I work with many new graduate nurses from healthcare organizations nationwide. For many, this program does exactly what it sets out to do. It improves their competence, confidence, and job satisfaction, and they become long-term, successful employees. In full transparency, there are also some participants for whom this is not the case. They leave within the year and never finish the program. Now, of course, many systemic issues factor into this. Still, I have always been curious as to why two clinicians working in the same environment can have different experiences and, ultimately, different outcomes in their employment status.
For one of my assignments for my DNP program, I was asked to locate an article on clinician wellbeing. Instead of starting a new search, I looked at the articles I have collected over the years. I came across one titled "The influence of psychological capital, authentic leadership in preceptors, and structural empowerment on new graduate nurse burnout and turnover intent." I remembered this article from a few years back. After reading through it again, I couldn't help but think how helpful this information would be to nurse leaders across the country and how it may hold the answer to that burning question that continues to enter my mind.
Dwyer et al. (2019) looked at the influence of intrapersonal, interpersonal, and organizational factors on new graduate nurse transition to practice. Specifically, they explored the combined effect of psychological capital, authentic leadership in preceptors, and structural empowerment on burnout and turnover.
What exactly are these factors?
Organizational Level Factor (work environment)
Structural Empowerment = organizational structures that facilitate access to support, resources, and opportunities to grow and learn. - think nurse residency programs
Interpersonal Level Factor (relationships with others)
Authentic leadership of preceptors = transparent and ethical behavior that encourages open information sharing by the new graduate's preceptor.
Intrapersonal Level Factor (relationships with self)
Psychological capital = the individual's state of psychological development.
Psychological capital includes:
- Self-efficacy = confidence in efforts leading to success
- Optimism = positive feelings about succeeding now and in the future
- Hope = preserving towards a goal, redirecting when necessary
- Resilience = bouncing back despite adversity
The article found that psychological capital (self-efficacy, optimism, hope, and resilience) has a positive relationship with the new graduate nurse's perception of structural empowerment and workplace relationships (p < 0.01). As psychological capital increases, so does their perception of their working relationships and the environment.
It also found a negative relationship between psychological capital, authentic leadership in preceptors, and structural empowerment in relation to burnout and turnover (p< 0.01). Higher scores in these areas lead to less burnout and turnover, and lower scores lead to more burnout and turnover. It was even found that psychological capital alone was an independent predictor of decreased burnout and turnover.
The takeaway of this article is that while healthy work environments, residency programs, and trained preceptors are essential in preventing burnout and turnover, developing the intrapersonal skills of hope, self-efficacy, resiliency, and optimism may be equally as important.
This reinforces why we have chosen to continue building content in these areas and integrating that content into our newly redesigned curriculum. In addition to building skills of self-awareness, self-regulation, connection, and optimism added in 2021, new 2023 users will explore even more content to build psychological capital. Topics include self-compassion, self-appreciation, meaning, engagement, grit, and achievement. While professional competence is a key focus area, nurses are whole human beings. It is difficult, if not impossible, to develop a person's professional competence, confidence, and satisfaction while ignoring their intrapersonal skills. Each month of this 12-month residency program, participants will learn to develop the professional and intrapersonal skills needed to thrive for years to come.
Nicole Weathers, MSN, RN, NPD-BC
Iowa Online Nurse Residency Program Manager
Reference
Dwyer, P. A., Hunter Revell, S. M., Sethares, K. A., & Ayotte, B. J. (2019). The influence of psychological capital, authentic leadership in preceptors, and structural empowerment on new graduate nurse burnout and turnover intent. Applied Nursing Research, 48, 37–44. https://www.sciencedirect.com/science/article/pii/S0897189718306335