A long-standing myth may help explain why so many newly graduated nurses leave the profession early. The myth? Practice-ready graduates. The solution? System-level readiness.
The term practice-ready suggests that a nurse is ready to practice without further education or training, according to an Aug. 31 discussion paper published by the National Academy of Medicine and written by 13 academic and health system nursing leaders. However, most nurses graduate with the licensure requirements, academic standards and graduation benchmarks required, but need more specific skills. Leaders who hold that view often cite new graduate nurses’ need for further training in location-specific technology competencies, time management and resiliency skills, the authors said.
Recently, the concept of practice readiness has come under scrutiny because it “tend[s] to assume a shifting new graduate ideal that more closely resembles the expert than the novice level of clinical competency,” the paper authors said. Nursing schools and practice partners have also raised concerns that practice-ready ideals place an uneven burden of responsibility on academia and individual clinicians compared to healthcare employers.
It could also help explain why so many new nurses leave their jobs one or two years post-graduation. An estimated 24% of nurses leave their role within the first year of practice, 33% leave within the first two years and 30% to 50% leave within five years. Expectations vary drastically from facility to facility, and when new nurses fall short of them, they are likely to blame themselves and leave the profession, the authors said.
“Investing in educational programs and increased enrollments alone is bound to result in a revolving door effect if graduates do not find career satisfaction,” the authors wrote. “If academic health centers are serious about addressing national workforce challenges, they need to move beyond disjointed academic-practice initiatives, toward true integration at every level of the academic health center.”
The goal is to implement “learning cycle” lens to career support for nurses. This approach is already used in medical school transitions through structured partnerships between schools and hospitals, and offers a lifelong, phased learning approach to create system-level readiness.
“Health systems and academic partners could strategically integrate pre- and post-licensure education efforts to ensure clinicians are continually prepared for context-specific realities,” the paper authors wrote. “Academic health centers are well-suited environments in which to develop models of career-long learning and whole-person support. Within academic health centers, clinical competency can be supported on a continuum, across career phases, with different levels of oversight and enrichment at each phase.”
However, three challenges stand in the way: academic-practice integration, sustainable clinician workforce pipelines and strategies to stay on top of new technology, AI and data science.
Despite challenges, the paper authors said that there is “a growing national consensus that dismantling silos between academic and practice organizations is essential to building a stronger, more resilient workforce. … Today’s leaders must act with urgency and vision to reimagine how the clinical workforce is prepared and protected.”
Read the full paper here.
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