The 50% turnover rates presented by Dracup (2007) and Hardin-Pierce and Butler (2005) call attention to 53% of new graduate RNs who leave their job within a year, highlights the issue of ineffective transition. Hardin-Pierce & Butler (2005) describe new graduate RN’s who experience a lack of supportive culture and horizontal violence which correlate to these dismal figures (Hardin-Pierce & Butler, 2005). Lavoie-Tremblay, O’Brien-Pallas, Gelinas, Desforges (2008) estimate by 2020 the United States will have a projected shortage of 808,400 full-time nurses at 29% (Lavoie-Tremblay et al, 2008). Lavoie-Tremblay et al (2008) highlight the changes that need to be made within the organizational structure that will positively impact work environments for new graduates by making more incentives (Lavoie-Tremblay et al, 2008). New graduate RN’s need knowledge concerning issues that affect transition to be able to speak to them in upcoming interviews and job opportunities.

Defining Aspects of Transition

  There are many different orientation to the workplace models for the new graduate RN including the mentoring model, preceptor, and residency program. Mills & Mullins (2008) studied the mentoring model implemented in California to increase retention rates (Mills & Mullins, 2008). Mentors were assigned to new graduate RNs for support and guidance. The mentor completed a 16-hour certification program, which defined their role and expectations (Mills & Mullins, 2008). The evidence concluded increased job satisfaction and professional confidence when relationships lasted over one year (Mills & Mullins, 2008).

  Wieland, Altmiller, Door and Wolf (2007) define the preceptor as “helping neophytes transition to the role of professional nurse, preceptors serve as coaches, role models, socializers and evaluators” (Weiland et at, 2007, p. 316). Weiland et al (2007) attributed success to building confidence in many skills they acquired including: time management, decision-making, collaborating and advocating for their patients (Wieland et al, 2007). Paton & Binding (2009) discuss the clinical expertise and attributes of the preceptor to properly assess the readiness of the new graduate RN using “intentional process of thinking, reflecting, debating and questioning students’ behaviors in relation to their understanding and intentions within clinical situations” during a three month time period (Paton & Binding, 2009, p. 115). Paton & Binding (2009) emphasize the dynamic relationship and evaluation involved in the preceptor role and difficulty preceptors face when new graduate RNs are not ready to practice independently after three months (Panton & Binding, 2009).

  Ricker (2008) describes the effectiveness of a new residency program lasting one year (Ricker, 2008). The first three to six months the new graduate RN works with a bachelor’s prepared RN focusing on clinical practice and skills. The second half of the year is geared toward building critical thinking skills by reviewing experiences of the new graduate RN with the input of the preceptor (Ricker, 2008). Throughout the program the new graduate RN communicates with the selected preceptor and clinical leaders to discuss success and challenges related to professional development (Ricker, 2008). The dynamic and open dialogue present within many steps of this program lend to a very appealing workplace for the new graduate where they are involved in their own progression through the transition, which has lead to a more loyal and committed nurse (Ricker, 2008).

  The authors Miller & Mullins (2008), Paton & Binding (2009), and Ricker (2008) all discuss different approaches and outcomes for new graduate RNs, however there is not enough evidence based practice to endorse one model. The programs vary in length from 3 months to one year without evidence based practice or conclusive data of what is most successful. All programs initiate a didactic and clinical component before allowing the new graduate nurse to work independently (Ricker, 2008, Paton & Binding, 2009, Miller & Mullins, 2008).

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