Best practices of formal new graduate transition programs: An integrative review

Abstract

Objectives: The aim was to identify the best practices of formal new graduate nurse transition programs. This information would be useful for organizations in their support and development of formal transition programs for newly hired nurses.

Design: An integrative review of the nursing research literature (2000-2018).

Data sources: The literature search included PubMed (MEDLINE), CINAHL (Cumulative Index to Nursing and Allied Health Literature), and EMBASE (Excerpt Medica dataBASE). Studies that dealt with programs geared towards pre-registration nursing students were removed. At least two researchers evaluated the literature to determine if the article met the inclusion and exclusion criteria. The final number of articles included in this review is 76.

Review methods: Cooper's (1989) five-stage approach to integrative review guided the process: problem formulation, data collection, evaluation of data points, data analysis and interpretation, presentation of results. This approach was supplemented by the PRISMA guidelines for reporting systematic searches.

Results: Selected studies (n=76) included a range of new graduate nurse program types. The literature was examined according to four major themes: education (pre-registration and practice), support/satisfaction, competency and critical thinking, and workplace environment. Common elements of programs were a specified resource person(s) for new graduates, mentorship, and peer support opportunities. Gaps were observed between pre-registration and new graduate nurse practice realities. A range of educational strategies were used but few were evaluated. Most programs staggered education over time but the limited evidence showed no difference in new graduate nurse transition or satisfaction. New graduate nurse support was an important emphasis of all programs with preceptors the most common form of support and with beginning evidence showing quality vs quantity in preceptor support. Strengthening the quality of preceptor support was evident across studies with the bundling of concurrent strategies found to be helpful. Competency and confidence were found to increase over time for new graduate nurses in transition programs. Workplace environments influenced new graduate nurse transition and organizational commitment.

Conclusions: The variable quality of evidence limits the conclusions that can be drawn. The strongest evidence consistently showed new graduate nurse programs enhanced critical thinking, competency and retention and there were advantages with use of bundled preceptor strategies to support new graduates.

Keywords: Clinical competence; Confidence; Education; New graduate; New graduate transition; New graduate transition program; Orientation; Precpetorship; Residency; Support; Workplace environment.