 With continuing evidence about the nursing shortage and the need for an increase in educational capacity, the Hawai’i State Center for Nursing realizes that it is critically important to address the issues of retention of the existing nursing workforce. Nationwide, there are numerous efforts focusing on the high risk groups of nurses that include new graduate RNs, frontline managers, and older nurses. Of particular concern is the retention of new graduate nurses who are expected, over time, to replace seasoned nurses retiring from the field. However, retention of new graduates is proving to be a challenge for the profession; it is estimated that up to 70% of all new nurse graduates leave their first job within the first year (Kovner et al., 2007).
To counteract this loss of new nurses, numerous nurse retention strategies have been developed and implemented. Evidence examining the impact of retention strategies directed at the transition to practice of new graduate RNs has demonstrated a significant reduction in turnover (Halfer, 2007). These strategies include comprehensive orientation programs, preceptor development programs and/or transition-to-practice programs.
After an extensive review of the literature as well as a state-wide survey of existing programs, the Center established criteria for programs to be considered. Programs needed to be standardized, theory-based, established with a track record of success, suitable for nurses from both BSN and ADN nursing programs, and was amenable for evaluation of outcomes, i.e. retention rates and satisfaction. The program had to be cost effective so that all healthcare facilities in Hawai’i could avail themselves of it, regardless of size or resource capability. Three preceptor programs across the nation were considered and the Vermont Nurse Internship Project (VNIP) was found to be the program which best met the criteria and has been adopted by the Center. To date, five healthcare facilities in Hawai’i have partnered with the Center and are in the process of implementing the program: (1) Kapi’olani Medical Center for Women & Children; (2) Maui Memorial Hospital; (3) Kapi’olani Medical Center at Pali Momi Hospital; (4) Queen’s Medical Center; and (5) Tripler Army Medical Center.
The Hawai’i Nurse Internship Program (HNIP) is modeled after VNIP and is structured with an intensive preceptor development component for nurses providing direct patient care who work with new graduate nurses. It is designed to build long-term sustainable capacity within each organization by developing nurse educators, managers, and staff RN preceptors to work with new graduates and enable them to teach, coach, mentor, lead, and evaluate new nurses. New graduates receive a minimum of 12 weeks of new graduate orientation, including 40 hours of didactic teaching and weekly competency assessments. An additional expected outcome of this Program is to change the culture of health care organizations to become a more supportive environment in order to assist the transition of the novice nurse into successful practice. |
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