Newly qualified nurses need better support in their first job if workforce retention is to improve, according to interim findings from a major new study.
The researchers also found that student nurses need better direction from university courses about how to ask more informed questions of prospective employers.
“We’ve been looking at what works in retaining nurses and what are the challenges”
Those behind the Supporting the Transition and Retention project (STaR) are aiming to identify how better support for newly qualified nurses can stop nurses leaving the profession prematurely.
“The literature is clear that this first year is critical to whether they continue with not just their first post but their whole nursing career,” said principal investigator Dr Jane Wray from the University of Hull’s school of health and social work.
“Existing models tend to focus on what employers need to do to improve retention,” she said. “They don’t look at what higher education needs to do or nurses themselves.”
The STaR researchers, who are nine months into a three-year study, are looking at all these things, she noted.
She said the first year of the project had been about gathering background data and, to ensure things moved quickly, it was a rapid evidence assessment and not a systematic review.
“Employers have to offer a package to attract newly qualified nurses”
Interviews are being conducted with 10 stakeholders in each of the following groups – final year nursing students, newly qualified nurses who have just started, newly qualified nurses who are eight or nine months in, higher education leaders and clinical partners.
“Essentially, we’ve been looking at what works in retaining nurses and what are the challenges,” said Dr Wray.
One of the key findings is that nurses can struggle in the transition from a degree course to the world of work. Employers should think about offering the equivalent of mentoring in the first few months, she said, referring to what are often called preceptorships.
This might be one to one support. However, other countries offer other models such as group support and peer support, noted Dr Wray.
For a nurse entering the NHS with all its structural and funding problems, year one can be a “baptism of fire”, she said, adding: “It’s about the move from being a student to a fully autonomous practitioner.
“The thing you can’t practice as a student is autonomy and accountability,” she said. “In other words, being responsible for the decisions they make and having to make decisions under pressure.”
Dr Jane Wray
As a student they will have been working with a mentor. There is a big “jump” from having someone working with you side by side to being on your own, she said.
“It takes time to be confident and competent in that decision making and the NHS environment can be very challenging,” she said. “Newly qualified nurses still need support to settle into that role.”
Some trusts have a supportive structure for new nurses and realise the need for an induction period, she said, while cautioning that others did not.
Nursing students should be asking prospective employers detailed questions to find out what support they offer, she said, noting that key to job satisfaction was learning to ask the right questions.
Dr Wray suggested such questions might include – what’s the induction look like, will they be supernumerary in the first month and what about mandatory training?
“We know that there’s been a recruitment challenge across the sector so our students can choose where they go,” she said. “Employers have to offer a package to attract newly qualified nurses.”
Central to this are universities who need to look at how they can help with career planning. It might be advice on which clinical area a nurse wants to work in?
But it can often be very practical issues, such as whether an hour-long commute is manageable, whether they should drive to work and what car parking provision there is, Dr Wray said. Debt is another important issue, she noted.
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She said nurses needed to “think through the nitty gritty of work, rather than jump into the first job that comes along, think what will work for me”.
“For example, a student nurse may want to work in the intensive care unit but it may be better to start somewhere less stressed, learn the ropes and only then move to ICU, she said.
The opportunity for flexible working is not being looked at specifically. But the study is asking generally about working conditions and support from employers, so views on this may emerge, said Dr Wray.
She stated: “I don’t want to pre-judge the data from all interviews, as it has not been analysed yet.”
The rapid evidence assessment, including interviewing the key stakeholders, is due to be finished this summer.
“The thing you can’t practice as a student is autonomy and accountability”
Year two of the project will focus on developing a best practice model. This will look at what higher education can do better, how employers can improve and what nurses can do to make the transition to the world of work easier.
It will work with around 100 to 150 nurses. Nurses being interviewed are in Hull but other stakeholder groups are from around the UK and also experts in Australia and the US.
Meanwhile, year three will focus on testing the best practice model on students doing a nursing degree at Hull. About 280 nursing students graduate every year from the university and the idea is that they will take the new model into their first jobs with them.
In addition to Dr Wray, the project is being led by Hull University colleagues Professor Roger Watson and Dr David Barratt.
The STaR project is being funded by the Burdett Trust for Nursing. The study is due to complete in June 2020.