New nurses often struggle with the transition from student to professional practice, contributing to high turnover rates. Explore the challenges new nurses face, the value of nurse residency programs, and how Marquette University’s Direct Entry MSN program helps prepare confident, practice-ready nurses through clinical training, simulation and supportive learning environments.
Nursing school is both exciting and challenging one for aspiring nurses. During their education, nursing students must demonstrate mastery of complex scientific concepts and hands-on clinical skills and develop the ability to exercise savvy clinical reasoning in high-stakes patient care scenarios in a clinical environment. A successful transition to professional nursing practice is essential to prepare newly licensed RNs for a long and successful career.
Prelicensure nursing education, such as that offered through Marquette University’s Second Degree Direct Entry Master of Science in Nursing (DE-MSN) program, prepares students for professional nursing practice. After graduation, success on the rigorous NCLEX-RN licensure exam marks a student’s official transition from graduate nurse to professional Registered Nurse (RN). Many resources are available to help this process go smoothly.
Below, I’ll share common anxieties about transitioning into RN practice in a clinical environment, factors that affect new nurse retention, and how nursing education and nurse residency programs make a positive impact.
Common Anxieties About the Transition to Professional Practice
Students gain skills and knowledge over the course of their prelicensure nursing programs and typically feel confident in their preparation by the time they graduate. However, it is common for newly licensed nurses to feel overwhelmed at the thought of transitioning to the professional nursing role.
The idea of being responsible for patient outcomes without the safety net of faculty supervision is a common cause of new nurses’ anxiety when anticipating their transition to RN practice, according to research published in Perspectives in Psychiatric Care. Factors such as worrying about the potential to harm a patient if making a mistake, uncertainty over supervision of unlicensed assistive personnel, and the need to communicate with physicians and other members of the interdisciplinary care team all contribute to transition stress.
New nurses also feel overwhelmed when trying to reconcile the knowledge acquired during nursing school with the practical realities of providing care. They often feel bewildered when navigating the adjustment to a new work environment, new systems, new people, and new responsibilities.
Discover the importance of health promotion in nursing practice on patient outcomes.
The Challenge of New Nurse Retention
Stress during the first year of one’s nursing career contributes to challenges retaining new nurses in the workforce.
Nearly half of newly licensed RNs leave their first nursing positions within 12 months of being hired, according to a study published in Creative Nursing, and about 24% leave the profession altogether within one year of licensure. An additional 19% exit the nursing workforce prior to the end of year two, according to Nursing Solutions Inc.
Given the significant investments in time and tuition required to make it through nursing school, such high turnover statistics are startling. As the American Association of Colleges of Nursing (AACN) has highlighted in their Nursing Shortage Fact Sheet, retention of new nurses has become an important focus in efforts to address a growing nursing shortage and stabilize the nursing workforce.
Factors Affecting New Nurse Retention
Many factors have been identified as negatively affecting the nursing profession’s ability to retain newly licensed RNs.
For example, according to research published in BMC Psychology, school-based clinical experiences don’t necessarily prevent shock and stress when new nurses face the weighty responsibilities of independent practice. Nursing students engage in direct patient care under the guidance of a staff nurse and with support and supervision of expert clinical faculty. Those safety nets are not present in the professional setting, when nurses are expected to be ready for autonomous practice.
The same study published in Creative Nursing indicates that new nurses also cited professional issues such as unsafe caseloads, poor communication, and patient safety concerns as reasons they left their first nursing jobs in less than one year.
Insufficient support to help new RNs navigate their initial transition to practice has been cited as a major contributor to both increased first-year turnover rates and the likelihood of newly licensed nurses quickly leaving the profession altogether.
The first year of professional nursing practice is indeed challenging; however, there are things students, nursing programs, and employers can do to support that transition.
A Good Transition to Practice Starts in Nursing School
The educational experience of students is an important factor that contributes to a nursing student’s readiness to transition successfully to the RN role. For example, research in Teaching and Learning in Nursing indicates that clinical learning experiences that became increasingly complex as students move through the curriculum help students feel better prepared to manage the additional increase in clinical responsibilities that comes with their first professional nursing position.
Opportunities to rehearse and master clinical skills in the safety of high-quality simulation and skills labs enhance student nurses’ confidence, both of which can support their readiness to take on the rigors of the professional nursing role after graduation. In skills lab, students are taught fundamental nursing procedures such as physical examination techniques, medication administration, catheter insertion, and more. High-tech simulation labs at Marquette provide DE-MSN students with multiple opportunities to apply their new skills to simulated patient care scenarios using high-fidelity mannequins, where there is no risk of a misstep causing real patient harm. Skills and simulation labs also ensure that all students receive a consistent foundation of clinical training experiences during which they can hone their essential skills under the supervision of expert clinicians.
Students also build on theoretical knowledge with opportunities to provide direct patient care during their in-hospital clinical rotations, where they are taught and supported by experienced clinical faculty while working alongside staff RNs on an active clinical unit.
Learn more about the experience of earning your MSN through a DE-MSN program like Marquette’s.
The Role of Nurse Residency Programs
Another factor that predicts the successful transition to practice for newly licensed nurses is participation in a comprehensive Nurse Residency Program (NRP) when onboarding to their first nursing job, according to the Journal of Professional Nursing.
