“Permanent whitewater.” That’s how Brene Brown—research professor, bestselling author and author of one of the world’s top five most-viewed TED talkscharacterized the nursing profession. Now imagine yourself a novice swimmer being thrown into the torrent.


That’s the kind of “reality shock” that newly graduated nurses (NGNs) experience upon transitioning from nursing school to the work force. Before the advent of computerized licensing in 1994, NGNs worked for several months under a provisional license. Now NGNs can take the board exam and be on the job as fully licensed nurses within weeks of graduation. But according to several studies, they often find themselves assigned to clinical units carrying responsibilities beyond their capabilities.

Nurses today must understand a dizzying array of practices and technologies that didn’t exist a decade or two ago, from remote health monitoring to EHR data and beyond.

It’s a well-known travesty that nearly one in five NGNs leave the profession within their first year on the job. That number rises to one in three nurses over three years. The challenges that drive nurses away are well reported. Some include the rising demand for technology competency and advanced certifications. Add to that a passel of pain points—regional and gender pay gaps, workplace violence, short staffing, withering work hours, workplace hazards (typically biological)—and you might wonder why any of them stay on.

Nursing schools typically focus on preparing their students to pass the board exam. But nurses and their employers need to think beyond NCLEX if effective public health is to survive the current, unprecedented nursing shortage.

Onboarding & Retention

Part of the solution to nursing retention lies in onboarding and continuing education. Hospitals and regulators are raising the bar for competency and education. While 13 US states today have no continuing-education requirements for license renewal, that number is down from 18 four years ago and will likely continue to fall. But even when not compulsory, continuing education is a smart career move for nurses wanting, for example, to extend their expertise by earning certifications in trauma, leadership, or critical care—anything beyond the basics learned in school. Membership in nursing organizations offer additional paths to upgrading one’s training.

Helping nurses to transition successfully into the practice should take the long, holistic view, as research in the North Carolina Medical Journal suggests:

  • Address the need for supporting nurses’ relationships with peers and coaches.
  • Provide formalized mentoring such as the three-stage approach suggested by researchers: an initiation phase, a collaboration phase and an autonomous phase.
  • Implement residency programs to stem turnover rates. This is vital. At Vidant Medical Center, “The mentor or coach is required to complete a didactic nurse-coaching class, a four-hour assessment with their nurse manager, a peer assessment, and three annual coaching update classes.”
  • Share resources. In rural areas of Oregon and North Carolina, where faculty vacancies persist (due often to retirement), universities, community colleges and healthcare partners combine their assets and efforts, the “RIBN” model, to offer students more class options with the goal of increasing the number of baccalaureate nurses.

New nurses report a great need to maintain workplace relationships, especially as they transition to new clinical units, and to cultivate new relationships and friendships. Seeing to nurses’ professional socialization should be viewed as a component of professional development.

The key take-away cited by researchers Susan Dyess and Rose O’Sherman is that “continuing education initiatives are needed that will meet the needs of new nurses during their first year of practice and that are inclusive of support efforts extending beyond clinical orientation and basic unit-specific preceptor programs” (409).

Pursuing advanced nursing degrees is more important than ever before. According to Forbes in 2015, nurse practitioner is one of the fastest growing health professions in the nation. There are currently more than 223,000 licensed NPs working today, many in retail: CVS Health employs 2,700 practitioners across its 960 clinics. Walgreens Boots Alliance employs another 1,200 practitioners at more than 420 clinics. Twenty states now have eliminated regulatory hurdles that prevented patients from accessing treatment from nurse practitioners. According to the American Association of Nurse Practitioners, approximately 350 US universities and colleges now offer master, post-master, and doctoral NP programs.

Opportunities for innovation abound

Whether it’s virtual social spaces, online platforms to support formal coaching and mentoring, portable online portfolios and credentialing services, or online resources for residency programs, tekMountain, the innovation center at CastleBranch, believes that the need for giving nurses better tools for navigating the whitewater of their profession has never been more urgent.


This blog was produced by the tekMountain Team of Sean AhlumAmanda Sipes, and Zach Cioffi with lead writer Bill DiNome.


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