The transition from student to staff nurse is stressful, and almost one-third of new graduates leave their first job within a year-that's more than half of the total nurse turnover at some hospitals. To smooth the way for new nurses and improve retention, the Johns Hopkins Hospital in Baltimore developed the Social and Professional Reality Integration for Nurse Graduates (SPRING) program.

The SPRING program, a yearlong internship offered to new graduates with less than one year of experience, includes 10 educational sessions emphasizing social and clinical skills, mentoring, and individualized development plans. Researchers compared organizational commitment and intention to stay in a group of new RNs before and after they participated in the SPRING program, as well as turnover in SPRING participants versus that in new nurses in a nonparticipating department. When SPRING participants completed a survey about their attitudes at six months, they were less likely to consider leaving their job and had a greater sense of belonging than they had had at baseline. At 12 months, 89% of SPRING nurses were still in their jobs, compared to 80% of those from the nonparticipating department. Retention rates at 18 and 24 months were similar in the two groups, suggesting that retention might be further improved by extending the program for another year.

The SPRING curriculum's educational component covers technical skills, such as administering injections and pain management, and interpersonal skills, such as dealing with coworker conflict and being assertive. The seminars also allow new RNs to share their hopes and fears, as well as to discuss ways to balance home and career. A dedicated SPRING nurse educator who makes clinical rounds assesses how participants are progressing and intervenes early to head off any problems. Lead researcher Robin Newhouse says that new RNs consistently rate the nurse educator as "one of the most positive aspects of the program" because they appreciate having someone they can talk to "who is not directly in their chain of command."

"Programs that are tailored to socialize the new graduate into the organization can foster retention," Newhouse and colleagues conclude, improving patient outcomes and lowering the overall cost of health care.

Carol Potera