Caring for our Newest Nurses During COVID-19: A Call to Action for Hospital and Nursing Leaders

by Katie Davis, MS-HSM, BSN, RN

Clinical Workforce Intelligence Director

While the full effects of the COVID-19 pandemic on the nursing workforce remain to be seen, we know that newly licensed registered nurses, or nurse residents, already are a vulnerable portion of the nursing workforce. The latest data from the Vizient and the American Association of Colleges of Nursing (AACN) Nurse Residency Program^TM show the negative impact that COVID-19 has had on the newest nurses in health care. The data serve as a call to action for hospital and nursing leaders if we are to successfully support and retain these nurses as a critical component of the health care workforce.

The transition for nurse residents from academic to clinical settings is a well-known challenge due to long shifts, inadequate orientation, challenging schedules and patient load and acuity. Even before COVID-19, about 17.5% of new nurses left their first job within one year¹. Turnover expenses, including recruitment and onboarding, cost organizations millions of dollars each year. These nurse vacancies create additional stress and burnout for other staff and impact patient care.

Last year, these newly licensed registered nurses entered their first professional role during a global pandemic which also was placing unprecedented strain and challenges on our nation’s health care system. These nurse residents had to navigate a work environment with surges in the number COVID-19 cases, decreased staffing, reduced personal protective equipment, redeployment to other units or sites and fears of a COVID-19 diagnosis for themselves and their loved ones.

Negative impact on the newest nurses

The self-reported survey data (collected March 2019–December 2020) from more than 11,000 newly licensed registered nurses across the nation who were 12 months into their first role at nearly 300 organizations participating in the Vizient/AACN Nurse Residency Program², revealed:

• Nurse residents are more stressed—Nurse residents reported a 6.6% increase (over 2019 data) in “other” stressors while reporting a decrease in other stress areas, such as finances, childcare, student loans, living situation and personal relationships. Nurse residents were not immune to the same mental health stressors that COVID-19 has placed on much of the population.

• Nurse residents report lower unit engagement—Nurse residents reported a decrease in unit engagement over 2019 data. On a four-point scale, nurse residents reported an engagement level of 2.37, down from 2.42 in 2019. This reverses what has been a steady trend of nurse residents feeling engaged and supported.

• Nurse resident resignations increasing—In examining reasons for leaving an organization, the data show that the percentage of terminations related to the pandemic was higher for nurse residents hired in 2020 than those hired in 2019; the percentage of terminations related to failing the National Council Licensure Examination (NCLEX) was higher for nurse residents hired in 2020 than those hired in 2019; and the percentage of terminations related to job satisfaction was higher for nurse residents hired 2020 than those hired in 2019.

A call to action for hospital and nursing leaders

As COVID-19 cases continue across the country, many hospitals struggle to maintain an adequate number of caregivers for patients and for large-scale vaccination efforts. These demands for patient care—coupled with their own fears for themselves and loved ones, financial and family pressures and uncertainty—are pushing caregivers to the brink of breakdown. Hospitals are facing increasing amounts of caregivers who are burning out, taking leaves of absence, leaving the profession and even taking their own lives. The need for health care leaders to support caregivers has never been greater. Here are five important ways:

1. Ensure that all staff are aware of support provided by the organization (such as employee assistance programs). Understanding causes of stress and how to support staff during this time are critical components to supporting and retaining staff. Vizient’s Clinical workforce well-being playbook: Leading through the COVID-19 crisis and beyond outlines the four core universal needs of employees and a checklist of practical ways to meet these needs. It also outlines four ways that health care leaders can support caregivers now and help them navigate during challenging times.
2. Examine your organization’s retention and engagement data and leverage national benchmark data from the Vizient/AACN Nurse Residency Program to assess differences in job satisfaction and stress among nurse residents beginning their careers during the pandemic. Share data and observations with nursing leadership. Trends at a local level can inform changes that need to be made within the organization to support retention and the successful transition of nurse residents.
3. Leverage academic/practice partnerships with schools of nursing and discuss what support new graduates might need to be successful with licensure exams and the transition to their first professional role. It is critical for both academic and practice organizations to understand how they can support nurse residents that have had to navigate significant changes in their academic preparations, including the conversion of many classes to an online setting and adjustments to clinical experiences.
4. Engage nurses at the unit level to address decreasing engagement (e.g., committees, listening sessions and huddles) and monitor that engagement. Reinforce a shared mission and goals to help teams stay aligned and ensure an inclusive team environment is promoted at all levels of the organization. Vizient’s Advancing team culture playbook: Workforce effectiveness during COVID-19 and beyond outlines the significant developments in clinical teamwork during 2020 and shares proven strategies for fostering effective teams.
5. Provide a nurse residency program. In 2010, the Institute of Medicine recommended organizations support new nurses with “transition to practice” programs, such as nurse residency programs, to expand competencies, improve patient outcomes and reduce turnover. For organizations with existing nurse residency programs, continue to have nurse resident program seminars. Support and connection are critical for nurse residents. Emphasize curriculum content areas to respond to resident needs. (e.g., stress management, inter professional communication).

Organizations without a nurse residency program should consider the Vizient/AACN Nurse Residency Program, which is designed to help decrease the nurse turnover rate, improve decision-making skills, enhance clinical nursing leadership practices and promote the incorporation of research-based evidence into practice. Currently about 600 organizations participate in the program, training some 25,000 nurse residents each year. Nurses in the program rated the overall residency program higher (3.0 out of 4.0 during 2020 versus 2.95 during 2019), signaling that nurse residents themselves find it valuable.

Supporting our newest nurses has always been important, but we are seeing that it is paramount this year. Trends outlined here likely indicate what we will see in the upcoming months and years—increased turnover and stress, challenges with licensure exams and decreased unit engagement. Understanding the challenges of the newest nurses at your organization is a great place to start in understanding how to best support them and ensure that they remain not only at your organization, but also in the profession of nursing for years to come.

Special thanks to Angela Renkema MPH, BSN, RN, NPD-BC, RN-BC, CPH, NRP programmatic advisor director, for contributing data analysis and insights to this information.

¹ Newly licensed registered nurses: facts and figures. RN Work Project website. http://www.rnworkproject.org/wp-content/uploads/RN-Trends-InfoGraphic-FINAL-12415.pdf. Accessed March 7, 2017.

²Vizient/AACN Nurse Residency Program^TM data comparing surveys completed March through December 2019 to March through December 2020.