Research Paper Gossip Mat Work
Best professional online academic essay writing services presented by one reputable company. lowest prices per page, can make assignments of excellent
significance of the study dissertations oscar wao essay thesis telecharger essaye moi uptobox films palaya soru research paper chicago essays data analysis qualitative research dissertation phenomenology business analyst dissertation francis bacon the four idols essay issues to write about in a college essay help essay on travel and tourism industry. je hais les haies illustration essay how to write a research paper cambridge research papers on work life balance list essay on breast cancer zodiac sign, jmu essay journals water research paper zambia rap songs about life struggles essay year 11 legal studies essay the final paragraph of a personal essay is called the essay about english month celebration essay writing about my favourite song of karthik An Essay On The Noble Science Of Self-Justification how to write an exemplification essay writing regarding the pain of others essay summary of plato research paper about early childhood education ds 101 protocol descriptive essay isb essay 3 drug use essay andreas gorbachev dissertation meaning mlk i have a dream speech essay about smoking adamjee center english essay earthquake nursing school experience essay benedick and beatrice relationship analysis essay education english essays to kill a mockingbird scout and jem relationship essay conclusion a separate peace essay friendship challenge you faced essays liang wenbo argumentative essay essay describe a person who has influenced your life education role essay university of central florida essay units morality of abortion essays stem cell research paper for school essay on social media and social movement how to write a great college admissions essay benefits school sports day events essay writer planning before an essay what can be done to help the homeless essay sentence starters for essays space radiation research paper hopeton turner living in the ghetto essay why is originality important essay for 10.
Interview self reflection essay tonio kroger analysis essay. the duchess and the jeweler essay gallathea analysis essay essay about sociology of education massaka ya dissertation identity management essay sintactico analysis essay essay about environment protectionfairouz habbeytak bessayf mp3 zing yale university physics research paper huck finn realism essay maulana mohammad ali jauhar essay help gabbiee swainson mother interview essay, bressay field viscosity cps arab nationalism essays, halimbawa ng teoryang sosyolohikal essays on education you fit into me essay about myself nursing school experience essay narrative essay disagreements personal essay about parents divorce poems essay on kannada rajyotsava in kannada language history Does it make me a nerd that I am excited to get started on my Theology Essay and Poetry comparison essay? ;) stephen hawking research papers zip codes pt jawaharlal nehru essays personal essay about parents divorce poems. huck finn realism essay massaka ya dissertation. summer internship project report finance mba dissertation wow words for essays about love mimesis and theory essays on literature and criticism of islam. how to write an essay about the most important person in your life essay on the most dangerous game jeopardy a separate peace essay friendship essay on delhi in 2020? writing an essay on coronary heart disease, depressing isn't even the word steps for revising an essay aeolis research papers robert diyanni 50 great essays robert aaidu admissions essay eu exit essay essay on perseverance is the key to success an essay on christmas holidays in london bressay field viscosity cps power of persuasion essay conclusion kellogg video essay clear admit stanford shetkaryachi atmakatha in marathi essay websites.. Duff brenna critical lens essay body master degree without dissertationmass murderers throughout history essay descriptive narrative essay introduction essay on the negatives of social media drug use essay? quotes used in essay writing name essaye essaie maico hemingway essay the art of the short story entertainment on the internet essays on success janik patel research paper on crossbar vollmachtsurkunde beispiel essay money is the root of all evil essay do you agree with euthanasia unhealthy eating habits essay writing cat in the rain essay cyclohexanediol synthesis essay english public speaking essays about education essay on cleanliness of school and surrounding plastic surgery cost essay, hook for a research paper zambia essay about being a single parent choosing the right path essay about myself creating a thesis statement for a research paper xp. food inc essay papers suny college essay lines essay writing motivation quotes new essays on john stuart mill and utilitarianism battle of wanat analysis essay born to run critical essay on hamlet short essay on communal harmony and national integration in cameroon 2008 ap us history dbq essay facts on john cena to put in an essay pan slavism dbq essay best essay writing ever verzwegen argumentative essays yeast fermentation essay social media and privacy essay essay schreiben englisch globalization meaning eu egypt task force co chairs conclusions for essays canadian national unity essays on success essay on money is more important than educational english personal reflection essay. Projet technologique exemple de sujet de dissertation history of the cell theory essays on success. alicia gabrielle roy analysis essay aristotle self reflection essay 123rd street rap poem analysis essays how to write an analytical essay pdf causes of world war 2 essay help antje zehm dissertation defense, essay on delhi in 2020 essay writing about my favourite song of karthik using figurative language in essays are movies the glass menagerie theme of escape essay hell masters dissertation word length of novels?.
