSN, RN, NPD-BC, RN Program Manager, System Clinical Education at SSM Health, kicked off the conversation. “We recently added more peer support into our residency program to create a healthier work environment,” she said. “In addition to standard orientation, we also offer specialty-specific programming for critical care, emergency, and medical-surgical departments to address some of the complexity gap,” she added. “It gives more assurance they are getting all of the key topics and the most evidence-based information as they go through and beyond their initial orientation period and that first year.”

“We understand and see that complexity gap, and so we are looking at our orientation and our residency programs to see if we need to beef them up and work with our orientees to provide some of the skills they are not being afforded in their clinical programs in school,” said Linda Bub, MSN, RN, GCNS-BC, NPD-BC, Regional Manager, Nursing Education and Professional Development at Advocate Aurora Health. During the merger of Advocate Aurora Health, Bub said the system developed a comprehensive education department that supports its 25,000 nurses across their career continuum.

“This allows nurses to stay and become educated and experienced, which helps shorten the complexity experience gap,” Bub added. The system offers a consistent orientation program that meets the unit needs for new nurses coming on board. After that, nurses participate in an accredited nurse residency program, which offers a platform for additional professional development and support.

“When we help our nurses develop critical thinking skills and learn new technical skills, we are helping them master the art and science of nursing,” said Fritz. “That is what helps drive an environment where people feel fulfilled and motivated in their work and want to stay,” she added.

Dennis Doherty, PhD, RN, NPD-BC, Senior Professional Development Specialist at Boston Children’s Hospital, commented that it is also important to look at the work environment for new nurses. “Are they leaving because they are not confident, getting the skills they need, or is it a product of where they are working? We have an accredited nurse residency program, and we spend time teaching them communication skills, promoting high reliability practices and ingraining patient safety in their work.” However, he points out, “if they are going into a practice area where they are not seeing these [skills] role modeled, then that is a problem.”

Nurse leaders play important roles in developing future and existing leaders. Fostering nurse leadership also helps strengthen retention. “We need to think critically about how we are preparing our nurses to take on expanded roles in our healthcare settings,” said Doherty. “If you are a great clinical nurse and you are awesome at the bedside, that doesn’t mean you will be a great preceptor, charge nurse, manager or educator.”

Bub said that in addition to clinical leader onboarding and orientation tools, organizations should be looking to informal leaders at the bedside when creating a succession plan. For example, establishing nurse professional development (NPD) practitioners is another way to foster leadership, because they are the ones who will help build the practice on their unit or at their hospital. She added, “We are starting a transition of practice for our NPDs, so that they can see that they are informal and semiformal leaders on their units and that they can build that leadership potential.”

Overall, in reviewing the contributions from our panel – it is clear how important it is to foster a positive organizational culture.  Leaders should continue to look for ways to encourage their staff and reinforce that they are valuable and should feel confident in their skills and abilities as nurses.

¹ Muntean, W.J. (2012). Nursing Clinical Decision-Making: A Literature Review.

² NSI Nursing Solutions, Inc. (2021) 2021 NSI National Health Care Retention & RN Staffing Report.