Tumultuous times bring new opportunities. For healthcare organizations, today’s soaring nurse turnover rates amplify the need for strong career development strategies.
The national average turnover rate for registered nurses rose to 27.1% in 2021—an increase of 8.4% over the previous year.(1) As more nurses choose to leave their organizations or the profession entirely, health systems face serious patient care and financial implications. In fact, the high turnover of staff nurses cost the average hospital over $7 million in 2021.(2)
Furthermore, continuous nurse shortages add stress to care team members, contributing to disengagement, staff burnout, and other indicators of decreased satisfaction. Even before the pandemic, one study suggested that 15% of nurses already were disengaged—and each disengaged nurse cost their organization more than $22,000 in lost revenue from lack of productivity.(3)
Despite such challenges, health systems can build morale by rethinking nurse retention and career development approaches. When nurses realize their employer’s dedication to advancing their careers, they are more likely to be motivated to stay, grow, and lead within the organization.
Recognizing that new graduate nurses’ needs differ from those of experienced nurses, it can be helpful to focus on ways health systems can support nurses through each stage of the nursing career journey.
One in five nurses leave their first job within 12 months(4)—highlighting the crucial need to support recent graduates transitioning from student to care team member responsible for real-world patients.
New nurses need to expand their competence in core skills and confidence in their ability to deliver excellent patient care. A streamlined orientation and onboarding approach can help achieve these objectives and should be interactive, engaging, and self-paced whenever possible. In general, new nurses expect orientation to be a quick-moving, efficient, and attention-worthy process.
Health systems may also want to supplement in-person or blended programs with coordinated and evidence-based eLearning courses. Some eLearning programs are specifically designed for the unique needs of new graduate nurses, focusing on professional skills or clinical areas that nurses may not have had much opportunity to practice in school.
Many of these courses are created in collaboration with leading nursing associations. Partnerships like these help ensure clinical competencies are covered across care settings and nurses are aligned with standards and evidence-based practices systemwide.
eLearning solutions may also focus on professional skills and knowledge outside the clinical setting—such as communication, leadership, and workplace wellness—which can benefit nurses no matter their career path.
To help new nurses transition to practice, health systems can leverage:
• Residency programs. Since the onset of COVID-19, some healthcare organizations have successfully adopted a primarily virtual orientation model, with a hybrid nurse residency program.
• Career and professional development paths. After completing orientation and residency, nurses can better see their career potential and manage job challenges common to new nurses if they leverage professional growth sessions and conversations with leaders.
• Post-residency mentorship programs. Mentorship programs can create and maintain a culture of openness. New nurses may feel more supported when given the chance to work with seasoned and empathetic colleagues, receive feedback, and have their questions answered.
The steps from novice to early- then mid-career nurse happen much faster now that in years past. Nurses often move quickly into preceptor and charge nurse roles and it’s no longer unusual, in fact, to find nurses in a preceptor class in the later stages of their residency.
Encouraging early- and mid-career nurses to become mentors for novice nurses is an optimal way to build a more engaging onboarding experience, help new nurses adapt, and increase new nurses’ satisfaction and confidence. In addition, preceptorship is an excellent introduction to leadership for early- and mid-career nurses.
Preceptors offer stability and play a critical role in providing consistent, high-quality patient care. One study suggests that effective preceptors can enhance nurse retention by up to 50%.5 In another study, 64% of nurses said their clinical experience improved due to preceptor support.6 Yet as many as 85% of health systems have no formal preceptor education.(7)
Bolstering preceptors through a standardized eLearning education program is beneficial for several reasons. First, it increases preceptors’ confidence in their ability to lead and better equips them to assist new graduate nurses in their transition to practice. It also makes preceptors feel valued by their organizations. Finally, it generates an ongoing culture of support that creates more competent and satisfied nurses at all stages of their careers.
From early in their careers, most nurses appreciate opportunities to improve their leadership skills, build upon their knowledge, and reinforce their education. So, health systems may also want to consider offering professional development activities such as:
Charge nurse workshops
Nurse fellowships or residencies for experienced nurses who are new to the health system
Certifications in areas of interest
Encouraging nurses to explore career options is vital to individual and organizational success. In the long run, it can help determine whether nurses stay with an organization and in the profession. Some health systems offer internal travel nurse programs that allow nurses to experience new specialties and care settings in new locales. Others offer certification pay to incentivize nurses to become certified in specialties that interest them. Certification preparation courses, including eLearning programs, can facilitate this enhanced knowledge and expertise.
Health systems working to retain nurses often focus on new, early-, and mid-career nurses. However, experienced nurses and nurse leaders are also at risk of turnover. Moreover, disengaged nurse leaders can contribute to the burnout and staff turnover challenges that health systems are trying to overcome.
