New graduate nurse retention is gaining more attention as literature reveals the adverse affects of new nurse attrition to the economics and quality of care that health care systems can provide. Factors such as orientation, mentoring, and positive role
socialization influence the intent of a new graduate’s decision to leave their job or
profession. This study is a partial replication and extension of the Newhouse et al. (2007) study. The purpose of this study is to examine whether an internship program improves new nurse graduate retention, sense of belonging, organizational commitment, and anticipated turnover. This chapter includes information about the population, sample, procedure, methodology, design and data analysis in this study.
Research Questions
The following questions guided this study:
1. Is there a difference in organizational commitment, sense of belonging, and anticipated turnover for new nurse graduates who completed the internship program in comparison with graduates who did not complete the program?
2. Is there a difference in retention rates of new nurses who do complete an internship program and new nurses who do not complete an internship program?
Population, Sample, and Setting
The target population for the study is new graduate nurses currently employed at one health care system in a Midwestern state. This organization includes five hospitals that hire approximately 100 new graduates each year. The anticipated sample will consist of 80 new nurse graduates who complete an internship program and a comparison group of 80 new graduates who will not participate in an internship program. The exact sample size required for statistical rigor will be determined by power analysis. Participation in the study will be voluntary. Criteria for inclusion consist of being a new graduate nurse participating in the internship program. There are no exclusion criteria based on gender, age or ethnicity. Demographic data collected will include age, sex, race, and education level.
Protection of Human Rights
The study will be presented to the appointed Institutional Review Board (IRB) at Ball State University for approval. During this process, a letter of intention will be sent to the participating hospitals’ Vice President of Nursing seeking permission to conduct the internship and study within the institution. This letter will explain the purpose of the study, time frame, criteria for inclusion, and anticipated sample size and instrument. A meeting will be arranged with the Vice President of Nursing, nurse educators, and unit directors to further explain details of the internship and study to obtain final approval. Participants will sign an informed consent, which will describe the researcher’s
commitment to keep the responses confidential. No attempt will be made to find out who participated in the study. No one will see the data but the researcher. Participants will be instructed to not write their names on any study materials. The only possible risk to
participants is the risk of being identified by demographics reported. In a sample of 80 nurses in each group, it is possible but unlikely that an individual will be identified by the demographic data. The only demographic data collected will be the broad area of clinical practice and age range. The participants will be informed that they can omit demographic questions if they do not wish to disclose demographic information. Data collection will continue until the target sample size is reached.
In order to sample the same nurses over time, questionnaires will be numerically coded. The list of participants’ names and code numbers will be kept in a locked file in the office of the researcher. Signed consents forms will be kept secured by the primary researcher in a locked file. The completed study instrumentation will be kept in a separate locked file. No one will have access to the list, signed consents and data but the
researcher. Data will be destroyed at study completion.
Procedure
After approval from the IRB and support from the participating hospitals, the internship will be implemented. The comprehensive internship will last one year and provide an intense socialization and educational experience to support the new nurses in their professional development and transition into the nursing role. During the course of this year, participants will be provided education, participate in group exercises, be mentored by educators and preceptors, and compose personal development plans. In addition to standard unit orientation, the new nurse interns will attend ten education seminars during the internship process. It will be decided by the participating organization which units will not participate in the internship program to establish a comparison group.
Participants who complete the internship will be invited by mail to complete the study instrumentation. The interns will be surveyed during their classes at baseline, six months, and twelve months. Non-interns will receive survey packets by intra-institutional mail at baseline, six months and twelve months later. An informed consent will be
included in the survey packet along with instructions and the researcher’s e-mail and phone number for any questions. Participation is voluntary, and the nurses may withdraw from the study at any time. All data will be anonymous and confidential and will be seen only by the researcher and data entry personnel. Students will be instructed to not write their names on the survey.
Participants will place the completed instrumentation in a sealed envelop and place it in a data collection box located centrally within the hospital. Signed informed consents will be placed in a second envelop and deposited in the centrally located data collection box. Neither surveys, consents, nor envelops will be coded in any way.
Signed consent forms will be kept secured by the primary researcher in a locked file. The completed study instrumentation will be kept in a separate locked file. Data will be destroyed at study completion.
The only possible risk to participants is the risk of being identified by
demographics reported. In a sample of 80 nurses in each group, it is possible but unlikely that an individual will be identified by the demographic data. The only demographic data collected will be the broad area of clinical practice and age range. No health-related information will be collected from nurse participants. The participants will be informed that they can omit demographic questions if they do not wish to disclose demographic information.
There are no benefits to the participants other than to contribute to professional knowledge needed to plan support for nurses’ role transition. The importance of the study will be cited in the cover letter and informed consent and will include gaining knowledge about the effectiveness of internship programs. No one can provide this data except new nurses who are in role transition.
Administrative data will also be collected concurrently to describe the number of non-interns and intern new nurses who remained in the organization for 12 months, 18 months, and 24 months over the three-year time frame. Retention data will be collected by the exact same formula throughout the course of the study. All retention data will be aggregated before released to the researcher. The researcher will not see the names of who continued employment and who did not remain employed.
Instrumentation
Three instruments will be used in this study. The first instrument used will be the Organizational Commitment Questionnaire (OCG) (Mowday et al., 1979). This tool will be used to measure how strongly an individual identifies with or is involved in the organization. This questionnaire will consist of a 15-item, seven-point Likert scale that ranges from strongly agree to strongly disagree. The researcher will also use the Hagerty- Patusky Sense of Belonging Instrument (Hagerty & Patusky, 1995). This tool measures the value of involvement and experience of belonging. This questionnaire consists of 32 items with two domains: Psychological Experience (18 items) and Antecedents (14 items). This four-point scale ranges from strongly agree to strongly disagree. The third instrument used for this study will be the Anticipated Turnover Scale (Hinshaw et al., 1987). This instrument will be used to measure the new graduate’s perception of the
prospect of willingly terminating the new nursing job position. The tool will consist of a 12-item self-report survey that uses a Likert scale with seven reply options ranging from agree strongly to disagree strongly.
