Angela Wolff - Fraser Health Research and Evaluation

Successful Transition and
Retention in New
Graduate Nurses
Principal Investigator: Heather K. Spence Laschinger, PhD,
RN, Professor, University of Western Ontario
Knowledge User: Angela Wolff, PhD, RN, Director, FHA
Professional Practice
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Sources of Funding
 Canadian Institutes of Health Research – Partnerships for
Health System Improvements (PHE – 122182)
 Health Canada: Office of Nursing Policy; Capital Health
District; London Health Sciences Centre; McGill University
Health Center; Providence Care; Registered Nurses’
Association of Ontario; Victorian Order of Nurses; Fraser
Health; St. Michael’s Health Care; Victoria General
Hospital; Niagara Health System
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Research Theme
 Top priority theme identified by the Listening
for Direction III report (2007-2010)
 Workforce and the work environment
 Investigating factors influencing new
graduate nurses’ successful transition to their
full professional role within today’s dynamic
health care settings.
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Research Questions
1.
2.
3.
4.
5.
6.
What are the personal and situational factors that influence new
graduate nurses’ satisfaction and intentions to remain in their jobs
and the profession within the first two years of practice?
How does the pattern of relationships among these factors change
over time as they gain experience?
What barriers and facilitators do they identify as influencing
successful transition to the graduate role?
What supports do new graduate nurses identify as relevant to
preparing themselves for the graduate roles?
To what extent are formal nursing graduate transition support
programs helpful?
Are there provincial /regional differences in factors influencing nurses’
job and career satisfaction/turnover intentions?
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Method
 3 phases, mixed methods between Nov 2012 to Mar 2013
 Phase 1
 Surveyed 3906 new graduate nurses within their first two years
of practices
 Stratified random sample drawn from ten provincial regulatory
bodies (n=1,161; 27.1% RR)
 Phase 2
 1,011 follow up survey 1 year later to examine changes over
the critical 1st year of experience (n=396; 44.5% RR)
 Phase 3
 Focus groups with newly graduated nurses
 Regional focus groups with nurse leaders
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Participant Response Rates
6%
14%
5%
1%
Alberta (57)
British Columbia (61)
15%
22%
Manitoba (50)
New Brunswick (43)
Newfoundland (21)
Nova Scotia (32)
Ontario NG (85)
Prince Edward Island (3)
13%
8%
5%
Quebec (21)
Saskatchewan (23)
11%
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Sample
Variable
Canada T1
(N/%)
Canada T2
BC T1
BC T2
Age (M/SD)
27.44 (6.36)
29.29 (7.08)
28.63 (6.68)
30.43 (7.19)
Compressed Time Frame - no
758 (75.3%)
n/a
63 (41.2%)
n/a
Employment FT
610 (60.6%)
247 (62.4%)
83 (54.2%)
37 (60.7%)
n/a
n/a
Orientation Program
Less than 2 wk
2 to <4 wk
4 to 6 wk
> than 6 wk
165
282
345
199
New Grad Program - yes
194 (19.3%)
90 (22.5%)
78 (51%)
73 (47.7%)
On same unit as hire - yes
686 (68.2%)
201 (50.8%)
111 (72.5%)
33 (54.1%)
(16.6%)
(28.5%)
(34.8%)
(20.1%)
16 (10.5%)
41 (26.8%)
66 (43.1%)
27 (17.6%)
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Findings: Change in Job and Personal
Factors Over 1st Year in Nursing
Variable
Mean T1
Mean T2
Change
Authentic Leadership
Score
Range
0–4
2.64
2.51
↓*
Structural Empowerment
4 – 20
13.73
13.39
↓*
Professional Practice Environment
Person-Job Fit
1–4
0–6
2.90
3.28
2.88
3.22
↓*
Trust in Management
0–5
3.82
3.64
↓*
New Graduate Support
1–4
3.23
3.23
-
Occupational Coping Self-Efficacy
1–5
3.59
3.62
-
Psychological Capital
1–6
4.56
4.65
↑*
Work-life Imbalance
1–7
3.67
3.77
-
Supervisor Incivility
0–6
0.71
0.72
-
Coworker Incivility
0–6
0.91
0.91
-
Physician Incivility
0–6
1.25
1.22
-
Bullying Severity (Bergen Bullying Index)
1–5
2.36
2.45
↑*
Note: All the significant differences (p < 0.05) between T1 & T2 study variables in the paired
samples t-test (N = 396). Dataset – Combined Time 1 and 2 Matched Cases
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Findings: Change in Job and Personal
Factors Over 1st Year in Nursing
Variable
Emotional Exhaustion
Cynicism
Interpersonal Strain at Work
Job Satisfaction
Job Turnover Intent
Career Satisfaction
Mental Health
PTSD
Sick Days
Hours worked per week
Score
Range
Mean T1
Mean T2
Change
0–6
0–6
0–6
1–5
1–5
1–5
1–4
0–6
3.28
1.55
1.21
4.05
2.33
4.00
2.76
1.79
2.99
37.78
3.30
1.79
1.43
3.98
2.43
3.94
2.81
1.75
3.36
36.41
↑*
↑*
-
Note: All the significant differences (p < 0.05) between T1 & T2 study variables in the paired
samples t-test (N = 396)
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Correlates of New Graduate Retention Outcomes (T1 to T2)
Authentic Leadership
Structural Empowerment
Professional Practice Support
