When a graduate nurse walks through the doors of your institution, what do they see, feel, hear and experience? What message is delivered by the nature of your corporate culture? Do they feel supported, or do they feel dismissed and disdained? Setting up new nurses for success isn’t rocket science, yet so many healthcare institutions miss the boat. Is your organisation on board with creating an environment that helps novice nurses thrive?

Onboarding vs. Precepting

Some healthcare facilities consider their onboarding process to be enough to get new nurses started on the right foot, but there’s often a big piece missing: high-quality preceptorship or nurse residency programs.

Onboarding is essentially a new employee’s introduction to the organisation and how it functions. During onboarding, the nurse learns what they need to know about navigating their new workplace on all levels; however, this does not in any way constitute actual precepting.

Well-organised preceptorship programs pair novices with experienced nurses who truly want to nurture new arrivals. A resentful preceptor gives a new nurse little or nothing of quality to work with, essentially wasting everyone’s time. However, when precepting is done well, everyone benefits, and the organisation grows as new nurses move along the trajectory from novice to competent to expert.

Retention of new nurses relies on there being the institutional will to create an environment geared towards success, rather than having those fresh recruits eaten alive after being summarily thrown into the fire.

Bullying and Support Don’t Mix

If your organisation knowingly turns a blind eye to workplace bullying of any kind, the institution itself is responsible for the situation. However, since personal autonomy also bears mention, every individual who does the same is also complicit in that bullying based on their silence.

In the United States, nurse-to-nurse bullying (also known as horizontal or lateral violence) is epidemic, and there’s no doubt that it also exists in the UK, Australia, and beyond.

We also see widespread bullying between doctors and other providers, doctors and nurses, and all manner of combinations of individuals within healthcare.

Bullying can come in the form of physical threats, exclusion, sabotage, emotional or psychological abuse, intimidation, harassment or other forms of ill treatment. Some bullying is subtle, and some is blatant.

The excuses made for bullying can be numerous, despite the ridiculousness of the reasoning behind such thinking:

• “Oh, that’s just the way they are. We can’t change them.”
• “We excuse their bullying because they're such a valuable nurse - we couldn’t survive without them.”
• “They've been here too long to be fired.”
• “Administration is so afraid of a lawsuit - that bully has to be tolerated until they quit or retire.”
• “That surgeon brings in millions; how could we ever discipline or fire them?”
• “I was treated like that when I was new, so why shouldn’t I do the same with those coming in behind me? They need to know their place and eat some humble pie. Now it’s my turn to dish it out.”

For anxious novice nurses, being bullied, harassed, intimidated or otherwise maltreated will in no way contribute to success. 'Toughening up' new nurses isn’t what’s called for here; rather, we need healthcare organisations to step up to the plate and institute anti-bullying policies and procedures with actual teeth, with the goal of truly eradicating this scourge from our workplaces. New nurses deserve better, as does everyone else on the team.

New Nurses are the Future

For the older nurses treating new nurses poorly, who do they think will be providing the majority of care 10 years hence? For managers who basically throw novice nursing staff to the lions without protection or adequate mentoring, what outcome do they hope for?

It’s been said that in the United States, more than one-third of new nurses leave the profession within the first three years of practice, if not sooner. In some areas, the numbers are even more dire. With a nursing shortage cycling around fairly regularly in various locales, this bodes poorly for the future.

We need new nurses to feel welcome and well-prepared for whatever comes their way. If those nurses are going to care for our neighbours, family, friends - and perhaps even us - there’s no wasting time when it comes to giving them the best possible chance of success.

Healthcare will continue to be utterly crucial to the world’s citizens, especially in countries where a growing population of older adults will demand even more highly trained workers. It’s our collective and individual responsibility to make sure nurses entering the fray have what they need and that the leadership succession pipeline is populated with their fresh ideas and approaches.

Without a younger stable of future nurse leaders who love their work and their profession, nursing, healthcare and actual patients with lives on the line will suffer. We can – and must – do better.