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How a Good Night's Sleep Can Aid New Graduate Nurse Retention

 |  By  
   January 12, 2010

Most healthcare executives have heard the bad news about new graduate nurse retention. Around 60% of new grads leave their first job within the first year. An alarming proportion leave nursing altogether. Nurses leave their first job largely as a result of the incredibly hard transition from nursing school to being a real-life practicing nurse. The learning curve is tremendous and many new grads report being thrown in at the deep end with only a few weeks of orientation, with little support or advice about how to find their way.

Research shows that new nurses do better, become competent practitioners faster, and stay at their organizations longer when they have some form of nurse residency or support program to help them through that first year. Successful programs mix clinical education with mentoring, support, and advice. And it's the latter that is most important to new grads and helps them survive that first rough year.

One of the things that can make that first year so rough is adjusting to working nights, which is something tackled in the innovative new grad nurse retention program at Centra in Lynchburg, VA. The program has seen tremendous results: Before its implementation in 2007, turnover for new grads was 28.8%. After implementation in 2008, turnover dropped to 5.7%, and 2009 saw continued success with similar numbers.

New graduates flock to the night shift due to numerous openings and extra pay, and it's well documented how tough it is for workers in any profession to adjust to working nights. Research demonstrates that nurses are at risk of deficits in the amount of restorative sleep they enjoy. Lack of restorative sleep:

  • Affects mental and cognitive abilities
  • Results in physiological risks such as increased incidence of cardiovascular disease, hypertension, and decreased immune response
  • Produces a greater risk of medical errors for night shift nurses than day shift nurses

Nurse Retention Coordinator Cheryl Burnette started looking into these statistics when she talked with new graduates during the new nurse graduate program she instituted at Centra.

"Starting professional practice is challenging the first year," she says. "As I met with each new nurse in orientation, I could hear them worrying about how they would onboard to this type of shift."

Burnette says the concerns were not only among 20-something new nurses for whom this was perhaps their first real job. "A lot of new nurse grads are not in their 20s anymore; some are starting nursing as a second career." Burnette notes these nurses are juggling many different responsibilities, making restorative sleep even harder to obtain.

As Burnette listened to the new grads' fears, she realized this issue was an important part of the transition for new nurses, so she started offering strategies to help them sleep better. She also began measuring their perception of sleep and how it relates to performance. She soon realized there was an opportunity to make the program more structured and provide more benefits to nurses.

Burnette worked with new graduates and leadership to design a program, researching sleep literature—utilizing the National Sleep Foundation as her educational model—best practices, and even consulting the organization's sleep lab for ideas. The result was a formal class offered as part of the new nurse graduate program.

Burnette delivers a PowerPoint presentation that explains why sleep is important and the effect it has if nurses do not receive sufficient restorative sleep. Each new grad receives a sleep kit that contains ear plugs (which block out up to 31 decibels) and an eye mask, which nurses have reported have improved their sleep tremendously.

Burnette ensures her program helps new grads and tracks the results over time by having new grads take an online Pulse Check survey, which measures key areas of practice. This survey includes two metrics that examine the effect of night shift on nurses, asks about their perception of sleep and performance, and also tracks the data over time.

She is continuing to examine the effect of night shift on nurses, their perception of their sleep, and how it relates to performance. The ongoing data should be most revealing, but Burnette already has enough anecdotal data to demonstrate her course improves quality of life for her new nurse graduates.

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Rebecca Hendren is a senior managing editor at HCPro, Inc. in Danvers, MA. She edits and manages The Leaders' Lounge blog for nurse managers. Email her at

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