Open Journal of Nursing, 2013, 3, 461-466 OJN
http://dx.doi.org/10.4236/ojn.2013.37062 Published Online November 2013 (http://www.scirp.org/journal/ojn/)
Orienting a ne w generation of nurses: Expectations of the
millennial new graduate
Elaine M. Riegel
Department of Nursing Education, St. Joseph Medical Center with Catholic Health Initiatives (CHI), Reading, USA
Received 30 July 2013; revised 1 September 2013; accepted 11 October 2013
Copyright © 2013 Elaine M. Riegel. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Generational diversity provides a unique quandary
for nursing leaders and educators to enlist, orient,
and retain nurses. Millennials are the largest cohort
since the Baby Boomers and the age group from
which the nursing profession will build its future
workforce. This study examined the experiences of
the new graduate nurse of the millennial generation
as they navigate orientation in an acute care setting.
Using a Web-based survey to conduct the study al-
lowed nurses from across the country to participate
while providing easy access to the study questions.
Analysis of the data through qualitative content ana-
lysis demonstrated a dominate theme of seeking stru-
cture while expecting an individualized orientation.
The survey also revealed the importance of the pre-
ceptor and manager in the perceived success of this
generation’s transition and a need to assimilate into
the professional role of RN. Recognizing that there is
a need to promote a more individualized orientation
with improved mentoring for novice nurses and their
preceptors is evident and challenges nursing leaders
and educators to rethink current practices to retain
new nurses. Established roles within the hospital and
individual nursing units are changing and traditional
strategies for recruitment and retention no longer ap-
ply. A structured orientation can facilitate the tran-
sition from new graduate to professional nurse and
assist in the retention of qualified nurses and ulti-
mately safe patient care.
Keywords: New Graduate Nurses; Millennial Nurses;
Orientation; Generational Diversity
1. INTRODUCTION
For the first time in 30 years, th e rate of aging in th e nur-
sing workforce has slowed, largely due to the increase in
employed nurses under the age of 30 and rising enroll-
ments in schools of nursing [1]. The increase in younger
nurses entering the labor force is owed to the increase in
baccalaureate nursing programs (BSN), whose student
population is younger when compared to other nursing
education programs [1]. A higher interest in nursing and
an increase in applications to nursing schools signi-
ficantly increased as the Millennial generation entered
college age [2]. Unfortunately, in 2008 nearly 40% of
recent graduates planned to leave their current jobs wi-
thin three years; this is a significant increase from the
27.1% pre-2001 graduates [1].
This change in the demographics of nursing will im-
pact all aspects of recruitment and retention as graduate
nurses have become a considerable part of acute care
hospitals strategy to fill workplace shortages [3]. A high
turnover and an influx of new graduate nurses into the
hospital setting leads to a higher proportion of inexpe-
rienced nurses, which may not only be traumatic for the
new professional nurses, but also may impact patient sa-
fety [4].
Orientation is the introduction into the world of nur-
sing and has the potential to influence not only the
novice’s nurse’s practice but patient outcomes. The tran-
sition of gradate nurse from student to professional has
been recognized as a time of stress, role adjustment,
interpersonal conflict, and reality shock [4-7]. Although
the discussion of practice readiness is not new, there is
evidence to suggest that a new graduate’s transition in
the current healthcare environment is unique [6]. In-
creased acuity of hospital patients, reduced length of stay,
nursing shortages, and demands for technology have
placed increased stress on leaders and educators to move
new graduate nurses into practice more rapidly [6]. Also,
there is a trend to place nov ice nurses directly into h ighly
specialized areas once reserved for the expert nurse [5].
In addition, hosp ital settings often have a bureau cratic
structure with different generations of nurses following
hierarchical lines. Younger nurses reported to people of

E. M. Riegel / Open Journal of Nursing 3 (2013) 461-466 462
the next generation with the oldest generation serving in
the highest managerial positio ns. With the advent of total
quality management and continuous quality improve-
ment, a more team based approach has been adopted [8].
Shared governance has led to a flattening of this tradi-
tional hierarchy and facilitated decision making across
the generations [8]. The information age has also altered
the dependence of younger nurses on tenured staff for
expert information.
The Millennials, also referred to as Generation Y or
Net, are 88 million strong, and will comprise the majo-
rity of the workforce within the next two decades [9].
Although there have been many studies investigating
new graduate transition into practice [5,6,10-14] only a
few address this generation’s distinctive characteristics
[7,15,16]. This study examined the experience of the
Millennial generation as they engage in the social con-
text of their orientation process. The goal of the study
was to inspire managers, educators, and coaches to re-
think current practices that are designed for the masses.
2. METHOD
2.1. Design
A descriptive study was used to examine the experiences
of Millennial new graduate nurses during orientation.
