(Introduction)

Stress and burnout are common themes in the nursing profession. New graduate nurses can experience a difficult time transitioning from their schooling to the demands of a job in acute care. The nursing profession can be demanding and new nurses can often feel unequipped to manage all the required responsibilities and feel supported at work. Job satisfaction is important to ensure sustainability and there are also harmful impacts on patient care when nurses experience burnout or feel overwhelmed. Literature has shown that there are high turnover rates for new graduate nurses, linking this to stress and inadequate support in place. There is a great need to identify what will help nurses feel supported at their jobs and how to promote effective and sustainable working environments. This paper will aim to review the literature on this topic and address if establishing stress reduction programs and implementing supports has an impact on job satisfaction and retention amongst new graduate nurses. The research question that this paper aims to answer is: Are new graduate nurses in acute care settings (P) who have access to employer run stress reduction programs (I) compared with those without it (C ) at lower risk of resigning (O) over a 1 year period (T)?

Literature review

Several research articles were examined throughout our investigation of this topic. All proved that stress is a significant problem among newly graduated nurses. One, in particular, was a cross-sectional comparative study that surveyed 113 nurses who had recently graduated and entered the workforce in Sweden; This study aimed to define the stress new graduate nurses deal with and see if there were any correlations in the workplace. The study identified moderately high stress levels in new graduate nurses and incidentally discovered that 43% of their study sample had already changed jobs at least once after graduation, despite having only been in the work force for an average of 9 months. Stress levels were found to be significantly higher in acute care settings such as nurses working in surgical units or inpatient hospital medical units, compared to out-patient, non-hospital workplaces. Expanding on the probability of new nurses to change jobs, another study looked at how work-related stress impacts new graduate nurses intention to quit. The researchers, based out of a Michigan University, explain the importance of this research as 10% of the nursing workforce is comprised of new graduate nurses therefore loss of these individuals has significant financial and patient care implications for hospitals. The study surveyed 153 nurses who had graducated in the past 3 years and found that 31% of nurses had intention to quit their current job with a negative correlation between the stress scores and length of time since graduation. This emphasizes the importance of focusing specifically on new graduate nurses to ensure they receive adequate support to stave off stress and burnout levels. An additional 2007 study performed by three California nurses found factors that helped decrease turnover rates in new graduate nurses. These factors include individual characteristics, such as seeking social support and engaging in healthy coping behaviors like positive reapprasial and planful problem solving. Other factors leading to lower turnover intention described were at an organizational level, such as preceptor support, orientation programs, an emphasis on teambuilding, and organizational commitment to nurse success and confidence building. It is clear that support is needed in institutions to help new nurses adjust to their new careers. Research out of southwest Florida asked new graduate nurses working in acute care settings open ended questions to gather qualitative data to help form strategies to improve retention including new curriculum and transition support. Multiple students described support from their immediate supervisors and coworkers as a driving motivating factor leading them to want to continue and improve; two specifically referenced having an individual they could go to as a mentor or someone to “take them under their wing”. To expand on this concept, we evaluated studies which looked at employer provided support programs and their impact on nurse stress levels. One 2016 study performed in Hong Kong focused on the appropriate psycho-social support during the first year for new nurses in a specific preceptorship program called ToUCH. This program was introduced for new nurses with data being collected from the cohort prior without the program, as well as the cohort after the rogram had been initiated for a year. An ANOVA was used to compare the results of three surveys regarding competency, stress level, and coping skills. Resignation rates where also compared after the first year of employment for both cohorts of nurses. Resignation decreased with program implementation 5:1 respectively with new nurse cohorts of 85 in 2013 and 101 in 2014. The researchers concluded, “This one-year ToUCH program can increase preceptees’ confidence in providing patient care, cope with stress more effectively as well as return quickly to state of mind after suffering stress”. A second, similar study looked ar nurse participation in an innovated mindfulness telehealth stress reducation program and their resulting changes in stress levels and burnout levels. They took baseline surveys and 8 week surveys and found a statistically significant improvement in general health, decreased stress level, and decreased work burnout; Results were maintained when researchers checked on the nurses 4 months after the fact. This is an example of a low cost and accessible option for hospitals to include as a resource for their new grad nurses. All of the research evaluated during this literature review described the high stress rates of new graduate nurses, the negative impact this has on patient care and hospital finances, and the usefullness of support programs to help new nurses transition to practice with less stress.