Understanding the variables influencing graduate nurse transition and retention in the workplace

Abstract

The transition of graduate nurses to practice has been identified as challenging. Graduate nurses report feeling stressed, ill prepared, and having intentions to leave (ITL) jobs and the profession. Concerns of ITL are worrisome for the nursing profession, especially when faced with the need to replace an aging nursing workforce, and to maintain quality patient care. Graduate nurse transition and ITL have been the focus of many studies, yet the constructs are typically studied separately without directly connecting graduate nurse transition to subsequent retention in a job and the nursing profession. Guided by a transition theory, the study aimed to test a theory linking ITL and transition, and the personal, community and societal conditions of transition. A predictive, non-experimental design using cross-sectional data was employed. Using a random sample obtained from the provincial regulatory body, registered nurses within their first 24 months of practice were surveyed (N=217) between June and July 2015. The mailed survey included validated tools to assess self-efficacy, work/family conflict, role stress, work environments, transition, and ITL. An overall response rate of 32% was obtained. The mean transition rating, on a scale from 1 to 10, was 6.9, suggesting a positive transition. Intention to leave measures, assessing ITL jobs and the profession were low; however, 45% of respondents reported having left their jobs, and one percent reported having left the profession. Exploratory and confirmatory factor analysis of all scales, and structural equation modeling (SEM) was completed to test the theory which hypothesized that transition is directly associated with ITL. Overall, the model was not supported by the data (χ2 245.07, df 106, p<.01, sRMR .07, GFI .88, CFI .88, RMSEA .08); however, significant relationships among study variables were identified. Thematic analysis of responses to an open-ended item revealed themes of facilitators (supportive work environment, personal factors, and policy), and barriers (feeling unprepared, negative work environments, personal struggles, and policy) to graduate nurse transition. Based on these findings, a number of implications targeting graduate nurse transition and retention at nursing practice, education, research and policy levels are proposed.