Abstract
This issue of the Journal of the American Psychiatric Nurses Association welcomes the new president of the American Psychiatric Nurses Association, Sattaria Dilks. While we wrote our editorial and column independently, readers should note that our messages have similar themes around supporting those who choose to be psychiatric nurses.
I recently began providing supervision to a psychiatric nurse residency program in a federally qualified health center. The program is aimed at providing structured experiences focusing on lifespan populations within the clinical setting. The first year is considered full-time employment with salary and exposure to several clinical departments along with frequent didactic training and supervision. In the second year of the residency, the nurse is assigned to a department or clinic as an employee with continued but less intense support. The model is fairly standard and has become a popular choice in the federally qualified health center systems and the Veteran’s Administration Hospitals. There are variations in length of time and program details but residencies are aimed at increasing the skill set, knowledge, and comfort of new graduates from both undergraduate and graduate nursing programs. The program I am involved with includes individuals with graduate nursing degrees in primary care and psychiatry.
When first meeting with the psychiatric nursing group, one participant shared a difficult experience from a non-psychiatric medical-surgical clinical setting in which there was limited professional and emotional support for a new graduate. The individual noted that the temptation was to completely leave nursing, in spite of years of training. Instead, the more positive reaction chosen by this nurse was to ascertain that psychiatry was a better choice and to focus on obtaining a graduate degree and then entering a nurse residency. Other participants in the group shared similar experiences in which the entrée into nursing was less than perfect. They spoke of their insecurity, lack of knowledge and confidence in their skills, and a lack of support in work settings.
While difficult to hear, this was not surprising. Retention issues and decreased satisfaction of new nurse graduates are related to stress in the work environment, the increasing acuity of patients, and a lack of experience and confidence in the ability to apply critical thinking to practice (Lin, Viscardi, & McHugh, 2014). The challenges encountered by all new nursing graduates is detailed in the literature (Van Camp & Chappy, 2017). In the Institute of Medicine report, The Future of Nursing, the entry period into practice for new nurses was identified as a problem for long-term retention of nurses (Institute of Medicine, 2011). Recommended initiatives to ameliorate this issue included implementation of nurse residency programs (NRPs). Since then numerous programs have developed across the country.
The cost of nursing staff turnover is staggering. The national turnover rate for RNs is 17.2% across all levels of experience in hospitals (NSI Solutions, Inc., 2019). The behavior health specialty had a turnover rate in 2018 of 23.1% across all ages of nurses (NSI Solutions, Inc., 2019). Behavior health is also predicted to see a large increase in nurse retirement worsening this rate (NSI Solutions, Inc., 2019). Based on the data from NSI Solutions, Inc. (2019), 22.9% of all new RNs left their employment within a year. The cost of leaving a hospital-based nursing position runs about $52,000 per year, per nurse, per institution. The average hospital cost of losing new graduates from employment is estimated to be $4.4 to $6.9 million each year (NSI Solutions, Inc., 2019). Nurse practitioners in hospital settings had a lower turnover rate of 11.3% in 2018 (NSI Solutions, Inc., 2019). With the increase in retiring nurses and the anticipated shortage of nurses at the registered nurse and advanced practice levels, these statistics are predicted to worsen. Why do so many nurses leave their jobs? Is there any action that administrators can take to combat this? What is our individual responsibility to support our nursing peers, especially those who are new graduates?
Nurse residency programs, similar to the one I work with, are one way to combat the retention issues in hospital and community settings. Asber (2019) found in an integrative review that the rate of retention after 1 year as a nurse was higher than the national average when that nurse was associated with a nurse residency program. Other NRP program influences on improved retention rates included length of program, organizational commitment to the process, and the nurses’ professional satisfaction with the program (Asber, 2019).
Van Patten and Bartone (2019) found that nurse residency programs were essential in transitioning the new graduate into the work setting. Their research also showed the importance of preceptors, mentors, and debriefing during the early experiences in the clinical setting (Van Patten & Bartone, 2019). These supportive elements are considered essential to success of the residency program. While residency programs are responsible for formally operationalizing these roles in the program, there is also a vital role for all of you reading this editorial. Whether or not involved in a formal nurse residency program, there is orientation and mentoring into the psychiatric nursing role that shapes and colors a new nurse’s perception of the work and the specialty. Your effort with this may help a new nurse avoid leaving psychiatric nursing.
Pelletier, Vincent, Woods, Odell, and Stichler (2019) noted that 26% of the psychiatric nurses participating in NRPs progressed into leadership positions, an unexpected benefit of the program. Obviously, experienced nurses have a responsibility to support and encourage new graduates of both undergraduate and graduate psychiatric nursing programs, but this is not an easy task given workloads, staffing pressures, and the ongoing risk of burnout. It involves patience with a new graduate’s lack of experience or knowledge, a willingness to mentor and support that individual, and a commitment to furthering the careers of the people who will eventually make up the psychiatric mental health nursing workforce. We all have a responsibility to support new graduates in our daily work within psychiatry. The future of psychiatric nursing does indeed rest with the new graduates joining us in the endeavor of improving mental health.