Effective orientation programs for new graduate nurses: A systematic review

doi:10.1016/j.enfcli.2019.04.094

Enfermería Clínica

Volume 29, Supplement 2, September 2019, Pages 612-618

https://doi.org/10.1016/j.enfcli.2019.04.094 Get rights and content

Abstract

Objective

To determine the most effective orientation program for new graduate nurses (NGNs) in hospital settings.

Method

A systematic review of existing literature was conducted following a search of the electronic databases Science Direct, PubMed, EBSCOhost, ProQuest, and Wiley Online (2008–2018). Searches utilized the following keywords nurse orientation, new nurse orientation, practical orientation, nurse transition, and nurse transition program.

Results

A total of fourteen studies met our review criteria. Evidence from these studies showed that current orientation protocols consist of preceptorship, classes, and simulations of patient care. The most efficacious orientations had well-established goals and utilized proven learning materials, support systems such as preceptorship and mentorship, learning methods, and evaluation instruments within the organization.

Conclusion

Well-designed orientation programs will result in positive effects on NGNs and patient care in the hospital.

Introduction

Newly graduated nurses (NGNs) undergo a difficult transition period from student to professional nurse following graduation. NGNs are both mentally and emotionally challenged as they adjust themselves to their new profession and organization.¹ Existing literature outlines several stressors on NGNs including waiting for National Council Licensure Examination (NCLEX) results, moving away from home to live independently, and adjusting to the new demands of their work environment.² All of these new responsibilities often produce stress and anxiety.³

NGNs also face certain personal difficulties during the transition period. Studies have shown that lack of confidence, high workloads, orientation issues, fear, frustration, and being overwhelmed are frequent transition difficulties for NGNs.2, 3 These can lead to transition-precipitated shock that must be recognized and addressed by nurses and hospital management. A lack of management involvement in overcoming shock can lead to negative emotions⁴ that can affect an NGNs’ intention to remain in nursing. Other hurdles include gaps in education, burnout, and negative experiences.⁵

Ideally, hospitals should be proactive when tackling these issues. Well-prepared orientation programs can help prevent shock by helping NGNs to assimilate into their new work environments and providing tools to help them adapt to their new workloads. Supportive orientation increases NGNs’ job satisfaction in the ward.⁶ Successful orientation programs can go a long way toward overcoming the problem of transition shock in NGNs. Hospital support of NGNs throughout the full first year of practice can promote the development of professional confidence.⁷ Despite this data, however, only 50.6% of nurses interviewed reported a structured orientation program at their hospitals.⁶ A review of existing orientation programs for NGNs could provide evidence-based strategies to improve NGN retention as well as the quality of nursing care. The study aims to determine the most effective orientation program for new graduate nurses (NGNs) in hospital settings.

Section snippets

Search strategy

This systematic review was conducted by gathering data from five databases, Science Direct, PubMed, EBSCO, ProQuest, and Wiley Online, from 2008 to 2018. Data collection was performed on studies gleaned from a search using the following keywords: nurse orientation, new nurse orientation, practical orientation, nurse transition, and nurse transition program (Table 1). Suitability was determined by reviewing the title, abstract, and overall content, and fourteen studies were aligned with our

Results

Data search and selection was performed in fourteen studies corresponding to the inclusion criteria. The target samples from those studies were NGNs with sample sizes ranging from three to 521. One of the studies did not specify sample size, and reported only use of a total sampling method.⁸ All studies covered implementation of an orientation program either developed by the study authors or based on existing theory and then assessed the results thereof. Research designs varied, and included

Discussion

Orientation time given to NGNs is a critical feature for analysis, as the length thereof can affect costs incurred and results derived from the program. The shortest orientation time in the study was six days, while the longest was twelve months. Comprehensive orientation processes correlated significantly to the length of orientation²²; research suggests that the NGN orientation period should be at least four weeks long.²³ All articles reviewed for this study met this guideline except for one,

Conclusion

Nursing managers should design and manage orientation programs aligned with evidence-based research. Modifications can be made as necessary with regards to the hospital's available budget and existing technology. Orientation length should be determined in accordance with orientation goals and activities. Components of a successful orientation program are learning materials, support systems, and learning methods with proven efficacy. Nursing managers must also design measurable goals for the

Conflict of interests

The authors declare no conflict of interest.

Acknowledgments

This work is supported by Hibah PITTA 2018 funded by Directorate of Research and Community Services Universitas Indonesia No. 5578/UN2.R3.1/HKP.05.00/2018.

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^☆: Peer-review under responsibility of the scientific committee of the Second International Nursing Scholar Congress (INSC 2018) of Faculty of Nursing, Universitas Indonesia. Full-text and the content of it is under responsibility of authors of the article.

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Effective orientation programs for new graduate nurses: A systematic review☆

Abstract

Objective

Method

Results

Conclusion

Introduction

Section snippets

Search strategy

Results

Discussion

Conclusion

Conflict of interests

Acknowledgments

Collegian

Nurse Educ Today

Nurse Educ Today

Nurse Educ Pract

Nurs Clin North Am

Clin Simul Nurs

Clin Simul Nurs

J Nurs Regul

Appl Nurs Res

Nurse Educ Pract

New nurse transition: success through aligning multiple identities

J Health Org Manag

The graduate nurse experience: qualitative residency program outcomes

J Nurs Admin

The transition from student to new registered nurse in professional practice

J Nurs Staff Dev

The helpfulness and timing of transition program education

J Nurses Prof Dev

On the road to a meaningful, cost-effective orientation program

Nurs Manag