Participants will be asked to provide demographic data. The participants will be informed that they can omit demographic questions if they do not wish to disclose demographic information. The only demographic data to be collected will be the area of clinical practice and age range.
Reliability and Validity
Reliability and validity have been examined on the Organizational Commitment Questionnaire (OCG) (Mowday et al., 1979), Hagerty-Patusky Sense of Belonging Instrument (Hagerty & Patusky, 1995), and Anticipated Turnover Scale (Hinshaw et al., 1987). In previous tests of the tools, internal consistency reliability was determined by calculating Chronbach’s alpha. The OCG reports a Chronbach’s alpha reliability of .53, which is low and requires further examination. The Hagerty-Patusky Sense of Belonging Instrument reports acceptable validity and a Chronbach’s alpha reliability of .84 for the psychological experience and .66 for the antecedent portion of the tool. The Anticipated Turnover Scale reports acceptable reliability at .84, and the construct validity was estimated by principal factor analysis and predictive modeling techniques (Newhouse et al., 2007). Chronbach’s alpha will be calculated on all three tools in this study.
Research Design
This study will use a quasi-experimental, longitudinal, control group design. This type of design allows the researcher to explain relationships, clarify why certain events happen, and examine causality between selected independent and dependent variables
(Burns & Groves, 2007). Data are collected three times, at baseline, six months, and twelve months. The internship serves as the intervention and is the independent variable. It is measured as a nominal level variable. Participants either took part in the internship or did not take part. Dependent variables are sense of belonging, organizational
commitment, anticipated turnover and retention rates, all of which were measured at a level presumed to be interval in nature. Demographic data are measured nominally.
Methods of Data Analysis
Survey responses will be scanned and data will be entered into a computer using the Statistical Package for the Social Sciences (SPSS) program. For research question one, the results will be described using inferential statistics such as analysis of variance (ANOVA), and presented in a table within the study. This analysis will compare
organizational commitment, anticipated turnover, and sense of belonging between groups of participants, within groups, and as a whole group. For research question two, analysis of data will describe the new graduate retention rate for 12, 18, and 24 months. For the results in this portion of the study, a post hoc test for ANOVA will be performed to determine if there are significant differences in retention rates between groups of new nurse interns versus new nurses not participating in the internship program.
Summary
The purpose of this study is to examine the effect of an internship program on sense of belonging, organizational commitment, and anticipated turnover among new nurse graduates and the effects of selected demographic variables on outcomes of the internship program. Results will provide information needed to develop comprehensive
programs that may improve the transition process of student to professional to increase nurse retention and decrease new nurses’ intentions to leave within the first year of employment.
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Source Problem
Purpose Research Questions
Framework or
Concepts Sample Design Instruments Results
1.
Newhouse et al. (2007)
The attrition rate of new nurses continues to rise. More research is needed on factors that influence turnover of new nurses. Of specific interest are the effects of internship programs on new graduates’ organizational commitment and sense of belonging. Explore whether an internship program (SPRING) improves new graduate retention, sense of belonging, turnover, and job commitment. 1) Is there a difference among new graduates who complete an internship vs. new graduates who do not complete an internship in relation to organizational commitment, sense of belonging and turnover? 2) Does? Donabedian’s model (1966). Examines relationships between structures, processes and outcomes of the healthcare provided to individuals. Concepts: Nurse Turnover Sense of Belonging Organizational commitment Convenience sample of new nurses: Approximately 200 new graduates hired by an academic institution over a 3 year period in the SPRING program. Baseline: N = 37 6months: N = 237 12 months: N = 212 Undisclosed number of new nurses who did not participate in the SPRING program in a comparison group also included in the sample. Quasi- experimental Control group Cross-Sectional 1. Organizational Commitment Questionnaire(OCQ) Reliability = 0.53 (Mowday, Steers, & Porter, 1979) 2. Modified Hagerty- Putusky Sense of Belonging Instrument divided into two domains. Psychological Experience
Reliability = 0.84 Antecedent Reliability = 0.66 (Hagerty & Patusky, 1995)
3. Anticipated Turnover Scale
Reliability = 0.84 (Hinshaw et al., 1987)
Source Problem
Purpose Research Questions
Framework or
Concepts Sample Design Instruments Results
participating in the internship (SPRING) result in higher retention of new nurse graduates than that of those who do not attend SPRING to leave than 6 mos or 12 mos SPRING NURSES. 2. Casey et al. (2004) Graduate nurses experience stress and challenges when transitioning from student to practicing professional. With the current nursing shortage, new graduates have become an important focus of hospital recruitment and administrators who are examining factors that affect turnover and retention. Identify the stresses and challenges experienced by graduate nurses. What factors influence graduate nurse retention? No theoretical Framework cited. Conceptual Framework: New Graduate Nurses Transition into Practice Perceived Stress Nurse Retention Convenience sample of 270 new graduate nurses from 6 acute care facilities in the Denver metropolitan area. Comparative/ Descriptive Data were collected at baseline, 3 months, 6 months, & 12 months following hire. Casey-Fink (n.d.) graduate nurse experience survey Reliability = 0.78 Variables measured included: Demographics, Skills/Procedure Performance, Comfort/ Confidence Job Satisfaction