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New Graduate Nurses, New Graduate Nurse Transition JNPD Journal for Nurses in Professional Development & Volume 31, Number 3, 128Y137 & Copyright B 2015 Wolters Kluwer Health, Inc. All rights reserved. New Graduate Nurses, New 2.0 ANCC Contact Graduate Nurse Transition Programs, Hours and Clinical Leadership Skill A Systematic Review Kathy B. Chappell, PhD, RN ƒ Kathy C. Richards, PhD, RN, FAAN leadership skill has been associated with improved patient This systematic review evaluated the relationship between outcomes (Aiken, Cimiotti, Sloane, Smith, & Neff, 2011; new graduate nurses and clinical leadership skill, and Kutney-Lee, Lake, & Aiken, 2009). In a study conducted by between new graduate nurse transition programs and clinical the Nursing Executive Center of the Advisory Board Com- leadership skill. New graduate nurse transition programs pany, nursing leaders expressed little satisfaction with new have been cited as one strategy to improve clinical leadership graduate nurses’ clinical leadership skill (Berkow, Virkstis, skill, but to our knowledge, no one has synthesized the Stewart, & Conway, 2008). evidence on new graduate nurse transition programs and New graduate nurse transition programs (NGNTPs) have clinical leadership skill. Results of this review showed that been proposed to facilitate transition of new graduate nurses new graduate nurse transition programs that were at least into practice and develop clinical leadership skill (Institute of 24 weeks in length had a positive impact on clinical leadership Medicine, 2011). Research suggests NGNTPs vary significantly skill. New graduate nurse transition programs using the in quality and length (Baxter, 2010; Kowalski & Cross, 2010). University HealthSystem Consortium/American Association New graduate nurse transition programs may be limited to of Colleges of Nursing Nurse Residency curriculum had brief hospital orientations followed by short clinical orien- the greatest impact, followed by curriculum developed by the tations, or new graduate nurse transition programs may be Versant New Graduate RN Residency, an important finding robust with supplemental experiences that take place over for nursing professional development specialists. 6 months or more months. Because organizations use the terms ‘‘residency program’’ and ‘‘orientation’’ to reflect BACKGROUND transition programs that vary significantly in scope, this sys- New graduate nurses are expected to rapidly develop clini- tematic review included search terms to reflect both, and cal leadership skill to provide safe, high-quality patient care. characteristics of the programs were used for comparison Clinical leadership skill is defined as ‘‘staff nurse behaviours purposes. that provide direction and support to clients and the health The Institute of Medicine recommends 1-year new grad- care team in the delivery of patient care’’ with five defining uate nurse transition programs (Institute of Medicine, characteristics: clinical expertise, effective communication, 2011). A robust new graduate nurse transition program re- collaboration, coordination, and interpersonal understand- quires significant fiscal investment. For nursing leaders to ing (Patrick, Laschinger, Wong, & Finegan, 2011). Clinical commit resources, there must be a positive impact on new graduate nurses’ clinical practice. The purpose of this study was to conduct a systematic review to evaluate the rela- Kathy B. Chappell, PhD, RN, is Vice President, Accreditation Program and Institute for Credentialing Research; and Director, American Nurses tionship between (a) new graduate nurses and clinical lead- Credentialing Center, Silver Spring, Maryland. ership skill and (b) new graduate nurse transition programs Kathy C. Richards, PhD, RN, FAAN, is University Professor for Doctoral and clinical leadership skill. Programs and Research Development, School of Nursing, College of Health and Human Services, George Mason University, Fairfax, Virginia. Dr. Chappell received grants from George Mason University and the METHODS Association for Nursing Professional Development. Dr. Richards has A systematic review was conducted following the Preferred received support from the National Institutes of Health. Reporting Items for Systematic Reviews and Meta-analysis The authors have disclosed that they have no significant relationship with, or guidelines (see Figure 1; Moher, Liberati, Tetzlaff, & Altman, financial interest in, any commercial companies pertaining to this article. 2009). Electronic databases (CINAHL, MEDLINE, and ADDRESS FOR CORRESPONDENCE: Kathy B. Chappell, PhD, RN, American Nurses Credentialing Center, 8515 Georgia Avenue, Suite Cochrane Library) were searched from January 2000 to January 400, Silver Spring, MD 20910 (e<mail: [email protected]). 