Conversely, health systems that cultivate strong nurse leaders who recognize and engage their nursing staff tend to retain strong performers and build satisfaction, loyalty, and referrals. To further nurture nurse leaders, health systems may want to provide opportunities for them to:
• Harness and improve their leadership skills. This can include self-paced courses to hone skills related to interviewing, performance reviews, finance, diversity, and more. It could also involve mentoring programs that connect nurse leaders with other leaders in the organization.
• Achieve leadership certifications. This might involve encouraging nurse leaders to pursue certifications. For example, the American Organization for Nursing Leadership (AONL) offers exams for nurse leaders such as the Certified in Executive Nursing Practice (CENP) and Certified Nurse Manager and Leader (CNML) certifications.
• Grow their teams. Ensuring that nurse leaders have the time they need to discuss career goals with staff enables them to nurture talent effectively, identifying and cultivating the next generation of nurse leaders.
Nurses consider leaving their hospitals, health systems, or the nursing profession for many reasons. Some may want to practice in a different clinical specialty. Some may prefer roles that permit a better work/life balance. Others may wish to alleviate the stress of direct patient care. Each nurse is unique in their career journey.
Health systems that actively encourage nurses to explore new opportunities are well-positioned to strengthen nurse retention, satisfaction, and loyalty. By recognizing the value of ongoing evidence-based education and inspiring career development, health systems can empower nurses to deliver top-quality care, grow professionally, and lead the way for nurses to follow.
Career development at every stage
Some professional development strategies work best when applied to a specific stage of the nursing career journey. Others can be adapted to every part of the journey to strengthen entire nursing units.
Consider these inclusive development approaches:
• Engage nurses in team-building activities
• Recognize staff “wins” during daily huddles or through “kudos campaigns”
• Approach learning opportunities from new perspectives—for example, as a motivator to strive for professional excellence, or as a benefit of being part of the healthcare organization
• Offer specialty and orientation courses to encourage nurses’ interest in different units and departments
• Support nurses at the point of care with easy access to evidence-based clinical skills, research, and reference tools
From Novice to Leader: Development Strategies for the Nursing Career Journey
Clinical eLearning supports nurses during orientation, residency programs, professional development, and practice improvement.
Nurses seeking career changes can leverage Clinical eLearning orientation courses in several specialties, including Critical Care, Emergency, Med/Surg, Pediatrics, Neonatal, and Home Health.
Emerging or existing nurse leaders can benefit from courses designed to strengthen their leadership skills such as becoming a preceptor, charge nurse, NPD practitioner, or nurse manager.
Transition to Practice and Shadow Health are learning and development solutions that help ensure novice nurses are successful at the start of their careers by cultivating a safe space to develop and assess their clinical reasoning and professional skills.
Clinical Skills allows organizations to promote consistent care by combining evidence-based skills and procedures at the point of care with continuing education and competency management functionality.
ClinicalKey for Nursing helps nurses of all experience levels expand their knowledge and support consistent, high quality treatment decisions by answering complex questions based on current evidence.
Complete the form for additional information on these solutions.
2022 NSI National Health Care Retention & RN Staffing Report. https://www.nsinursingsolutions.com/Documents/Library/NSI_National_Health_Care_Retenti on_Report.pdf
The impact of nurse turnover, in 2 charts | Advisory Board. https://www.advisory.com/daily-briefing/2022/10/17/nurse-turnover?utm_source=member_db&utm_medium=email&utm_campaign=2022oct17&utm_content=member_ headline_finala_x_infogram_x_x&elq_cid=975990&
Nurse Engagement: What are the Contributing Factors for Success? © 2016 OJIN: The Online Journal of Issues in Nursing
Thew, J. Want to Keep Nurses at the Bedside? Here’s How. HealthLeaders. March 27, 2019. https://www.healthleadersmedia.com/nursing/want-keep-nurses-bedside-heres-how
Watkins, C., Hart, P., Mareno, N. The effect of preceptor role effectiveness on newly licensed registered nurses’ perceived psychological empowerment and professional autonomy. Nurse Education in Practice. Vol 17, March 2016, Pages 36-42. https://doi.org/10.1016/j.nepr.2016.02.003
Kaniaru, D., Nyagena, E., Kathuri, N., Chebor, A. Perception of Preceptor and Student Nurse Partnership on Clinical Teaching and Learning. American Journal of Nursing Science. Vol. 5, No. 4, 2016, pp. 141-145. doi: 10.11648/j.ajns.20160504.13
Goss, C.R. (2015). Systematic review building a preceptor support system. Journal for Nurses in Professional Development, 31(1), E7–E14. doi:10.1097/nd.0000000000000117
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