How to engage recent grads
Q I'm having difficulty with the number of new graduates and matching them with appropriate preceptors. What suggestions do you have for improving the level of engagement between both parties?
New graduates aren't well prepared for practice in uncertain and time-pressure situations. Clinical rotations in nursing school are focused on skill building and task completion, generally with an unrealistic patient assignment of one to three patients. In addition, the clinical instructor model shelters the student from the politics and complexities of the patient care unit; students are treated more like guests than members of the team. The precepted experience has been identified as valuable in clinical education, and a single preceptor during this experience is most desirable.1
In order to help new graduates better develop their abilities to deal with these strategic situations, the nurse leader can provide resources for the development of a new graduate residency program. These programs allow a structured transition from the academic environment to the real world and provide support, education, and continual mentoring. The feedback from the residents is that the program's structure, as well as the ongoing mentoring, provides as seamless a transition as possible. In addition, nurse residents report the development of critical thinking skills, strong relationships with medical staff who are involved in the residency program, and the ability to better rank the competing priorities inherent in our complex environment.
Although the residency program provides a strong framework for transitioning the new graduate to practice, there are other ways in which the nurse leader can introduce the complexities inherent in the practice environment, including formal team training programs, the development of a structured mentoring program and the use of progressive 90-day development plans, and engagement of the new graduate in the shared governance structure.
Formal team training programs, such as TeamSTEPPS, provide an interdisciplinary approach to improving teamwork and communication in complex, high-risk environments.
Another strategy to lighten the burden for preceptors is a structured mentoring program. These programs fill the gap that typically exists from the end of the new graduate orientation period to the end of the first year of practice. Our program provides a mentor, different from the preceptor, from the end of orientation through the end of the first year of clinical practice. The mentor has a handoff session with the new graduate and the preceptor, and then the pair uses the progressive 90-day development plan for continued growth and development.
The progressive 90-day development plan is a formal, ongoing document that captures the learning needs of the new graduate, strategies to address the identified needs, and progress toward the established goals. The plan is reviewed every month and then updated at the 90-day mark. The review includes the unit manager, educator, and other appropriate members of the team, in addition to the mentor and new graduate. The effectiveness of a multitiered approach to staffing orientation and continual mentoring has been demonstrated.2
Finally, including the new graduate in the shared governance structure can add an additional level of relationship building, as well as a better understanding of the organizational complexities outside of the time-pressured clinical environment. It seems counterintuitive to include a new graduate in a clinical practice council, for example; however, in my experience, this provides a set of "new eyes" on existing problems and gives new graduates a unique view of the processes necessary for driving clinical change.
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