The evolution of healthcare has increased the need for experienced registered nurses. Compared to all other occupations, employment rates of nurses are expected to increase by 15% from 2016 to 2026 (United States Department of Labor Bureau of Labor Statistics, 2018). Medas et al. (2015) estimate there will be a more than 400,000 of a shortage of nurses by the year 2020. New novice nurses joining the workforce are meant to help to battle this deficit, but unfortunately, they are only adding to the numbers of this deficit. Novice nurses are leaving nursing at an estimated rate of 35% to 60% within one year of being hired due to struggling with the transition from academic practice into clinical practice (Van Camp & Chappy, 2017). To combat this crisis hospitals are being encouraged to provide programs to improve retention rates among novice nurses (Medas et al., 2015).
During the last year of nursing school, students pursue externship programs to help secure employment and on-the-job training. Externships can be a handy way for hospitals to recruit nurses while still in school. During the externship, senior nursing students are exposed to the clinical setting as they shadow and mentored by experienced staff nurses. According to Soto (2015), the key to improving retention and reducing cost is by the implementation of a nurse residency program in the form of an externship, internship, or mentorship. Some organizations rotate nurse residences through different units, helping them to find the specialty that complements their skill set and interest. Hence helping decrease the turnover rate within the first year due to the dissatisfaction of the unit by placing them with a specific population of interest (Walsh, 2018). Patricia Benner’s model “From Novice to Expert: Excellence and Power in Clinical Nursing Practice” is a concept of competence and gain experience that helps nurses regarding patient care as they continue with their career; nurses less than six months to a year of expertise are in the novice stage and learns through instructions (Arzani, Lotfi, & Abedi, 2016).
The cost spent on training is roughly $88,000 per nurse with 6 to 15 months invested is unfavorable if turnover rates are high (Eckerson, 2018). If training is in a specialty area, the cost could be upwards to $120,000 for per novice nurse (Van Camp & Chappy, 2017). Novice nurses face exciting and stressful challenges upon entering the clinical setting, constantly learning critical skills that are fundamental for the longevity of practice, which can be overwhelming and discouraging. Lack of support from the organization may impact the recruitment and retention rates. Participation in nurse residency programs offers a transition and guided supportive training environment, which provides consistency in a safe place to discuss, while building confidence and competence in nurses (Medas et al., 2015). During debriefing sessions free of disciplinary actions; facilitates future ethical practices of patient safety. Having a residency program reduces stress and anxiety compared to new nurses with no program to adjust to a new role by themselves (Edwards, Hawker, Carrier, & Rees, 2015). Improving job satisfaction by increasing nurses feelings of empowerment by reducing work-related bullying and burnout can sway nurses from leaving unit or organization (Bontrager, Hart, & Mareno, 2016).
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