Factors Contributing to Turnover Among Critical Care Nurses During the Transition to Practice Period
Abstract
Background: New nurses are the major source of hiring for most hospitals. They fill vacancies left by seasoned nurses. As a result, an experience-complexity gap is created. The turnover of new graduate nurses is as high as 85% in the first two years of employment. Despite previous efforts to improve the transition to practice, turnover at the local level remain high.
Purpose/Specific Aims: The purpose of this study was to determine the most important factors contributing to turnover and the opportunities to mitigate or reduce turnover in the critical care setting.
The specific aims were to evaluate the perceptions of the new graduate nurse and experienced nurses related to the transition to practice period and to evaluate the perception of all nurses’ health of the work environment.
Methods: The AACN’s Healthy Work Environment Assessment Tool was distributed to all nurses permanently employed on four study units. The Casey Fink New Graduate Nurse Survey was distributed to all permanent nurses on the study units with less than one year of experience on the unit. The survey was in effect for three weeks during February 2022.
Results: New nurses felt the support of their preceptors and senior nurses in their new units. The HWEAT revealed areas of opportunity across all six standards, however, nurses with two to six years’ experience note appropriate staffing, true collaboration, and meaningful recognition as elements of the work environment most challenging. New nurses indicated dissatisfaction with staffing, length of orientation, and multiple preceptors.
Conclusion: This study has provided a more detailed understanding of the local practice setting related to the health of the work environment and the experiences of new nurses during their transition to practice. The findings from this study inform further Quality Improvement efforts at the local setting and the need for further research.
Notes
Presenter notes available in attached slide deck.
Additional reference list included in attached slide deck.
Selected References:
1. AACN Scope and Standards for Progressive and Critical Care Nursing Practice Cain C, Miller J, eds. Aliso Viejo, CA: American Association of Critical-Care Nurses. Crit Care Nurse (2019) 39 (4): 69. https://doi.org/10.4037/ccn2019865
13. Kramer M, Halfer D, Maguire P, Schmalenberg C. Impact of healthy work environments and multistage nurse residency programs on retention of newly licensed RNs. J Nurs Adm. 2012;42(3):148-159. doi:10.1097/NNA.0b013e31824808e3
15. Casey K, Fink R, Krugman M, Propst J. The graduate nurse experience. J Nurs Adm. 2004;34(6):303-311. doi:10.1097/00005110-200406000-00010
2. Poindexter D. Yes, America has a nursing shortage. (But it is not what you think.). October 2019.2019 https://www.advisory.com/daily-briefing/2019/09/27/nursing-shortage2 Accessed October 2019.
3. Ulrich B, Barden C, Cassidy L, Varn-Davis N. Critical Care Nurse Work Environments 2018: Findings and Implications. Crit Care Nurse. 2019;39(2):67-84. doi:10.4037/ccn2019605
23. Kester K, Pena H, Shuford C, et al. Implementing AACN's Healthy Work Environment Framework in an Intensive Care Unit. Am J Crit Care: An Official Publication, American Association of Critical-care Nurses. 2021 Nov;30(6):426-433. DOI: 10.4037/ajcc2021108. PMID: 34719717
Sigma Membership
Delta Epsilon
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Other
Keywords:
New Graduate Nurses, Clinical Competence, Personnel Turnover, Nursing Practice, Transitional Programs, Reality Shock, Work Environment, Experience-Complexity Gap, Transition to Practice, Healthy Work Environment
Recommended Citation
Gellner, Paula M., "Factors Contributing to Turnover Among Critical Care Nurses During the Transition to Practice Period" (2026). Creating Healthy Work Environments (CHWE). 134.
https://www.sigmarepository.org/chwe/2024/presentations_2024/134
Conference Name
Creating Healthy Work Environments
Conference Host
Sigma Theta Tau International
Conference Location
Washington, DC, USA
Conference Year
2024
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-03-05
Factors Contributing to Turnover Among Critical Care Nurses During the Transition to Practice Period
Washington, DC, USA
Background: New nurses are the major source of hiring for most hospitals. They fill vacancies left by seasoned nurses. As a result, an experience-complexity gap is created. The turnover of new graduate nurses is as high as 85% in the first two years of employment. Despite previous efforts to improve the transition to practice, turnover at the local level remain high.
Purpose/Specific Aims: The purpose of this study was to determine the most important factors contributing to turnover and the opportunities to mitigate or reduce turnover in the critical care setting.
The specific aims were to evaluate the perceptions of the new graduate nurse and experienced nurses related to the transition to practice period and to evaluate the perception of all nurses’ health of the work environment.
Methods: The AACN’s Healthy Work Environment Assessment Tool was distributed to all nurses permanently employed on four study units. The Casey Fink New Graduate Nurse Survey was distributed to all permanent nurses on the study units with less than one year of experience on the unit. The survey was in effect for three weeks during February 2022.
Results: New nurses felt the support of their preceptors and senior nurses in their new units. The HWEAT revealed areas of opportunity across all six standards, however, nurses with two to six years’ experience note appropriate staffing, true collaboration, and meaningful recognition as elements of the work environment most challenging. New nurses indicated dissatisfaction with staffing, length of orientation, and multiple preceptors.
Conclusion: This study has provided a more detailed understanding of the local practice setting related to the health of the work environment and the experiences of new nurses during their transition to practice. The findings from this study inform further Quality Improvement efforts at the local setting and the need for further research.
Description
This study simultaneously compares the results of the Healthy Work Environment Assessment Tool and the Casey Fink Nurse Experience Survey to determine the perceptions of new graduates in their transition to practice.