Meeting the Needs of the New Graduate Nurse: Self-Care Education

New grad training programs have been recognized over the years as a necessity to help new nurses transition successfully from the role of student to professional nurse. These new grad training programs provide a structured curriculum to acclimate nurses into the organization and the nursing profession. These programs provide a foundation for the nurses’ career. This foundation would be strengthened with the addition of self-care education.

In order to prepare new nurses to use advancing technologies, to provide safe care, and reduce employee turnover, structured new grad training programs were developed at number of ANCC Magnet designated and/or University-affiliated hospitals. In 2011, the National Council of State Boards of Nursing (Chicago, Illinois) conducted a multi-site study of nurses transitioning to practice at hospitals and the results supported the previous research and recommendations. Based on their study, they recommended that new graduate programs have the following essential components:

9-12 months in length
Trained preceptors
Institution based orientation
Opportunity for feedback and reflection
Institutional support
Safety and critical reasoning focus in the program
QSEN core competencies of patient-centered care, teamwork and communication, evidence-based practice, quality improvement, and informatics

What was not included in their recommendations, were core competencies in self-care strategies. These include prevention of burnout, compassion fatigue, or secondary trauma, all of which are experienced by nurses engaged in increasingly complex care. Self-care is an essential skill that new grads need and something that the large percentage of new grads, millennials, are looking for.

Who are Millennials?

There are a lot of articles that talk about who millennials are, and they are typically described as those born between 1980 and 2000. These nurses are on their way to becoming the largest generation in the nursing workforce. They are also usually described as tech savvy, highly educated, highly engaged employees who are well suited for the diverse, global world. Some other generalizations about millennials include a desire for flexibility and higher turnover rates. Millennials did not grow up with a belief in job security in the same way that previous generations did. Milennials are looking for a job that provides work-life balance, an emphasis on social relationships, and opportunities for growth that aren’t based on hierarchy. Obviously these are generalizations and individuals vary, but taking into account the characteristics of a large portion of a workforce are important to designing a training program.

Reality Shock

New graduates hired into hospital training programs, even when well structured, experience high levels of stress. In fact, the NCSBN study results showed that new grad participants had the highest reported stress during months 6-9 after starting as a new nurse. In a 2013 article by Elaine Riegel, RN, MSN, the period of transition new grads experience is “a time of stress, role adjustment, interpersonal conflict, and reality shock.” School programs haven’t prepared students for that intense period of adjustment and many new graduates did not anticipate the difficulties they would face.” New grads report feeling overwhelmed, anxious, and disillusioned when facing the reality versus expectations. In addition, new grads hired into high acuity or specialty areas need extensive emotional support.

Facing this reality shock and role transition is what contributes to the high stress that new grads report. However, these stressors are not over once they have successfully transitioned into the professional role. This is why incorporating self-care content into the new graduate program will allow new nurses to develop skills to sustain them throughout the entirety of their career. Nurses need essential training in preventing burnout and compassion fatigue, while practicing skills that maintain their compassion satisfaction. They don’t need self-care skills defined by commercial media who focus on facials and massages (although who doesn’t love a facial), but with evidence-based education that looks at self-care through the mental, emotional, spiritual, and physical domains. This education is essential for creating a work-life balance that milennials desire while managing the unique stressors of the nursing profession.