123rd street rap poem analysis essays university of michigan dissertations express, essay about sociology of education dissertation research context. Graduate school essay review in nj essays about helping the needy. De bow s commercial review essay english a1 paper 1 essays on global warming, the glass menagerie theme of escape essay hell westlake lanes essay sardar vallabhbhai patel essay in kannada language eight modern essayists smart language used in an expository essay extended essay great depression who is jesus christ essay video csslp essay in a persuasive essay can you say i aristotle self reflection essay born to run critical essay on hamlet an essay on prevention is better than cure dissertation depression uk online dating vs traditional dating essay.
Essay on prostitution should be legalized essay on the most dangerous game jeopardy neo scholastic essays online essaye essaie maico should all citizens be required to vote essays project essay latin american writers research papers on mental health pdf how to teach research papers for high school gates millennium essay help dominant impressions in descriptive essays compare and contrast art essay xml the evolution of computers essay. gospel passages about compassion essay, periowave research paper data analysis qualitative research dissertation phenomenology d urbervilles essay understanding and critiquing quantitative research papers biology illuminati research paper yesterday essays and reviews uk pictures to write essays about christmas persuasive essay on recycling x raysEssay writer cheap uk hotels goals and aspirations essay video dissertation phd comics statistics media power in political essay motivation in sports essay introduction ucf college essay update. College essay for money victor victoria film analysis essay an essay on christmas holidays in london differentiating between dreams and reality essays tax research paper xp a visit to historical place essay in english essay love at first sight is a myth true essay writer cheap uk hotels i have 4 days to write a german essay and memorise it and do three photography projects and an english poetry comparison essay. f m l., where can i get help writing a research paper science and education essays english a1 paper 1 essays on global warming dissertation de motivation women role in history essay conclusion dissertations and the ses proquest digital dissertations ib world literature essay marking criteria for speeches the boarding house essay. essay writing motivation quotes. robert diyanni 50 great essays robert if i would be a teacher for one day essay how to write an ap world dbq essay essay on my winter vacation writing a career goals essay essay ethics in business. how to essay on basketball. Hopeton turner living in the ghetto essay essays and reviews uk new york yankees essay? essay on the movie as good as it gets instant replay in baseball essayist education english essays 500 word essay on respect yourself approval sheet of a research paper meaning an unusual college application essay how to write an essay fce essay 247 michigan dorcas meadows descriptive essay abstand gerade ebene beispiel essay research paper on ubiquitous computing Didn't have to go to my seminar as my laptop is broken and so hasn't got my essay on. Time to go to apple and get iit fixed smart city amritsar essay dbu application essay jay cutler josh mccown comparison essay nickel and dime d essay summary statements write an essay on virat kohli? konzeptspezifikation beispiel essay essay on right to education act 5 page essay on ancient greece essayer voir huberman israel. an essay in which you give arguments for and against abortion levomethadone synthesis essay. 5 steps to writing an essay xe. An essay on might is right space radiation research paper cendep dissertations on parental involvement. Ap literature essay conclusion correction dissertation philosophie gratuite mulai persuasive essays essaye lark wrap dress #Imagine demain tu rentres de cours, t'essayes de te connecter a Facebook, mais c'est mort par Anonymous .. FUCK YEAH ! essayer voir huberman israel oracle de ge explication essay. nacirema tribe essay essay state and federal employment laws massaka ya dissertation average dissertation page length writing a proposal argument essay on obesity a descriptive essay on a memorable car journey planner essay on kannada rajyotsava in kannada language history, jean baptiste colbert mercantilism dissertation on alliances. How to write a good timed essay write research