NUR 7120 Module 2 Human Resources Paper: Costing Nurse Turnover and Funding a New Graduate Transition Program Example

Six Departures, Four New Graduates: The Price of Losing Nurses in Their First Year

Student Name

M.S. in Nursing, Nursing Administration, Thomas Edison State University

NUR-7120: Nursing Administration: Resource Acquisition and Management

Mentor Name

Month Day, Year

Six Departures, Four New Graduates: The Price of Losing Nurses in Their First Year

The Problem

In the past 12 months, six registered nurses left our 42-nurse telemetry staff, a turnover rate of about 14 percent. Four of the six were new graduates who had been on the unit less than a year. Exit interviews described feeling overwhelmed, receiving little feedback after a six-week orientation and being given the heaviest assignments on nights. Each departure left gaps that were covered with overtime and agency nurses, contributing to the rate variance in our budget. The remaining staff carried heavier loads, and two experienced nurses said the constant turnover made them consider leaving too.

What Turnover Costs

Jones (2008) updated her earlier methodology for calculating the cost of registered nurse turnover, which counts both pre-hire costs, such as advertising, recruiting and interviewing, and post-hire costs, such as orientation, training, lost productivity while new nurses learn, temporary replacement and the vacancy itself. In 2007 dollars, she put the price of losing one registered nurse between about $82,000 and $88,000. Lost productivity and vacancy costs made up a large share, items that rarely appear in a unit budget as turnover costs.

How Turnover Is Measured

Kovner et al. (2014) found that published nurse turnover figures differ a great deal, in part because organizations define and calculate turnover differently, for example by counting or excluding transfers within the hospital, part-time staff or voluntary versus involuntary departures. Among the newly licensed nurses they followed nationally, 17.5 percent had left their first employer by the end of year one, and roughly a third had left by the end of year two. They urged leaders to define turnover consistently so that comparisons and trends are meaningful.

Measuring Ours

Following their advice, I defined our turnover as voluntary departures of registered nurses from the unit, including transfers to other units, divided by the average number of registered nurses employed during the year. By that definition our rate was 14 percent overall, but 4 of 9 new graduates hired in the previous two years were gone within twelve months, a first-year loss rate of 44 percent, more than double the national figure Kovner and colleagues reported.

Why Our New Graduates Left

Exit interviews and conversations with current new graduates pointed to the same moments. After six weeks of orientation, new nurses took full assignments, often on nights, with no one checking in. Several described their first rapid response as the point at which they decided to leave. Preceptors, for their part, said they were given new graduates while carrying full patient loads and had never been taught how to precept.

Preceptor Workload

Preceptors are the program's most important resource and its most easily exhausted one. The proposal reduces a preceptor's patient load by one during the first four weeks of orientation, limits each preceptor to one orientee a year and recognizes preceptors publicly at the end of each cohort.

Calculating the Cost

Applying Jones's method with our hospital's current figures, and adjusting her estimate for inflation, the cost per departure on our unit is roughly $95,000 when vacancy coverage with agency nurses is included. Six departures cost about $570,000 in a year; the four first-year departures alone cost about $380,000.

What Works for New Graduates

Rush et al. (2019) reviewed studies of formal transition programs for new graduate nurses. Programs associated with better retention, competence and confidence tended to share several features: a length of about a year rather than a few weeks, a structured curriculum that continues after orientation ends, preceptors who receive formal training and protected time, regular peer support sessions where new nurses can debrief and gradual increases in patient load and acuity. The authors noted that programs vary widely and that the strongest evidence supports structure and preceptor preparation rather than any single model.

The Proposal

I proposed a 12-month transition program for all new graduates hired to the unit. It extends orientation from six to twelve weeks with a consistent preceptor, followed by monthly two-hour seminars for the rest of the year on topics such as rhythm interpretation, prioritization and difficult conversations, along with a monthly peer support session facilitated by the unit educator. New graduates would not work nights alone or take the heaviest assignments in their first six months. Preceptors would complete an eight-hour preceptor workshop and receive a small hourly differential when precepting.

Program Cost and Return

The program costs about $68,000 a year for an expected cohort of five new graduates, mainly the extra six weeks of orientation, seminar time, preceptor training and differentials. If it reduces first-year departures from four to two, a modest goal given the national rate, it would save about $190,000, nearly three times its cost.

Building Support

The chief nursing officer supported a one-year pilot on our unit, with the hospital education department contributing seminar content. Experienced nurses were invited to apply as preceptors, and four volunteered.

Measuring Results

We will track first-year retention, overall unit turnover by our stated definition, new graduate confidence using a validated scale at three, six and twelve months and agency and overtime hours.

Limits

Jones's estimates are national averages from 2007, and local costs vary. Retention depends on factors beyond any program, including pay, scheduling and leadership. The unit and figures are invented.

Conclusion

Jones showed how much each nurse departure costs, Kovner and colleagues showed how often new nurses leave and why turnover must be defined consistently and Rush and colleagues identified the features of transition programs that help nurses stay. A 12-month residency with trained preceptors, protected assignments and peer support costs far less than the departures it is designed to prevent.

References

Jones, C. B. (2008). Revisiting nurse turnover costs: Adjusting for inflation. Journal of Nursing Administration, 38(1), 11-18. https://doi.org/10.1097/01.NNA.0000295636.03216.6f

Kovner, C. T., Brewer, C. S., Fatehi, F., & Jun, J. (2014). What does nurse turnover rate mean and what is the rate? Policy, Politics, & Nursing Practice, 15(3-4), 64-71. https://doi.org/10.1177/1527154414547953

Rush, K. L., Janke, R., Duchscher, J. E., Phillips, R., & Kaur, S. (2019). Best practices of formal new graduate transition programs: An integrative review. International Journal of Nursing Studies, 94, 139-158. https://doi.org/10.1016/j.ijnurstu.2019.02.010