New nurses are leaving the profession at an alarming rate, with nearly half exiting within three years. In this blog, we explore how structured transition-to-practice (TTP) programs can improve retention, reduce burnout and build a confident, competent nursing workforce.
How To: Build A Successful Transition To Practice Program To Empower Nurses
Roughly 18% of newly licensed registered nurses (RNs) in the U.S. quit the profession within the first year. More than 33% leave their job within two years, and 43% are out within three years of employment. Millennial nurses, who represent the largest generation in the nursing workforce, experience a high turnover rate and resignations due to their increased desire for work-life balance. As the Nurse Leader journal points out, 63% of nurses under the age of 35 report they intend to leave or are considering leaving their current position.
These numbers are troubling in a healthcare landscape already facing a nursing shortage. As noted in our blog, “Strategies for Retaining Top Nursing Talent,” a Health Affairs study found the RN supply dropped by over 100,000 from 2020 to 2021 – the largest drop observed over the past four decades.
Nursing shortages have a high impact on working environments, patient outcomes and the long-term health of nurses. They result in longer shifts and higher nurse-to-patient ratios, increasing stress, fatigue and the risk of injury to nurses.
In this blog, we’ll discuss the advantages structured transition-to-practice (TTP) programs offer healthcare providers, the components crucial to a successful TTP initiative and how leading health systems are putting them into action.
Breaking the Cycle: Addressing Nurse Turnover Through Transition-to-Practice Programs
What’s causing so many new RNs to abandon the profession they dedicated multiple years of their life to attain? According to the American Nurses Association (ANA), challenges for these newly-minted healthcare professionals include:
- Lack of confidence and competence to provide safe patient care?
- A shortage of experienced leadership
- High nurse-to-patient ratios
- A feeling of being undervalued in their workplace
- Inadequate work-life balance
- Changing shift schedules and department assignments
- Increased overtime
- Higher workloads
- Understaffed facilities
- Reduction in patient length of stay
It’s no surprise the transition to practice has been identified as a stressful and challenging time for new nurses as they try to adjust to caring for multiple patients with chronic and complex health conditions. Such a steep learning curve in a first-year nurse experience can be stressful for even the most prepared individuals.
The Impact of Transition-to-Practice Programs in Today's Nursing Landscape
Transition-to-practice (TTP) programs have become a critical tool for supporting newly-licensed nurses as they develop the clinical judgment necessary to provide safe and effective patient care.
A mixed-method study in the Journal of Clinical Nursing found a substantial increase in new graduate nurses’ competence from zero to three months and then again at 12 months. It also indicated a positive and supportive environment that prioritizes life/work balance and acclimation to the professional role was deemed essential by new graduate nurses to expand their competencies.
As the Accreditation Commission for Education in Nursing (ACEN) notes, current research suggests that successful transitions to practice result in improved patient safety and higher-quality nursing care. The agency points out a structured TTP program:
- Acts as a bridge between academia and clinical practice for licensed nurses
- Provides opportunities for new RNs to observe and engage in real-world clinical practice in a planned and supportive learning environment.
- Recognizes the need for structured support and formalized onboarding for nurse graduates
- Instructs new nurses on identifying their learning needs, utilizing effective communication, employing evidence-based nursing practices, adhering to employer policies and procedures and managing time.
Although the common language for supporting the newly licensed nurse is Transition to Practice or Nurse Residency programs, emerging fellowship programs provide a similar structure and support for nurses who are changing roles or practice settings.
The cost savings from such programs also verify their efficacy. A multisite study on the return on investment (ROI) achieved when using a structured TTP program (compared to a limited program) found savings of $1,458 per NGRN once programs are implemented and in place.
Building a Strong Base: Key Components of a Successful Transition to Practice Program
Some TTP programs utilize outdated and non-engaging content, while others often lack a competency-based focus and aren’t designed to accurately track and measure learner progression. They provide broad, generic instruction — with little or no preceptor training and support — instead of promoting targeted, competency-based learning that can be instantly put into practice from day one.
We cannot expect to continue the same approaches and obtain a different result. Directors of TTP programs must engage in Continuous Quality Improvement, adapting to the current issues and trends in healthcare. This includes generational differences and how we conceptualize competency.
Today’s TTP programs should adopt a competency-based approach to decrease the divide between academia and clinical practice. They should center on knowledge, skills and attitudes that align closely with clinical practice realities and include tailored content and delivery methods suited to the specific needs of the populations they serve.
Some of the most important components of competency-based TTP programs consist of:
- Hybrid learning models
- Apprenticeship-style training & competency-based curriculum
- Preceptor training/support
- Data tracking and outcome measurement
- Individualized Learning Plans (ILPs)
- Scalable technology infrastructure
- Evidence-based learning models
Without these elements, such programs are rarely impactful, nor are they engaging, which presents a big problem for new nurses. A survey of pre-licensure nursing students found low self-perceived preparedness hinders self-confidence, quality of work, patient safety and outcomes, job satisfaction and overall competence.
Building Confidence: The Impact of Strong Preceptor Support on New Nurses
As the American Association of Critical-Care Nurses (AACN) describes, preceptors guide the next generation of nurses by providing practical experience and facilitating learning experiences. Research examining the effect of nurse preceptorship programs reveals a 94% retention rate at 18 months and up to 83% at three years.