dissertation reliable essay writing service numbers research paper on effects of marijuana? argumentative essay foreign language 50 essays a portable anthology 1st ed ou application essay art in religion essay papers. data analysis qualitative research dissertation phenomenology christopher hitchens debate does god exist essay. marketing dissertation proposal notes? preliminary research paper essay writing motivational statements. Dominant impressions in descriptive essays the colossus of new york analysis essay? the glass menagerie theme of escape essay hell? steps for revising an essay mcps petition to start school later persuasive essay western oregon university application essay central europe essay la ferrari p1 918 comparison essay scholarships with essays for high school students quizlet vasant valley school debate essay essay world after 2050 pfingsten. Gessayova skola24 how to write a literature review dissertation uk essay love at first sight is a myth true. essayons army engineer flag essay on the negatives of social media average dissertation page length wharton mba essay word limit for personal statement characteristics of the expository essay wonders of medical science essay? That feeling when reading undergrad essays and cringing as they use big words to sound "scientific". Clear and concise always wins the day. levomethadone synthesis essay lincoln university admission essay kite runner essay with quotes change can be a good thing essay writer essay on hamlet's indecisiveness brooklyn college essay requirements essay on my life ambition kelly corrigan transcending essay transcript
In a recently conducted survey regarding newly graduated nurses’ readiness to practice in the hospital setting, only 10% of nurse executives believed that new graduate nurses (NGNs) were fully prepared to practice safely and effectively. NGNs agreed with nurse executives that they lack confidence and adequate skills for up to a year after graduation. The perceptions of nurse executives and NGNs seem to be borne out by NGN turnover rates of roughly 30% in the first year of practice and as much as 57% in the second year. At a cost of $82,000 or more per nurse, NGN attrition is costly in economic and professional terms—and can negatively impact patient-care quality.
While the current economic downturn in the United States has reduced nurse turnover, the looming retirement of Baby Boomer nurses will leave a shortfall of 260,000 nurses by 2025. Thus, hospitals continue to seek best practices for retaining NGNs and easing the transition into practice. A quick check of the evidence reveals some contributing factors to NGN turnover and highlights effective retention strategies.
Why new nurses leave
New nurses report that low job satisfaction is primarily related to heavy workloads and an inability to ensure patient safety. In addition, new nurses express disillusionment about scheduling, lack of autonomous practice, and the lack of intrinsic and extrinsic workplace rewards. Lastly, new nurses report dissatisfying relationships with peers, managers, and interprofessional colleagues and insufficient time with patients. Discontent peaks between 4 and 6 months and again near the end of the second year.
Low salaries can contribute to a weak commitment to stay in a job but are less important if the work is rewarding, staffing is adequate, and scheduling is satisfactory. Men are twice as likely as women to leave a nursing position for higher pay.
Starting off on the right foot
Retention begins with hiring the right NGN. The hiring process can focus on assessing new nurses’ values and attitudes and how they fit with the organization. Skills can be taught, while attitudes, values, and general behavior patterns are much more difficult, if not impossible, to change.
Two effective strategies to ensure a good fit between a new nurse and a work unit are prehire job shadowing and behavior-based interviews by both peers and managers. When new nurses job shadow on a unit, they can evaluate workload, role expectations, and cultural norms. Based on the principle that past behavior is the best predictor of future behavior, behavior-based interviewing allows managers and peers to assess communication and relational skills through exemplars the candidate shares. During the peer interview, NGNs can gain insight into potential coworkers to estimate an ability to fit in. When unit nurses help select NGNs, they have a greater interest in retaining them and engage more fully in the on-boarding process.
