Joining the Nursing Workforce During COVID-19: Lessons for Hospital and Nursing Leaders

by Katie Davis, MS-HSM, BSN, RN

Clinical Workforce Intelligence Director

As our nation’s newly graduated nurses are collecting their diplomas and celebrating graduations both in person and virtually, health care organizations across the country are preparing to welcome them into practice. Because these new nurses received much of their education and training during the COVID-19 pandemic, they are reporting to their first day of orientation with different preparation and perspectives than their predecessors.

I recently reached out to a group of these new nurses via survey as well as personal conversations to learn more about their experiences. What I learned from this group both inspires me and provides important insights into the challenges they faced (and continue to face) and support needed to ensure these nurses not only stay with the profession of nursing, but also grow and thrive professionally.

Survey confirms impact of COVID-19 on nurse training

As a follow up to the latest data from the Vizient/American Association of Colleges of Nursing (AACN) Nurse Residency Program^TM, I reached out and surveyed nearly 50 newly licensed registered nurses (NLRNs) that are (or have) participated in program in the last year.

Nearly 50% of respondents (from across 14 states) reported COVID-19 had a major or severe impact to their nursing education. An estimated 16% plan to transition into a different nursing care environment, while 3% plan to leave the profession entirely.

On a brighter note, nearly half of the respondents reported they are happy they chose nursing as their profession. Well over half reported that family, friends and peers were their biggest support system during the pandemic.

Conversations highlight challenges, demonstrate resiliency

In addition to conducting the survey, I spoke with three nurses who participated in the Vizient/AACN Nurse Residency Program and were new to the profession during the COVID-19 pandemic. They shared with me the unique challenges and stressors that they had to face over the past year. Here’s what they had to say:

Nurse #1—The first nurse I spoke with described her experience sitting for the NCLEX-RN exam, which under normal circumstances is a stress-inducing experience. She explained that the exam was scheduled during a city-wide lock-down due to protests in response to racial injustice. She wasn’t sure if she would even be able to sit for the exam due to road and bridge closures and rules imposed related to COVID-19. This nurse was able to make it to the exam and passed. Her experience is undoubtedly different from what most new nursing graduates have experienced when sitting for the NCLEX exam.

Nurse #2—This new nursing graduate described her first role in a medical intensive care unit that was dedicated to patients with COVID-19 exclusively. She described how she only cared for patients with COVID-19 and had no exposure to other disease processes. She was unable to interact with the patients due to intubation or family members due to visitor restrictions. Her experience left gaps in exposure to a variety of disease processes as well as collaboration with patients and families as part of the care team.

Nurse #3—This new nursing graduate was initially hired into a step-down unit. Once her organization started seeing more patients with a diagnosis of COVID-19, she received one day of ventilator training and was transferred to work in the ICU. After only 6 months into her first professional role in the step-down unit, this nurse gracefully pivoted to where she was needed by her patients, teammates, and organization. Her attitude and ability to embrace these incredible challenges enabled her to navigate these stressful situations.

Three areas of critical support

While the challenges that these new nurses have had to face is unimaginable for many of us, the silver lining is the passion that these individuals bring to the profession, their patients, and their team. Here are three areas that helped these nurses get through the last year.

• Clinical care team: In both the survey results (63%) and my personal conversations, these new nurses reported that their peers were a major support system. Hierarchical structures within and between teams that are typically in place were often broken down during the COVID-19 pandemic; and in turn, brought the teams closer together. One nurse shared that a physician on her unit announced that he would throw a party for the entire unit once the pandemic was over.
• Leadership: In the survey responses as well as the personal interviews, unit leadership was referenced as a key support system for these new nurses throughout the pandemic. This feedback highlights the critical roles unit managers play in supporting and retaining nursing talent.
• Organizational support: Time and time again, survey respondents as well as those new nurses I interviewed indicated that leadership’s communication, presence, visibility and willingness to listen was highly valued during the pandemic.

A call to action for hospital and nursing leaders

Much like I’ve done here via survey and with personal conversations, I encourage hospital and nursing leaders to engage with individuals at your organizations that began their nursing career during a pandemic. Take the time to capture their experiences and perspectives. Understanding the impact of COVID-19 on this cohort of RNs in the future will be key to supporting them.

I also encourage you to leverage data from the Vizient/AACN Nurse Residency Program to identify opportunities to provide tailored support to NLRNs. The data is from more than 20,000 NLRNs across the country that began their first professional role in 2020. This type of data, paired with conversations, can help hospital and nursing leaders understand the unique challenges NLRNs have faced in the past year. Listen to what NLRNs have to say about their first professional roles in health care, and what they think would be beneficial moving forward.

Continue to share with NLRNs, and your entire nursing staff, what you as a leader are doing to address these challenges. Many organizations have continued routine communication with staff to convey the importance of their presence as a team member at the organization. Finally, collaborate with academic partners that your organization typically hires from to understand the implications COVID-19 has had on the new graduates hired by your organization. This will help inform how your organization can close any gaps that the NLRN may have experienced in the past year and inform what changes to expect in the future.

There is so much to learn from the newest nurses in this profession that can help to inspire continued growth, development and evolution in the health care setting.