As the American Association of Critical Care Nurses (AACN) explains, the four primary roles in successful preceptor relationships are role model (influencer), socializer, coach (educator) and protector. For TTP programs to succeed, though, comprehensive preceptor training is crucial.
Take our National Nurse Preceptor Program for Newly-Licensed Registered Nurses, for example. This program integrates best practices of teaching and learning to deliver a robust professional development program for the preceptor to meet the organizational and individual needs for transitioning nurses into the role and setting.
A successful preceptor program should also focus on several key areas to ensure preceptors can provide a safe learning environment, evidence-based teaching and effective feedback and evaluation. In addition to precepting, clinical mentorship offers additional benefits by enhancing communication skills and amplifying self-confidence and job satisfaction. In a study of nurse mentees, almost 60% of the respondents shared that mentorship influenced their decision to remain in nursing. Structured mentorship programs have been shown to reduce turnover by 2% to 15%.
Preceptors proficient in nursing career development along with mentorship help new nurses:
- Visualize their long-term career goals
- Identify the necessary steps to achieve them
- Make informed decisions about their professional development
In a similar study, approximately 85% of Generation Y nursing students — a demographic born between 1981 and 1996 — stated having appropriate support for their career development is a top factor influencing their work field preferences.
Making Informed Decisions: Why Data and Insights Are Key to Successful TTP Programs
Without tracking specific data and measuring outcomes, it’s difficult to assess and continuously improve TTP programs. Traditional transition to practice models leave health systems without clear data on the skill development and readiness of new nurses.
Successful TTP programs utilize evidence-based, data-driven training strategies to improve system-wide efficiencies while addressing critical challenges in healthcare staffing. They take advantage of measurable data to assess nurse competency, track skill development and identify areas for improvement. By incorporating data-driven tools into nurse training programs that include high-fidelity simulation, health systems are able to:
- Calculate training ROI: Leaders can measure training ROI and track learner engagement and retention rates, ensuring training aligns with organizational goals.
- Identify early dropout risks: Proactive intervention strategies can be implemented to support nurses who need additional training, reducing burnout and turnover.
- Strengthen healthcare workforce retention and reduce costs: Programs that integrate competency validation have demonstrated significant workforce benefits, leading to improved nurse retention and measurable cost savings.
- Measure nurse competencies: Valid assessment of the newly licensed nurses' safe practice and early identification of behaviors that may undermine a culture of safety.
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Real-World Success: How Leading Health Systems Are Transforming Nurse Transition
At OpusVi, we’ve developed scalable TTP initiatives that adapt to diverse operational needs and resource levels. These programs have delivered measurable improvements in nurse confidence, competency and retention for partners like CommonSpirit Health and the Arizona Hospital and Healthcare Association (AzHHA).
Case Study #1: CommonSpirit Health
As the second-largest nonprofit healthcare system in the United States, CommonSpirit Health boasts more than 2,200 care sites in 24 states coast to coast. These care sites are served by over 35,000 providers and 45,000 nurses.
OpusVi partnered with this expansive health system to create a streamlined and scalable TTP solution encompassing Nurse Residency, Preceptor and Mentor Training across 67 facilities. Designed to support the nursing workforce within their organization system-wide, improve employee well-being and combat the rising burnout seen across the healthcare industry, the initiative has achieved a 92% aggregate new nurse retention rate and more than $16.3M in cost savings. OpusVi plans to further expand this successful model over the next five years by developing training programs for additional specialty areas.
Case Study #2: Arizona Hospital and Healthcare Association (AzHHA)
Representing a diverse range of hospitals and healthcare organizations across Arizona, the mission of the Arizona Hospital and Healthcare Association is to build better healthcare and health for Arizonans. Through the 12-month TTP program, OpusVi established with AZHHA for new graduate RNs, the association provides evidence-based professional development, more rapidly accelerates the novice nurse to a competent nurse, decreases turnover and increases retention.
The program enabled AZHHA to implement a hybrid learning model and preceptor training, leading to an astonishing 81% new nurse retention rate across 22 facilities — supporting 139 new nurses and training 153 preceptors.
It has also yielded exceptional outcomes across multiple programs, showcasing the potential for a statewide model for nursing transition to practice.
Unleashing Potential: Why TTP Programs Are More Important Than Ever
The powerful impact of TTP programs for new nurses is evident. They produce great educational interventions to mitigate the effects of the nationwide nursing shortage and develop competent and confident new nurses. This is why they’re a central component of so many nurse retention strategies.
Structured TTP programs benefit not only new nurses but also current staff and the organization and build trust in the quality of care. Along with nursing orientation programs, clinical training for new nurses enables these professionals to apply theoretical knowledge to real-world patient care, which ultimately leads to improved patient outcomes and enhanced career satisfaction.
Are you ready to elevate and empower your nursing workforce by equipping them with a best-in-class TTP program proven to increase retention rates and achieve cost savings? Download our whitepaper now to learn how TTP programs can revolutionize your health system and provide the framework for success every new nurse deserves!