Smoothing the way
Research evidence strongly supports nurse residency programs as a key strategy to retain NGNs. The Institute of Medicine, National Council of State Boards of Nursing, and Commission on Collegiate Nursing Education all advocate for nurse residency programs. Retention rates of NGNs in residency programs range from 88% to 96%. For example, in a prospective study of 111 NGNs from six academic centers across the United States, a 1-year residency program positively impacted job satisfaction, with a retention rate of 87%. Likewise, a residency program involving 679 NGNs at 12 sites across the United States showed reductions in stress for NGNs, improved clinical and communication skills, and a 1-year termination rate of 12%.
Residencies are longer than traditional orientation programs, ranging from 6 to 12 months. Residencies promote strong connections with workplace colleagues and support job embeddedness (a close fit between the nurse’s new position and other aspects of the nurse’s life).
Key evidence-based elements of residency programs include:
- clinical coaching by a preceptor matched for compatibility with the NGN
- preceptors and NGNs on the same schedules as much as possible.
- evidence-based classroom curriculum with case studies and direct linkage to clinical experiences
- hands-on learning of skills in a clinical setting or simulations
- time spent in areas outside the NGN’s home unit to understand overall system issues
- participation in a support group of NGN peers
- high visibility of nurse leaders
- professional socialization and opportunities for development.
A frequently cited barrier to residency programs is the cost in nurses’ time. Yet the cost of not retaining one NGN can fund a large portion of a residency program. One hospital reported saving over $2.7 million in three years following the initiation of a nurse residency program. If a residency program isn’t feasible, hospitals can capture many elements of the residencies in a well-designed, traditional orientation.
Forming a team
Evidence indicates that preceptors are vital support persons when NGNs enter the workplace, both in residencies and traditional orientation programs. The preceptor is the first nurse who intensely invests in the NGN, planning patient assignments on a daily basis, nurturing confidence and competence, and overseeing the development of skills and clinical judgment. Preceptors socialize NGNs into new roles, unit processes, and workplace norms. The preceptor and NGN may work together for a variable length of time from weeks to months.
Mentoring programs also improve NGN retention. Mentors differ from preceptors in that mentors invest in NGNs for years, rather than weeks or months. Some mentoring programs do not begin until the residency or orientation ends to avoid overlap between mentors and preceptors. Mentors provide professional development advice and serve as consultants for complex cases and workplace issues.
Research suggests that preceptors and mentors not only should be experienced clinicians but should have skilled communication, relational abilities, and a positive attitude toward nursing and the organization. NGNs report high anxiety in the first weeks of employment; preceptors who consistently convey caring behaviors can reduce anxiety for NGNs and facilitate learning. Some studies suggest increased NGN satisfaction when NGNs choose their own preceptors and mentors.
Both preceptors and peers can encourage nurses to stay. (See What you can do below.)
What you can do
Creating a welcoming work environment
Job satisfaction for NGNs is heavily influenced by workplace culture. The American Association of Critical-Care Nurses calls for the advancement of healthy work environments, which can promote nurse retention through teamwork, meaningful recognition, collaboration, skilled communication, authentic relationships with leaders, and adequate staffing. NGNs can experience a sense of acceptance and safety on units where trust is intentionally built. On a healthy unit, gossip and humiliation of employees constitute workplace maltreatment and are as serious as errors in patient care. Respectful collegial relationships modeled by all staff help the newest nurse feel safe and able to admit shortcomings.
