Five Strategies to Implement Now to Support Your Hospital’s Newly Licensed Nurses

by Angela Renkema MPH, BSN, RN, NPD-BC, CV-BC, CPH

Vizient Director, Programmatic Advisory Services, Vizient Nurse Residency Program

Throughout the country, nursing vacancies are at an all-time high. Many hospitals and health care organizations are filling these vacancies by hiring a record number of newly licensed nurses (NLNs). NLNs have different onboarding needs than experienced nurses such as additional exposure to complex clinical situations and multiple patients; frequent feedback to build confidence; and coaching on communication with the care team, patients and families.

We know that NLNs are at the highest risk of leaving an organization within the first couple of years of practice. So, as we navigate nursing workforce challenges, organizations need to focus on addressing the unique needs of these nurses in creative ways.

Here are five strategies nursing leaders can implement now to support your hospital’s NLNs.

Ensure transition support

Implement a nurse residency program (NRP) with structured seminar time.  NRP’s can provide a solid foundation to ensure NLNs are supported in their first year of practice. Organizations should then build on the NRP foundation with additional strategies that become part of an overall supportive culture within the unit and organization. A supportive culture ensures there is time to attend seminars—especially during times of stress—supportive preceptors and peers and an encouraging manager.

In addition to a 12-month nurse residency program, consider these strategies:

• Six-month sit down—Six months after hire is a vulnerable time for most NLN's as they’re no longer on orientation and may not receive frequent feedback and support from their preceptor, nursing professional development specialist and manager. Consider having a six-month sit down with your NLNs to ask how they’re doing and provide feedback on their strengths and opportunities. Data from the Vizient/AACN Nurse Residency Program found that NLNs who stayed in an organization reported a statistically significant higher score of feeling supported by managers, peers and preceptors than those who left the organization.
• Non-traditional preceptors and mentors—As we continue to see experienced nurses retire from the workforce, we see that the years of experience in clinical areas are decreasing. Creating non-traditional preceptor and mentor roles will be key to addressing this gap. Ideas such as having a lead preceptor float between units to support less experienced preceptors and NLNs could be beneficial.

Grow and strengthen academic partnerships

Identify the clinical practice areas where you have few applicants and open them up for nursing school clinical rotations. This will give nurses in school the opportunity to explore an area they may not have considered applying to after school. In addition, clinical rotations are an excellent way for prospective employees to see an organization's culture and for managers to meet prospective applicants. Another benefit is that applicants familiar with the organization often have an easier transition into the role.

Connect with the academic partners to understand NLNs’ competency and skill levels at graduation. Nursing schools have adjusted curriculum and clinical experiences over the past couple of years. What does the mean for the preparedness of nurses? Are there gaps you should consider focusing more on during your onboarding, preceptorships and nurse residency programs?

Identify gaps and educate

Identify the gaps from the conversations with the academic partners and provide additional educational support. New nurses who do not feel confident in their skills reported it to be a barrier to transition into nursing.

To meet staffing challenges, organizations are implementing different care models for patient care, such as team nursing. With team nursing, NLNs will be asked to delegate more and be a team leader, which are skills that may not have been fully developed in nursing school. This presents an opportunity for organizations to create enhanced learning, so NLNs feel more confident and supportive of this care model.

Learning experiences could include an enhanced review of scope and standards to understand their role and responsibilities with support personnel, and case studies and simulations on delegation. Have frequent debriefs in the first few months of practice that discuss delegation, team nursing and challenges they are facing to help improve their comfort with the practice model. Create interdisciplinary simulations in which all new providers (medical assistants, nursing assistants, respiratory therapists, physicians, advanced practice providers and licensed practical nurses, etc.) participate to create a safe space for learning and building relationships.

Create professional development plans and pathways

Promote ways in which nurses can grow in your organization. Showcase all the different areas in which nurses work and create pathways to achieve the positions. Many NLNs are coming out of nursing school looking for growth opportunities. Start professional development conversations and goal setting at the beginning of their employment and continue the discussions throughout their nurse residency programs and beyond.

Be intentional and committed to their growth. In the Vizient/AACN Nurse Residency Program, we found that organizations with higher numbers of NLNs completing professional development plans had higher retention rates.

Listen to NLNs’ ideas

The NLNs have a unique perspective, and as nursing leaders, we need to harness their ideas and be open to their suggestions. We need to ask them: What would make you stay in the organization? What makes you want to leave the organization? What can we do to keep you?

Provide them with a safe space to develop ideas on how to solve the current challenges we see in health care. You may be surprised by some of the ideas. Be open and try piloting them in your organization. Have a NLN be your mentor. Set up a time to connect and discuss their professional challenges and ideas regarding the profession and organization. Having a relationship where you can learn from them may provide you with some great insights into how to support them best.

I will leave you with a recent idea from an NLN participating in the Vizient/AACN Nurse Residency Program. The NLN asked their nurse residency program coordinator why their health care organization does not offer mental health days as they have become more prevalent in other industries. Mental health days are paid time off, in addition to other time-off benefits, to be used for a mental or emotional break when needed, without advance notice. The NLN shared that peers in other industries have this and that health care is one of the top industries with significant emotional and physical exhaustion. The NLN worked with the nurse residency program coordinator to explore implementation at their organization.

Unfortunately, there is no quick fix for our current nursing shortage; however, there are opportunities to help continue to support NLNs and retain them. I challenge us all to think of innovative ways to encourage our current nurses to stay in the profession and entice future nurses to join.