New Nurse Paradox

The New Nurse Paradox

A juxtaposition where newly licensed nurses are expected to make complex care decisions that require critical thinking and clinicial decision making skills. However, these skills are developed over time, yet nurses are expected to execute them with nearly zero clinical experience.

What is the “New Nurse Paradox”?

The New Nurse Paradox is the situation where newly licensed nurses are expected to make complex care decisions right from the start. These decisions require critical thinking and advanced clinical decision-making skills—abilities that are typically honed over time through hands-on experience and feedback. The paradox? New nurses are expected to perform these intricate tasks with minimal clinical experience, creating a steep learning curve right at the beginning of their careers.

This intent of this gap identification is not to undermine or trivialize the vast amounts of influential and positive work that nursing educators in academia pour into their students - it’s meant to highlight the realistic gap that exists when a burgeoning nurse is no longer under the guide of a nursing instructor or preceptor. In many instances, they are thrust into independent practice far too soon, and mostly without the necessary practice support or educational resources.

How the New Nurse Paradox Impacts the Nursing and Healthcare Industry

Here are some startling facts about new nurses within their first year of practice:

  • First-Year Nurse Turnover Rate: Before the pandemic, nurse turnover had reached worrying levels. RN turnover stood at 18.7% nationally, with a third of hospitals reporting an RN vacancy rate over 10%. Notably, first-year nurse turnover continues to outpace all other tenure categories. RNs with less than one year of service make up as much as 83.3% of a hospital’s total turnover, and nurses leaving their organizations within the first year account for nearly a quarter of all RN separations nationally.

  • High Attrition in First Year: Up to 33% of new nurses decide to leave their first full-time nursing job before they have spent a year in the position, indicating a significant level of attrition among first-year nurses​​.

  • Burnout Rates Among Younger Nurses: A 2020 survey revealed that nearly two-thirds of nurses (62%) experience burnout. This issue is especially prevalent among younger nurses, with 69% of nurses under 25 reporting burnout. Given that new nurses are typically younger, this statistic highlights the burnout risk they face in their initial years of practice​.

And what’s more concerning…

The annual cost of nursing turnover for nurses is $52,350 and will result in the average hospital losing between $5.9-10.2 MILLION dollars.

Impact to Patient Care and Nursing Education

These numbers are staggering, and greatly contribute to the construct that nursing burnout causes a detriment to the nursing profession, excessive costs to the healthcare industry (and taxpayers in safety net areas), and disrupt the lives of so many. Despite the statistics, there are other negative impacts due to the challenges of the New Nurse Paradox:

  • Patient Care - With hospital units being understaffed or the staff being poorly prepared (or in some cases, rushed into a level of independent practice where they are not capable), several negative consequences may arise. These include longer patient stays in the hospital, increased incidence of patient falls, medication errors, and lower patient satisfaction scores. Such outcomes indicate a direct correlation between the turnover rate among nurses and the quality of patient care​.

  • Nursing Education - One study highlighted the experiences of newly educated nurses working in internal medicine and surgical units. The study found that these nurses were surprised by the discrepancy between the ideals and the theoretical and practical knowledge gained during their nursing education, and the routine care tasks assigned in the hospital. This led to feelings of frustration, inadequacy, and unpreparedness, with holistic nursing not felt to be a priority within the unit. ​

What steps can we take to make meaningful change for the nursing profession when it comes to new nurses?

If you’re a Nurse Educator…

  • Implement Comprehensive Nurse Residency Programs: Developing nurse residency programs is essential. These programs have been shown to increase retention rates and improve job satisfaction, performance, and patient outcomes. Effective residency programs should include support from the entire nursing workforce, including nursing leadership, clinical nurse educators, and staff nurses. Hospital administration and human resources should also endorse the program​​.

  • Use Best Evidence to Build Programs: Nursing is based on evidence-based practice, and the creation of nurse residency programs should follow these guidelines. Researching other residency programs and organizational perspectives can shape decisions about which practices are most effective. Continuously examining reliable, measurable evidence allows for ongoing modification of the residency program components​​.

  • Stage-Based Development Support: New nurses develop confidence and skills in stages, not all at once. Programs should support nurses as they transition through different stages of development, achieved through educational sessions and regular check-ins with preceptors and clinical nurse educators​​.

  • Evaluate and Measure Outcomes: Evaluating the performance of graduate nurses and reviewing measurable outcomes such as changes in skills, confidence, or attitude towards work helps determine the program's success​​.

If you’re a New Nurse (or Graduate Nurse)…

  • Acknowledge Limits in Knowledge: Understanding that you won't know everything and recognizing your resources is crucial. Knowing who to consult in various situations is a vital skill in nursing​​.

  • Autonomy and Decision Making: Be prepared for a significant amount of autonomy and develop a personal style for tackling problems while adhering to necessary procedures and medication schedules​​.

  • Slow Down and Prioritize Self-Care: It's important to take time and slow down, especially in high-stress environments. Self-care, including healthy eating, ample sleep, and exercise, is essential for maintaining emotional and physical health in nursing​​.

  • Effective Communication and Organization: Learn to communicate effectively with patients and colleagues, and be organized in your approach to tasks. Listening to patients and understanding their needs is crucial​​​​.

  • Continuous Learning and Adaptation: Nursing is a field of continuous learning. Be open to learning from experiences, seniors, and doctors, and be prepared to adapt to new situations and challenges​​.

  • Professional Development: Invest in continuing education early in your career to develop expertise and excel in your chosen field of nursing​​.

While we know that we can’t solve all of the problems when it comes to the transition to practic, we can take steps to make small, incremental changes to both our mindset and how we approach alleviating the new nurse fallouts and bridging this gap. For more infomation, read my blog posts to learn how you can better your approach to new nurse practice.

  • American Nurses Association. (n.d.). Nurse burnout and how to prevent it. American Nurses Association. Retrieved from https://www.nursingworld.org/practice-policy/work-environment/health-safety/nurse-burnout-and-how-to-prevent-it/

    Becker's Hospital Review. (2023). The cost of nurse turnover in 24 numbers. Becker's Hospital Review. Retrieved from https://www.beckershospitalreview.com/workforce/the-cost-of-nurse-turnover-in-24-numbers-2023

    Biomedical Journal. (n.d.). Nursing turnover: Trend, causes. Biomedical Journal. Retrieved from https://biomedj.org/healthcare/nursing-turnover-trend-causes/

    Nurse.org. (n.d.). Tips for surviving your first year as a nurse. Nurse.org. Retrieved from https://nurse.org/articles/first-year-nursing-tips/

    University of Florida College of Nursing. (2023, June 6). UF nursing researchers explore tactics to combat first-year nurse burnout. University of Florida. Retrieved from https://nursing.ufl.edu/2023/06/06/uf-nursing-researchers-explore-tactics-to-combat-first-year-nurse-burnout/

    Wolters Kluwer. (n.d.). Nurse residency programs: Best practices for helping new nurses succeed. Wolters Kluwer. Retrieved from https://www.wolterskluwer.com/en/expert-insights/nurse-residency-programs-best-practices-for-helping-new-nurses-succeed