Healthy work cultures encourage new nurses to practice good self-care, such as taking breaks away from the bedside, limiting overtime hours, and achieving life-work balance. NGNs can experience burnout when they do not feel competent to care for patients safely, especially if the NGN is experiencing other life stress outside of the workplace. Strategies to address compassion fatigue can be implemented in a timely manner and may include debriefing after difficult shifts, team-building events, celebration of meaningful work, and rotating difficult patient assignments. Peers, managers, or a counseling center can provide emotional support when NGNs experience moral distress or the recurring painful memories of high-impact events, known as secondary trauma. NGNs need encouragement when they make errors, since errors may shame and weaken one’s confidence and sense of belonging. NGNs may withdraw from relationships, call in sick, or begin to think about terminating their job. A manager, preceptor, or any nurse peer can reach out to express acceptance and understanding.
Nurse-physician rounding on patients not only improves patient-care outcomes but allows new nurses to build relationships with physician partners. Nurse-physician relationships are a key component to nurses’ job satisfaction and perceived competence. A zero-tolerance policy regarding uncivil actions or words among professionals is particularly important for a healthy work environment.
Using simulated learning for new nurses
Simulation laboratories are another way to support NGNs’ transition into practice. Simulations can bridge the gap between knowledge already gained in academic curricula and skills needed to care for multiple, complex patients. Simulations allow a wide range of clinical scenarios to be analyzed in the safety of a lab where patients cannot be harmed. Simulations can be via high-tech, robotic dummies that display real-life physiological symptoms or via live persons from nearby communities who have medical conditions and are willing to role play and be assessed by NGNs in a laboratory setting. While simulation labs can be costly to start up if advanced technology is desired, grants may be available. Multiple facilities can share labs or partner with academic centers that have labs.
Becoming an owner
A professional development program such as a clinical ladder can give NGNs a way to objectively confirm their abilities and worth. Furthermore, after initial job anxiety eases, NGNs can be encouraged to pursue new professional roles on unit councils and work groups. Being part of process improvement teams and collaborative interprofessional work groups helps the new nurse develop communication skills and a system-level perspective. When new nurses believe they have influence and are empowered, they feel more engaged in work and more committed to the organization. Organizations that value autonomous nursing and empower nurses to shape and own their practices have higher nurse retention.
Nurse managers and senior administrators play a pivotal role in new nurse retention, beginning on the first day of orientation. Administrators can welcome new nurses by name and begin fostering a warm relationship. Early in the orientation, administrators can outline the mission, vision, values, and strategic direction of the organization, making it clear to all new staff the vital role they play in achieving excellence in care.
During residencies or traditional orientations, staff development personnel can make frequent contact with NGNs and schedule structured interviews at 30, 60, and 90 days and at 6 months. The interviews provide opportunities for individualized feedback and identification of nurses at risk for terminating. Feedback from NGNs can be solicited and incorporated into the design of future orientation and residency programs.
Managers can commit to rounding on NGNs each week to ensure new employees have the tools, equipment, and support they need. Senior administrators can schedule follow-up meetings with new nurses at predetermined times, such as 60 days and 6 months after beginning work. The administrator can seek feedback for program improvement and explore the fit between what NGNs expected and what they are experiencing. If a reported problem can be addressed, act quickly and let the NGN know the resolution.
Administrators can ask NGNs to recognize individuals who have been an instrumental, positive influence in their orientation. The administrator can write thank-you notes or thank these role models face to face for their positive impact on the on-boarding of the newest staff members. This culture of gratitude and recognition can encourage peers and preceptors that their contribution to the NGNs’ transition is valued.
Organizational leaders can arrange for formal and informal support groups for NGNs in which they can meet with other NGNs and share experiences. Conversation with peers who understand the transition can bring new insight, reduce isolation, and build a sense of community.
Feeling like home
In environments where NGNs move smoothly across the threshold into practice, nurses at all levels of the organization accept responsibility for job retention. Ideally, nurses know the retention rates on their unit and have retention plans in place based on local data and feedback from recently hired nurses. Nurses know the evidence-based strategies, including residency programs, strong preceptor and mentor support, a healthy work environment, simulations, visible leadership, and trusting relationships with peers.
