Robin Devey - WINN-NTF

Improving new graduate transitions:
An innovative approach to new
graduate on-boarding
Robin Devey RN, MN
Cheryl Anne Smith RN, MScN, Grad Cert Program
The Ottawa Hospital, Ottawa, Ontario
• 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)
• 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
• 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.
Nurses Required
Regional Grads
Out of region grads
New Grad Challenges
Transition from student to new grad is a “realty
Transition phases: honeymoon, shock, recovery &
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
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
Transition shock as immediate, acute and
dramatic stage occurring within first month
Interaction with colleges vital to successful
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
New grads take at least one year to
master a job
New Grad Challenges
Want reassurance, specific and precise
Need to feel connected to people in the
Sense of belonging linked to their
successful transition into their professional
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
• Definition:
approach combining people, process & technology to
optimize impact new hire has on organization
• Process that begins after hire, but before they “enter the
• Key to personalized engagement
• Studies indicate new hires more productive sooner and
improves retention
• Employee feels welcomed, valued and prepared for their
new career
• 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
• Newcomer adjustment consists of both task and social
• 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
-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
• 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
Follow up received
Meet and Greets
On going support
Manager support
Registration assistance New grads
Registration assistance Managers
Satisfaction with program
“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
• 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
• Innovative approach to new grad on boarding has proven to be very
• 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
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