Person-Job Fit
Trust in Management
New Graduate Support
Orientation Satisfaction
Coping Self-Efficacy
Psychological Capital
Work-life Imbalance
Supervisor Incivility
Coworker Incivility
Physician Incivility
Bullying Severity
Emotional Exhaustion
Cynicism
Interpersonal Strain at Work
Mental Health
PTSD
Overall Health
Sick Days
NS, not significant
Job
Satisfaction
.22
Intent to
leave the job
-.11
Career
Satisfaction
.16
Intent to
leave nursing
-.10
.24
-.17
.18
-.11
.32
-.20
.23
-.14
.40
-.27
.30
-.18
.27
-.19
.18
-.11
.35
-.26
.25
-.25
-.21
.20
-.13
.11
.23
-.13
.17
-.12
.39
-.28
.36
-.28
-.24
.19
-.21
.23
-.22
.11
-.17
.10
-.19
.18
-.22
.16
-.17
.13
-.18
Ns
-.13
ns
-.14
ns
-.38
.32
-.28
.25
-.44
.38
-.40
.36
-.29
.23
-.26
.24
.31
-.24
.24
-.21
-.18
.15
-.18
.12
.23
-.13
.21
-.16
ns
ns
ns
ns
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Correlates of New Graduate Health Outcomes (T1 to T2)
Authentic Leadership
Structural Empowerment
Professional Practice Support
Person-Job Fit
Trust in Management
New Graduate Support
Orientation Satisfaction
Coping Self-Efficacy
Psychological Capital
Work-life Imbalance
Supervisor Incivility
Coworker Incivility
Physician Incivility
Bullying Severity
Emotional Exhaustion
Cynicism
Interpersonal Strain at Work
Age
Job Satisfaction
Job Turn Over
Career Satisfaction
Career Turnover
NS, not significant
Time 2
Mental Health
.12
.14
.17
.27
.15
.18
.13
.20
.28
-.23
-.15
-.14
-.12
-.10
-.32
-.33
-.27
ns
.25
-.15
.25
-.27
Time 2
PTSD
-.16
-.16
-.18
-.27
-.12
.19
-.15
-.19
-.24
.30
.23
.26
.19
.26
.34
.33
.31
ns
-.46
.19
-.31
.28
Time 2
Overall Health
ns
ns
ns
.11
ns
ns
ns
.21
.17
-.22
ns
-.13
-.13
-.11
-.20
-.25
-.12
ns
.36
ns
.22
-.15
Time 2
Sick Days
ns
ns
ns
ns
ns
ns
ns
ns
-.13
.13
ns
ns
ns
ns
.22
ns
ns
ns
-.20
ns
-.11
ns
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Job
Satisfaction
β
Job
Turnover
β
Career
Satisfaction
β
Career
Turnover
β
Mental
Health
β
Overall
Health
β
.316
.227
.388
.368
.195
.255
.166*
.169*
.468*
.464*
.226*
.426*
.008
-.087
.040
-.084
-.041
-.025
-.072
.095*
-.076
.081
-.024
-.044
.144*
-.114
.133*
-.069
.112
-.008
-.025
.037
.067
-.035
-.007
.016
-.097
.027
-.031
.076
-.054
-.028
.045
-.054
-.050
-.094
-.070
-.081
.133
-.053
-.074
.062
.070
-.127
.130*
-.041
.073
-.060
.031
-.026
-.004
.044
-.042
.045
.028
.144*
-.053
-.014
-.038
.003
-.060
.017
.027
.072
-.046
.039
.032
-.058
.067
-.085
.014
-.078
.019
-.060
-.113
.106
.044
-.044
-.118
.117
-.161*
.181*
-.214*
.140*
-.080
-.230*
.071
-.070
.041
.058
.014
-.052
Findings: Outcomes with T2 predictors
Model R-squared
T1 Dependent
Variable
Age
Employment Status
PsyCap
Leadership
Empowerment
Support for NG
Nurses
Worklife
NWI
Occupational SE
Incivility
Supervisor
Co-worker
Physician
Burnout
EE
Cynicism
Worklife Interference
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Preliminary Findings Summary
What are the personal & situational factors that influence new graduate nurses’ satisfaction
& intentions to remain in their jobs and the profession within the first two years of practice?
 Psychological capital is a factor that influences NGN’s
satisfaction.
 Greater personal resources (hope, optimism, self-efficacy and
resilience) results in the greater career and job satisfaction of
NGNs.
 Cynicism (aspect of burnout) and occupational coping
self-efficacy are factors that influence NGN’s overall
health.
 Increase in NGN’s mentally distancing themselves/indifferent
attitude towards work/employer there is a decrease in their
overall health.
 When NGN’s have a higher occupational coping self-efficacy
they have better overall health.
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Preliminary Findings Summary
What are the personal & situational factors that influence new graduate nurses’ satisfaction
& intentions to remain in their jobs and the profession within the first two years of practice?
 Cynicism (aspect of burnout) is a factor that influences
NGN’s satisfaction and turnover.
 The more new grads who have a cynical/indifferent attitude the
greater likelihood that they will be satisfied with job and career.
 Increase in NGN’s mentally distancing themselves/indifferent
attitude towards work/employer there is greater likelihood that
they will leave their job and career.
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Conclusions
Satisfaction – Job and Career
 Mitigating cynicism
 Providing opportunity for greater positive state of high hope, selfefficacy, optimism and resilience
Turnover – Job and Profession
 Mitigating cynicism
Overall Health
 Mitigating cynicism
 Providing opportunity to develop occupational coping self-efficacy
Image source; http://farmstyle.com.au/news/buying-small-farm-%E2%80%93-starting-out
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Questions and Comments
We came for the job,
but stayed for the people
Angela.wolff@fraserhealth.ca
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