Associations Between the COVID-19 Pandemic and New Nurses' Transition to Practice Outcomes: A Multi-site, Longitudinal Study.

Background: The transition between nursing school and nursing practice has been well studied and recognized as a turbulent time for new nurses. Existing literature suggests that transition to practice (TTP) programs can successfully support new nurses through this challenging period. However, TTP program outcomes have not been studied related to the COVID-19 pandemic, which altered TTP experiences for many new nurses by limiting their access to clinical sites for hands-on patient care experience and shifting delivery of nursing education and TTP programs from in-person to virtual environments. Purpose: The purpose of this study was to analyze the associations between TTP outcomes and the COVID-19 pandemic. Methods: This was a retrospective correlational, longitudinal study using secondary analysis of Vizient /AACN Nurse Residency Program survey data from the Casey-Fink Graduate Nurse Experience Survey and the Nurse Resident Progression Survey. Self-reported data from new nurses in Southeast Texas who participated in a standardized TTP program before the COVID-19 pandemic (2017-2019) were compared with self-reported data from nurses who participated in the TTP program during the pandemic (2020 and 2021). Results: A total of 2,673 nurses participated in this study. When adjusting for demographic composition of the cohorts, statistically significant differences (p < .05) were identified in the advocacy, patient safety, and commitment outcomes with a decline in change scores from baseline to 12 months in the COVID-19 pandemic cohort compared to the pre-COVID-19 pandemic cohort. Conclusion: Our findings provide new information on the impact of the COVID-19 pandemic on new nurses' participating in a standardized TTP program. The results indicate that patient safety and commitment to staying employed in the organization and the nursing profession should be priority improvement areas for employers and TTP program staff as they work to support new nurses' TTP in a pandemic.

Work environment factors other than staffing associated with nurses' ratings of patient care quality.

BACKGROUND: The impact of registered nurse (RN) staffing on patient care quality has been extensively studied. Identifying additional modifiable work environment factors linked to patient care quality is critical as the projected shortage of approximately 250,000 RNs over the next 15 years will limit institutions' ability to rely on RN staffing alone to ensure high-quality care. PURPOSE: We examined the association between RNs' ratings of patient care quality and several novel work environment factors adjusting for the effects of two staffing variables: reported patient-to-RN ratios and ratings of staffing adequacy. METHODOLOGY: We used a cross-sectional, correlational design and a mailed survey to collect data in 2009 from a national sample of RNs (n = 1,439) in the United States. A multivariate logistic regression was used to analyze the data. FINDINGS: Work group cohesion, nurse-physician relations, procedural justice, organizational constraints, and physical work environment were associated with RNs' ratings of quality, adjusting for staffing. Furthermore, employment in a Magnet hospital and job satisfaction were positively related to ratings of quality, whereas supervisory support was not. PRACTICE IMPLICATIONS: Our evidence demonstrates the importance of considering RN work environment factors other than staffing when planning improvements in patient care quality. Health care managers can use the results of our study to strategically allocate resources toward work environment factors that have the potential to improve quality of care.

Transition-to-U.S. Practice Experiences of Internationally Educated Nurses: An Integrative Review.

Internationally educated nurses (IENs) are an important part of the U.S. nursing workforce. Optimizing their transition-to-practice (TTP) experiences in the United States is crucial for ensuring high-quality patient and IENs' outcomes. The purpose of this integrative review is to analyze and synthesize the current evidence surrounding IEN TTP experiences in the United States from 2000 to 2018 to inform improvements in TTP. Eighteen studies were included. TTP was defined through IENs' description of facilitators and barriers of the transition process and presented in seven themes. Two themes were facilitators: support from family and nursing colleagues, and perceptions of self-efficacy. The remaining five themes were barriers: (a) the stigma associated with educational preparation, (b) communication and language, (c) differences in culture, (d) differences in nursing practice, and (e) legal issues. Findings are important for improving TTP programs. Further research focusing on the outcomes of transition programs is needed to inform policymaking surrounding IEN recruitment and retention.

Charting the course for nurses' achievement of higher education levels.

To improve patient outcomes and meet the challenges of the U.S. health care system, the Institute of Medicine recommends higher educational attainment for the nursing workforce. Characteristics of registered nurses (RNs) who pursue additional education are poorly understood, and this information is critical to planning long-term strategies for U.S. nursing education. To identify factors predicting enrollment and completion of an additional degree among those with an associate or bachelor's as their pre-RN licensure degree, we performed logistic regression analysis on data from an ongoing nationally representative panel study following the career trajectories of newly licensed RNs. For associate degree RNs, predictors of obtaining a bachelor's degree are the following: being Black, living in a rural area, nonnursing work experience, higher positive affectivity, higher work motivation, working in the intensive care unit, and working the day shift. For bachelor's RNs, predictors of completing a master's degree are the following: being Black, nonnursing work experience, holding more than one job, working the day shift, working voluntary overtime, lower intent to stay at current employer, and higher work motivation. Mobilizing the nurse workforce toward higher education requires integrated efforts from policy makers, philanthropists, employers, and educators to mitigate the barriers to continuing education.

Newly Licensed RNs Describe What They Like Best about Being a Nurse.

About 25% of newly licensed registered nurses (NLRNs) leave their first job within two years, but only 2% leave the nursing profession in this same timeframe. Therefore, the researchers sought to discover what new nurses like best about being a nurse, in hopes of gaining information that might help facilities to reduce turnover rates. Data were collected between January and March 2009 from 1,152 NLRNs licensed in 15 US states. Krippendorff's method was used to analyze survey responses. Five themes emerged: "providing holistic patient care," "having an autonomous and collaborative practice," "using diverse knowledge and skills to impact patient outcomes," "receiving recognition," and "having a job that is secure and stimulating." Strategies are discussed that organizations might employ in helping NLRNs to realize what they best like about their work, which might lead to improved retention rates.

The nursing career process from application through the first 2 years of employment.

The purpose of this analysis is to describe the attrition process from application to associate and baccalaureate basic RN programs through the first 2 years of work using estimates from best available nationally representative data. Results of the analysis show that although about 41,000 qualified applicants are not admitted to basic RN programs, most students (76.2%) who enroll in basic RN programs graduate, and most RN graduates who pass the National Council Licensure Examination stay in their first nursing job (73.8%) and nursing (97.9%) for at least 2 years. The results suggest that room for improvement exists for retention across educational and work settings, but the system appears to be most leaky at the point of admitting qualified applicants. Precise data about attrition from educational and employment settings are essential for resolving educational capacity and workforce retention issues, but precise data are difficult to obtain. A solution may be to assign each applicant a unique identifier.