Nurse leaders report persistent gaps in practice readiness among new nurses — and they’re affecting patient care, staff turnover, and the bottom line. Specifically, CNOs cite needs for better clinical judgment, prioritization, team communication, and greater ability to meet specialty care demands.
Although many organizations have implemented transition-to-practice models, many lack consistency, structure, and the right resources due to the increasing costs associated with such programs. What are nurse leaders to do to develop the needed skills to care for patients in the specialty units they are hired into directly from academic programs? Resource the on ramp.
Current State: Generalists Need to Become Specialists — Quickly
Today’s new nursing graduates bring a commitment and growth mindset, but they need scaffolding to apply judgment in real-world settings that include greater acuity. Due to an aging population, patients with multiple chronic conditions, and advances in technology used to care for patients, patients are more complex today due to an aging 1— and so are their treatments. Especially in hospital settings, nurses need to get up to speed quickly so they can develop the more specialized skills that are needed.
A 2025 survey of nurse leaders by the American Organization for Nursing Leadership identified onboarding as an emerging operational priority, and staff recruitment and retention as the overall top concern.2
An important underlying reason for onboarding concern is that the gap between nursing preparation and nursing practice is widening. Academic programs and their curricula are designed to prepare nursing generalists who can enter practice and provide safe, competent care. But that education does not always prepare them to meet the rapidly expanding specialist care needs in today’s hospitals, with many new hires going directly into specialty divisions like Intensive Care Units. To meet this need, practice settings must rethink their onboarding strategies.
Future State: Shore Up the On Ramp to Clinical Practice
The first 6 to 12 months are a pivotal time that can cement or potentially shatter their commitment to the profession. National data show that quick job turnover is common: 24% to 33% of new RNs leave within their first year, and as much as 50% leave within the first 2 years.3 But targeted strategies can encourage retention and improve clinical performance. A study by the National Council of State Boards of Nursing followed new RNs and LPNs in hospitals and in public health, home health, and nursing home settings.4 Outcomes were significantly better in settings that provided formal 9- to 12-month onboarding programs that were integrated into the institution and supported by higher administration. It also identified preceptorship as an essential component of new grad success.
These findings, plus a multitude of other published research, point to specific and achievable strategies. Here are three steps that healthcare employers can take now:
- Be strategic in your onboarding. Healthcare systems have a dedicated mission and vision, which include strategic imperatives. In nearly every example, one of these strategic imperatives would be related to quality. For example, say a hospital system’s strategic imperative based on quality is “reducing catheter-associated urinary tract infections.” It is critical that leadership not only understands these imperatives but also develops the associated competencies, ensures evaluation of those competencies, and aligns activities in the clinical ladder that award more points for activities directly associated with supporting strategic imperatives. This will have the cyclical effect of improving the competence of your nursing workforce.
- Provide and protect preceptors. Closely train and mentor new nurses with preceptorships that provide personalized learning and feedback. Carefully select and train preceptors, and preserve their time and resources. Additionally, consider developing clinical ladders to support the career advancement of preceptors. Consider establishing nurse residencies to build skills for high-need clinical areas.
- Collaborate with academia. Establish or strengthen academic-practice partnerships to pave the way for collaboration on nursing curriculum changes that will produce graduates better equipped to meet real-world needs. Consider developing specialty tracks within your nursing programs that allow the student to complete clinical hours on a specialty unit.
Don’t Delay: Lack of Action Is Costly
At first glance, this list may seem aspirational. If you tap into current talent and resources or seek commercial partners that can help you standardize clinical development, it’s not
With RN turnover rates of 16.4% and vacancies nearing 10%,5 the time to act is now. The 2025 National Healthcare Retention and RN Staffing Report found that the average cost of a single bedside RN turnover is $61,110 — a YoY increase of 8.6%. Each 1 point change in RN turnover alters the average hospital’s P&L by $289,000/year, the research found.
By appropriately resourcing your on ramp for new nurses, your institution will improve patient care, reduce turnover and its associated costs, and fine-tune a nursing workforce that is eager to embrace and succeed in their profession.
References
- Journal of the American Medical Association. Population-Based Trends in Complexity of Hospital Patients. 2025. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2813852
- American Organization for Nursing Leadership. Nursing Leadership Insight Study. 2025. https://www.aonl.org/system/files/media/file/2025/03/AONL-Nursing-Leadership-Insight-Study-2025.pdf
- 50% of New Nurses Quit Within 2 Years — Why They’re Leaving. Nurse.org. https://nurse.org/news/half-of-new-nurses-quit-within-2-years/
- National Council of State Boards of Nursing. Transition to Practice Study Results. https://www.ncsbn.org/nursing-regulation/practice/transition-to-practice/study-results.page
- NSI Nursing Solutions. 2025 NSI National Health Care Retention & RN Staffing Report. https://www.nsinursingsolutions.com/documents/library/nsi_national_health_care_retention_report.pdf
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