Improving new graduate transitions:
An innovative approach to new
graduate on-boarding
Robin Devey RN, MN
Cheryl Anne Smith RN, MScN, Grad Cert Program
Evaluation
The Ottawa Hospital, Ottawa, Ontario
Context
• The Ottawa Hospital (TOH) is one of the largest academic
health science centres in Canada
-13,000 employees with 4,500 nurses
• Nursing shortage predictions:
- In Canada CNA (2009) predicted shortage of 60,000
RN’s by 2022
-In U.S. predicted shortage of 260,000 RN’s by 2025
(Buerhaus et al., 2009)
Context
• 30-60% New graduate Nurses leave their first employer
within the first year
• Turnover cost per nurses is $27,000 Canadian
• Recognized new grads were dominant pool and that we
needed to ensure low turnover
Context
• TOH needed to recruit over 522 nurses in 07-08 with 276
projected regional grads 619 nurses in 08-09 with 245 regional
grads and 637nurses in 09-10 with 259 regional grads.
07-08
08-09
09-10
Nurses Required
522
619
637
Regional Grads
276
245
259
Out of region grads
246
374
378
New Grad Challenges
•
Transition from student to new grad is a “realty
shock”
•
Transition phases: honeymoon, shock, recovery &
resolution
•
Transition is a rite of passage with three phases:
separation, transition & integration
•
Transitional challenges include: lack of
preparation to live up to ideals, challenges of task
vs. patient needs, focus on developing
competencies vs. client autonomy & reluctant to
consult with colleagues and participate in decision
making
New Grad Challenges
•
Transitional stressors include: lack of
confidence in decision making, deficits in
critical thinking and clinical knowledge,
relationships with peers & preceptor,
struggling with independence, frustrations
with work environments, organization,
setting priorities and communicating with
staff
•
Transition shock as immediate, acute and
dramatic stage occurring within first month
•
Interaction with colleges vital to successful
integration
New Grad Challenges
•
Sense of belonging linked to successful
transition to new role
•
Need to feel connected to people in the
organization or they may not stay long
enough to try to fit in
•
Turnover reported up to 60%
•
40% perceive lack of opportunities for future
career development
•
Leave because they never feel welcomed or
part of the organization
New Grad Challenges
•
Frustrated by lack of care shown by staff
•
Demonstrate stress regarding competence,
confidence, making errors & adjusting to
new workplace environments
•
Complain of lack of support, problems with
organization, completion of tasks & quality
of work
New Grad Challenges
•
Do not feel skilled, comfortable or
confident for as long as one year after
hire
•
New grads take at least one year to
master a job
New Grad Challenges
•
Want reassurance, specific and precise
guidelines
•
Need to feel connected to people in the
organization
•
Sense of belonging linked to their
successful transition into their professional
role
Program Objectives
• Provide supportive safe environment (on-boarding)
• Ensure large numbers of new grads not “lost in their sheer number”
• Increase new grad engagement / sense of belonging
• Decrease new grad turnover
On-boarding
• Definition:
approach combining people, process & technology to
optimize impact new hire has on organization
• Process that begins after hire, but before they “enter the
door”
• Key to personalized engagement
• Studies indicate new hires more productive sooner and
improves retention
• Employee feels welcomed, valued and prepared for their
new career
On-boarding
• Strategic on-boarding programs involve high levels of
human interaction and tailored to individual’s needs
• New grad face more drastic transition than those with
experience
• Newcomer adjustment consists of both task and social
transition
• 69% of hires stay after 3 years if well structured onboarding
The Ottawa Hospital Approach
• Created new nursing role
-Responsible for connecting with nursing students / new grads
-Attend college / university events
-Maintaining contact with them throughout the hiring process
-Following up with them to the end of their first year of
employment
-Wiki sites for new graduate resources and support for those
who were unsuccessful writing their licensing exams.
The Ottawa Hospital Approach
• On boarding process includes:
-Face to face meetings
-Email and telephone contact
-Meet & Greets
-Group meetings
-Social events
Evaluation Methodology
• Program Logic Model approach
• Stakeholder engagement
• Qualitative and quantitative data
• Focus groups and follow up surveys
• Outcomes and processes both evaluated and recommendations
made which led to changes in the 08-09 program and continued in
09-10 as were well received.
-main changes involved the method of communication about the
program (holding open forum meetings and attending
department/program meetings to review processes) as well as the
interview process and allocation of new grads per clinical program.
Evaluation Results
• Turnover rate decreased and has remained low throughout this
initiative
• Hired over 220 new grads in 07-08, 08-09 & 09-10, an 86% increase
over 06-07
• Survey and focus group results indicated overall satisfaction by new
graduates and managers with the new approach
Evaluation Results
100.0%
90.0%
Follow up received
80.0%
Meet and Greets
70.0%
60.0%
On going support
50.0%
40.0%
Manager support
30.0%
Registration assistance New grads
Registration assistance Managers
20.0%
10.0%
0.0%
Satisfaction with program
Results
“Thank you so much for the good wishes. Now comes the long wait for the
exam results…”
“Thank you so much for those encouraging words! The exam was very
challenging, but hopefully we were able to prove ourselves competent!”
“Hey!! Things are going really well here. It’s been getting really busy so I am
just loving it!”
“Thank you so much for your e-mails. I really appreciate you taking the time to
help and meet up with me/check up. It means so much! Looking forward to
talking with you soon!”
Lessons Learned
• Change in practice
• Confusion about the role and responsibilities
• Timely communication challenging
• Meet & greets so successful we ran out of room
• Difficulties connecting with out of town hires to assist with HFO
website registration
Next Steps / New Challenges
• Will continue with the personalized approach to new graduate on
boarding
• Will develop further resources to assist with new graduate
engagement with the organization
• Will continue to evaluate the program and solicit feedback from new
grads and major stakeholders to further refine the program to meet
the need of those involved
Conclusion
• Innovative approach to new grad on boarding has proven to be very
successful
• TOH recognized that needed to ensure new grads well connected to
the organization to ensure we could provide quality care
• We are assured that we are on the right track, connecting new grads
to TOH, where they have career options for life