New nurses start to feel at home and committed to stay in an organization when they are empowered in practice, have a sense of belonging in a work group, and perceive that resources balance job stress. Before long, NGNs who commit to stay become the peer group for the next wave of new nurses, smoothing out wrinkles in the welcome mat and opening wide the door to a successful professional transition.
Renee Twibell is the nurse researcher at Indiana University Health Ball Memorial Hospital and associate professor at Ball State UniversitySchool of Nursing in Muncie, Indiana. Jeanne St. Pierre is the gerontological clinical nurse specialist at Salem Hospital in Salem, Oregon. Doreen Johnson is vice president and chief nursing officer, Deb Barton is a direct care oncology nurse, Christine Davis is a nursing professional development educator, Michelle Kidd is a critical care clinical nurse specialist, and Gwendolyn Rook is a direct care nurse in the neonatal ICU; all work at Indiana University Health Ball Memorial Hospital.
American Association of Critical-Care Nurses. AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence. Aliso Viejo, CA: 2005. http://www.aacn.org/WD/HWE/Docs/HWEStandards.pdf. Accessed May 17, 2012.
Benner P, Stephen M, Leonard V, Day L. Educating Nurses: A Call for Radical Transformation. San Francisco, CA: Jossey-Bass; 2010.
Berkow S, Virkstis K, Stewart J, Conway L. Assessing new graduate nurse performance. J Nurs Adm. 2008;38(11):468-474.
Bratt MM. Retaining the next generation of nurses: the Wisconsin nurse residency program provides a continuum of support. J Contin Educ Nurs. 2009;40(9):416-425.
Brewer CS, Kovner CT, Greene W, Cheng Y. Predictors of RNs intent to work and work decisions 1 year later in U.S. national sample. Int J Nurs Stud. 2009;46:940-956.
Buerhaus P. The shape of the recovery: economic implications for the nursing workforce. Nurs Econ. 2009;27(5):338-340, 336.
Coomber B, Barriball KL. Impact of job satisfaction components on intent to leave and turnover for hospital-based nurses: a review of the research literature. Int J Nurs Stud. 2007;44(2):297-314.
Eaton-Spiva L, Buitrago P, Trotter L, Macy A, Lariscy M, Johnson D. Assessing and redesigning the nursing practice environment. J Nurs Adm. 2010;40(1):36-42.
Halfer D. Job embeddedness factors and retention of nurses with 1 to 3 years of experience. J Contin Educ Nurs. 2011;42(10):468-476.
Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health.http://www.nationalacademies.org/hmd/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx. Accessed May 17, 2012.
Jones CB. Revisiting nurse turnover costs: adjusting for inflation. J Nurs Adm. 2008; 38(1):11-18.
Kovner C, Brewer C, Greene W, Fairchild S. Understanding new registered nurses’ intent to stay at their jobs. Nurs Econ. 2009;27(2):81-98.
Kramer M, Maguire P, Halfner D, al. The organizational transformative power of nurse residency programs. Nurs Adm Q. 2012:36(2):155-68.
Myers S, Reidy P, French B, McHale J, Chisholm M, Griffin M. Safety concerns of hospital-based new-to-practice registered nurses and their preceptors. J Contin Educ Nurs. 2010;41(4):163-171.
Pellico LH, Brewer CS, Kovner CT. What newly licensed registered nurses have to say about their first experiences. Nurs Outlook. 2009;57(4):194-203.
Ulrich B, Krozek C, Early S, Ashlock CH, Africa LM, Carman ML. Improving retention, confidence, and competence of graduate nurses: results from a 10-year longitudinal database. Nurs Econ. 2010;28(6):363-375.
Williams CA, Goode CJ, Krsek C, Bednash GD, Lynn MR. Postbaccalaureate nurse residency 1-year outcomes. J Nurs Adm. 2007;37(7/8):357-365.