New graduates' values and the effect of a nurse transition program on neophyte staff nurses' clinical competency, role adjustment, job satisfaction, length of stay, and turnover

Persistent fluctuations in the supply of new graduate nurses into the labor force, concomitant with an ever increasing demand for experienced nurses in a variety of settings, has prompted hospital nursing administrators to increase their departments’ attention on promoting staff nurse retention and reducing turnover. Specifically, in an attempt to address the causes and consequences of new graduates’ experience of “reality shock” during their first year of employment, many institutions have implemented transition programs to aid in bridging the gap between education and service. Using longitudinal data from a convenience sample of 890 new graduate staff nurses, this study addressed the following questions: what is the effect of a nurse transition program on neophyte staff nurses’ clinical competency, role adjustment, job satisfaction, length of stay, and turnover?; and, what are the nature and discriminating characteristics of neophyte nurses’ professional and role-oriented values? Repeated measures analyses of variance (RM-ANOVAs) indicated that the new graduates’ clinical competency significantly increased over time, as did their familiarity with work demands and the hospital environment. In addition, subjects demonstrated a significant increase in their level of job satisfaction concerning involvement. However, nurses’ scores significantly declined over time with regard to their perceptions of the actual practice of professional nursing. Subjects’ length of stay was slightly higher than the average length of stay of new graduates at the hospital study site prior to implementation of the transition program; and, compared to the pre-program neophyte turnover rate, nurses in the study had a substantially lower rate of attrition. There were no significant differences between new graduates who stayed beyond 15 months after hire (stayers) and those who terminated employment within 15 months (leavers) on the outcome variables of clinical competency, role adjustment, and job satisfaction. Investigation of the professional and role-oriented values possessed by the new graduate nurses revealed that their strongest values were associated with dimensions of personal and professional benevolence, growth, and opportunity, and working effectively with others and within the hospital system. The results of RM-ANOVAs indicated that the new graduates’ values significantly decreased over time with respect to intrinsic and extrinsic rewards and stress and autonomy. However, subjects’ values related to organizational relationships and roles, as well as professional development and clinical practice, increased significantly over time. There were no significant differences between stayers and leavers with respect to their professional and role-oriented values.

The results of this study suggest that the transition program was effective in promoting the new graduates’ increase in clinical proficiency and service role functioning, and in sustaining a positive degree of job satisfaction. In addition, the study’s findings suggest that the transition program was effective in increasing the length of stay and lowering the turnover rates for new graduates at the study hospital. However, the study does not provide evidence that the transition program was effective in promoting the new graduates’ professional role development. Rather, the results indicate that either the nurses’ declining sense of professionalism was moderated by an increasing service orientation; or, that the consequences of their increasingly negative perceptions of professional nursing in general, and their professional role in particular, were not apparent within the time frame of data collection. Nevertheless, the results of this study have important implications for nursing education, practice, management, research and V knowledge development.

Recommendations are made for additional analyses of the data in order to provide more in depth description of the relationships between neophyte staff nurses and their clinical skill level, role functioning, perceptions of professional nursing, and job satisfaction. Future research should also focus on the outcomes associated with the organizational structures currently advocated in the nursing and non-nursing organizational literature which may further enhance the clinical functioning, role adaptation, and job satisfaction of new graduate staff nurses in hospital settings. Furthermore, it is recommended that future research related to organizational factors include data that is collected through naturalistic methods of inquiry, as well as information on social and economic factors. Research of this type is needed in order to provide critical perspectives to interpretation of the such studies’ findings and to assist in the formulation of more conclusive results with regard to transition programs and nurses’ professional and role-oriented values.

Note: Abstract extracted from PDF file via OCR.

Digitization of this thesis was made possible by a generous grant from the Jefferson Trust, 2015.

Thesis originally deposited on 2016-02-18 in version 1.28 of Libra. This thesis was migrated to Libra2 on 2017-03-23 16:33:29.