2013 to identify studies evaluating the relationship between DOI: 10.1097/NND.0000000000000159 new graduate nurses and clinical leadership skill, and between 128 www.jnpdonline.com May/June 2015 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. sults from baccalaureate nurses (two); associate degree and baccalaureate nurses (six); diploma and baccalaureate nurses (two); and associate, diploma, baccalaureate, master’s, and ‘‘other’’ prepared nurses (one; see Table 1). Study Designs and Characteristics of NGNTPs Fifteen studies were based in the United States, one in Scotland, and one in New Zealand. Study designs were re- peated measures with and without a comparison group, pre/ posttest with and without a comparison group, case study, or classified as program evaluation (see Table 2). Two studies evaluated academic preparation. Only six studies used a com- parison group, and the most common comparison group was new graduate nurses completing orientation prior to imple- mentation of an NGNTP. No studies using a randomized controlled trial or comparative effectiveness design were iden- tified. Eight studies were published between 2000 and 2008, and nine were published between 2009 and 2012, indicat- ing an increased interest in this topic. Curriculum for NGNTPs was developed by the University HealthSystem Consortium/American Association of Colleges of Nursing (UHC/AACN) Nurse Residency Program (three), FIGURE 1 Systematic review process to evaluate the relationship between an academic practice partnership (three), the Versant New (a) new graduate nurses and clinical leadership skill and (b) new graduate Graduate RN Residency (two), or the organization running nurse transition programs and clinical leadership skill. the NGNTP (eight). Most NGNTPs were 1 year in length (13), and three NGNTPs averaged 22Y24 weeks in length (see NGNTPs and clinical leadership skill. Search terms included Table 2). ‘‘new nurse,’’ ‘‘new graduate,’’ ‘‘new graduate nurse,’’ ‘‘resi- dency,’’ ‘‘internship,’’ ‘‘orientation,’’ ‘‘transition,’’ and ‘‘lead- ership.’’ Additional limitations included English language, Clinical Leadership Skill Measurement Clinical leadership skill was most often measured through research studies, and published in peer-reviewed journals. self-report; however, three studies also reported new grad- Ninety-three articles were identified. Three additional arti- uate nurses’ peer and supervisor evaluations. Instruments cles were identified through bibliography review. Nineteen used to measure clinical leadership skill included researcher- duplicate articles were eliminated. Upon review of abstracts, developed tools, the CaseyYFink Graduate Nurse Experience 28 articles did not pertain to the topic and were excluded. Survey (CaseyYFink), the Essentials of Magnetism Scale, the Forty-six full text articles were assessed for eligibility, and Gerber Control Over Nursing Practice Scale (Control Over 29 articles were excluded. Studies were excluded if they did Nursing Practice), the HalferYGraf Job/Work Environment not evaluate the relationship between new graduate nurses Nursing Satisfaction Survey (HalferYGraf), the Leader Em- and clinical leadership skill, or between NGNTPs and clin- powerment Behaviours Scale, the McCloskeyYMueller Satis- ical leadership skill. A total of 17 articles were retained. One faction Scale (McCloskeyYMueller), the Nurses’ Self-Concept study evaluated the relationship between new graduate Questionnaire, the Schutzenhofer Professional Nursing Au- nurses and clinical leadership skill in the absence of any tonomy Scale (Schutzenhofer), and the Schwirian Six-D intervention, and 16 studies evaluated the relationship be- Scale (Schwirian; see Table 3). Instruments measured clin- tween NGNTPs and clinical leadership skill. A synthesis of ical leadership skill directly or clinical leadership skill as a the 17 studies meeting inclusion criteria is presented below. domain of an instrument, or items in the instrument mea- sured clinical leadership skill as defined by Patrick et al. RESULTS (2011). Demographics The total number of new graduate nurses participating in Study Results the inclusion studies was over 4,000 (range, 5Y1,100+). Findings were analyzed based on two outcomes: new grad- New graduate nurses were predominantly female and uate nurses and clinical leadership skill independent of younger than 35 years. Educational preparation was not an interventional program, and NGNTPs and clinical lead- reported in six studies. The remaining studies included re- ership skill). Journal for Nurses in Professional Development www.jnpdonline.com 129 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. TABLE 1 Participant Demographics Reference Sample size Degree types Age of participants Gender of participants Bartlett
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