Purpose: New graduate and experienced nurses in their first year on a hospital unit experience many stressors, including complexity of care, feeling a sense of belonging, being challenged professionally, lack of perceived competence, and lack of partnership with supervisor.  These stressors can lead to nurses leaving a job or leaving clinical nursing overall. Currently, first-year retention for all nurses is 83%, lower than previous rates.  Nursing turnover can negatively impact continuity of care, productivity, the safety and well-being of patients.  In addition, turnover comes a steep cost.  For most hospitals, it costs approximately 1.3 times the nurse’s salary to replace them.  Studies show that supervisors who engage with new nurses in a participatory style, offering recognition, emotional support, development opportunities, and consistent communication will see less turnover and decreased anxiety and burnout in their new nurses.

Project Design: In the CICU, as we increased our staffing to support a bed expansion, we took to opportunity to hire a new Assistant Nurse Manager (ANM) and repurpose an existing ANM role to allow us to dedicate both ANMs to supporting all new hires.  These ANMs supported our new graduate nurses, as well as our new experienced nurses.  Their approach was focused on providing consistent, individualized support to the new hires.  Because they were supporting nurses with the same level of experience in the unit, they were very effective and consistent with: 

Managing competencies and skill advancement
Promoting professional development 
Providing effective, continuous communication 
Offering support and emotional wellness resources
Coaching using face-to-face communication  
Delivering clear expectations 
Recognizing staff when appropriate
Seeking ways to promote a sense of belonging to the unit

Results: First Year Retention:
Over the past 4 years, the CICU has been able to maintain higher than average first-year retention.  Retention dropped nation wide in 2020 and 2021, but despite increasing the number of new nurses hired in 2020 and 2021, we have maintained a consistent first-year retention rate, averaging 90%.

Manager Effectiveness Scores:
The CICU ANMs over all new hires scored significantly higher than the benchmark in the engagement survey.

Skills Advancement:
Having these ANMs manage skills advancement for all new employees, we saw more consistent advancement and decreased the time it took to be fully advanced in the CICU.

Conclusion: We have seen great success by having 2 dedicated ANMs for all new hires. In the past 2 years, we have maintained a high level of retention, achieved high manager effectiveness scores, and new nurses are advancing sooner.  Direct supervisors can have a tremendous impact on retaining new nurses.  Based on the success we have seen; we will continue to support this structure and remain focused on providing a high level of support for the new nurses in our unit.