Nurse residency programs provide support that extends beyond the unit-specific orientations that nurses receive when starting a new job. Research published in the journal Nursing Management shows that in addition to providing ongoing support and training in clinical competencies, NRPs also address non-clinical skills such as time and stress management, socialization to the clinical environment, and complex clinical communication structures.
It is no surprise that NRPs have been shown to increase both confidence and competence in newly licensed RNs, which in turn improves both role satisfaction and retention rates. According to Lillee Gelinas in American Nurse Journal, patient outcomes also improve when new nurses receive the support of an NRP in their first year of professional practice. The mentorship and programming enjoyed by new RNs through their participation in an NRP serves as a bridge between their prelicensure education and their professional responsibilities, supporting their successful transition to the professional role.
Many NRPs have started seeking accreditation to validate the quality of their new nurse onboarding programs. Two of the many available accreditation options for NRPs include the American Nurses Credentialing Center Practice Transition Accreditation and the Commission on Collegiate Nursing Education Accreditation Standards for Transition to Practice Programs.
What Aspiring Nurses Should Look For
Aspiring nurses should first seek a nursing program that provides robust, scaffolded clinical learning experiences as a core part of the prelicensure curriculum. Training oriented around practicing in a clinical environment ideally should include a combination of hands-on patient care and high-quality simulation experiences guided by expert faculty clinicians to ensure students develop both the confidence and competence necessary to succeed in professional practice.
As student nurses approach completion of their prelicensure education and turn their attention toward the job search, they should then seek an employer that offers a comprehensive, accredited, NRP to support them through their initial year as licensed RNs. Many healthcare systems advertise their NRP offerings on their recruitment websites, making it easy to identify potential employers that offer this important benefit to new nurses. If uncertain about the availability of an NRP for a specific job opportunity, new nurses should inquire during the hiring process to determine whether their potential new employer provides a comprehensive onboarding program that includes this essential first-year support.
Prepare For Professional Nursing Practice With Marquette
Offering a master’s-level prelicensure nursing curriculum that can be completed in five or eight semesters, Marquette’s DE-MSN program equips students with everything needed to succeed in a career as a professional nurse. To learn more about Marquette’s innovative DE-MSN curriculum, request information today to connect with a Marquette DE-MSN admissions adviser and explore your options.
Holly Nerone, PhD, MSN, RN, CNE is a clinical instructor and director of the Direct Entry MSN program at Marquette University. Her professional background includes instructional design, nursing education and program leadership. Her primary clinical specialties are labor and delivery, cardiothoracic, and surgical nursing. Dr. Nerone’s research interests include diversity in nursing, diversity in nursing education and support for nontraditional college students.
References
- Yildirim-Hamurcu, S., & Terzioglu, F. Nursing students’ perceived stress: Interaction with emotional intelligence and self-leadership. Perspectives in Psychiatric Care, 58(4), 1381-1387 (2022). https://pubmed.ncbi.nlm.nih.gov/34449096/
- Shatto, B., Meyer, G., Taylor, J., Aldhamari, Y., Seth, P., & Maas, M. Factors associated with new nurse turnover. Creative Nursing, 32(1), 77-84 (2026). https://pubmed.ncbi.nlm.nih.gov/40790998/
- NSI Nursing Solutions. 2021 NSI National Health Care Retention & RN Staffing Report. https://www.emergingrnleader.com/wp-content/uploads/2021/04/NSI_National_Health_Care_Retention_Report.pdf
- American Association of Colleges of Nursing (AACN). Nursing shortage fact sheet (2024). https://www.aacnnursing.org/news-data/fact-sheets/nursing-shortage
- Ibrahim, R. K., Safi, M., Darwish, A., et al. From student to nurse: exploring transition shock through stress, locus of control and coping strategies in newly graduated nurses. BMC Psychology, 13, 957 (2025). https://link.springer.com/article/10.1186/s40359-025-03315-6
- Alsalamah, Y. S., Al Hosis, K., Al Harbi, A., Itani, M., El Tassi, A., & Fawaz, M. Student to nurse transition and the nurse residency program: A qualitative study of new graduate perceptions. Journal of Professional Nursing, 42, 195-200 (2022). https://pubmed.ncbi.nlm.nih.gov/36150861/
- Pullen, D., & Ahchay, D. A case study of new nurses’ transition from university to work. Teaching and Learning in Nursing, 17(3), 282-295 (2022). https://www.sciencedirect.com/science/article/abs/pii/S1557308722000439?via%3Dihub
- Mohamed, Z., & Al-Hmaimat, N. The effectiveness of nurse residency programs on new graduate nurses’ retention: Systematic review. Heliyon, 10(5), e26272 (2024). https://www.cell.com/heliyon/fulltext/S2405-8440(24)02303-X
- Wolford, J., Hampton, D., Tharp-Barrie, K., & Goss, C. Establishing a nurse residency program to boost new graduate nurse retention. Nursing Management, 50(3), 44-49 (2019). https://pubmed.ncbi.nlm.nih.gov/30817432/
- Gelinas, L. Nurse residency programs. American Nurse Journal (April 2026). https://www.myamericannurse.com/nurse-residency-programs/