The focus was to gain insight into the expectations of
this generational cohort as they enter the health care
workforce.
2.2. Participants
The nurses in this study were born between the years
1980-1989, and graduated from a nursing program wi-
thin three years of the study. They were employed in
acute care and had started or had recently finished their
orientation process within the clinical setting. Of the
seventeen participants, 47% (n = 8) worked in critical
care, 35% (n = 6) medical/surgical, 12% (n = 2) in a
pediatric setting and 6% (n = 1) in ECU; 16 of the par-
ticipants were female and 1 was male. Their nursing
educational background included diploma (n = 4), as-
sociate degree (n = 1) and baccalaureate degree (n = 12).
In order to recruit participants, nurse educators wi-
thin the Catholic Health Initiatives (CHI) health system
and Kutztown University were provided, via email,
information about the research proposal. The nurse
educators were asked to seek out new graduate nurses
via “word of mouth” who would meet the age criteria
and provide an email address to contact the researcher
if interested in participating in the survey. The new
graduate nurses who contacted the researcher by email
only needed to provide a return email address and were
not asked to share any additional information. They
were then sent a link via email that would be used to
connect them to the Web-based survey. If they agreed to
share their experiences, instructions were provided in
the introduction of the survey explaining their consent
and information to contact the researcher, the research-
er ’s advisor and IRB representative with any questions.
No potential risks were identified by participating in
this research survey, and none of the nurses were
compensated for their time. During completion of the
survey, if they wished to d iscontinue th eir particip ation,
they needed only click out of the screen and no infor-
mation would be saved
2.3. Instrumentation
Using an online tool and email for communication as-
sured confidentiality and permitted collection of data
using technology familiar to this cohort. The study re-
quested demographic data and proposed several open
ended questions which required narrative responses. All
questions used in the study were validated by a research
advisor in the role of subject matter expert.
Questions included: “Describe your expectations of
how nursing orientation wou ld be conducted”, “Describe
ways in which your orientation met these expectations”,
“Describe ways in which your orientation did not meet
these expectations”, “What were your experiences of
being a new graduate nurse in orientation”, “Why did
you select nursing as a profession?”, “How did your ori-
entation impact your thoughts about nursing as a pro-
fession?” and “If you could give advice to another new
graduate nurse entering their orien tation, wh at w ould you
tell them?”
2.4. Data Collection
The Web-based survey was available to research parti-
cipants for three months and was closed when participant
responses met saturation.
Changes brought by the use of computer technology
have allowed the use of asynchronous communication
such as email and online surveys to recruit and conduct
research. The Internet has been used by other disciplines
for both qualitative and quantitative data collection, as it
allows for a wider geographical sampling, while decrea-
sing the costs associated with data collection and time
taken to collect the data [17,18]. Broader sample collec-
tion, easier recruitment of particip ants through the use of
message boards, email lists and chat-rooms and speed of
responses are several advantages of using the Internet for
research [17-20].
2.5. Data Analysis
Colaizzi’s [21] framework was used to guide the analysis
of the participant’s responses. Using this outline involved
reading and rereading the responses, extracting signifi-

E. M. Riegel / Open Journal of Nursing 3 (2013) 461-466 463
cant statements and exposing meanings. Information was
clustered into themes and then integrated into an exhau-
stive description of the phenomenon [22]. As this frame-
work also requires returning to the participants to vali-
date that the data represents their experiences [23], the
participants were sent a follow-up email describing the
themes extracted from the survey responses requesting
any additional input.
3. RESULTS
The responses generated by the new graduate nurses
reflected the theme of seeking structure including the
expectation of an individualized orientation and open
communication with preceptors and managers. A sub
theme of role transition also surfaced as the new nurses
expressed the need to assimilate into the unit’s culture.
3.1. Seeking Structure
As the new graduate nurses described their experiences
during orientation, the need for structure was a theme
voiced by all of the participants. Within this topic of
structure, the respondents revealed a need for consistency,
organization and open communication. The new nurses
entered their employment with a plan of how their ori-
entation would flow. From review of policy and proce-
dures, to actual task management in their unit, the nurses
expected moving from simple to more complex tasks.
One survey participant described the structure of their
orientation as “the framework for me to build upon to
become a more confident nurse”.
Building on a foundation of classes then clinical, new
graduates anticip ated their orientation to mimic the stru c-
ture of their school environment. Several nurses describ-
ed an expectation of orientation being similar to nursing
school practicum with a mix of classes and on the unit
training. One nurses commented that she “wanted more
hands on learning, skills training or simulation”.
Not having exposure to the hospital environment other
than in the clinical setting as a student, the new graduates
did not anticipate the difficulties they would encounter
practicing as an RN. Having a faculty nursing instructor
allowed the student a consistent preceptor and provided
structure dur ing their clinical experiences. As a new RN,
the nurses needed to find this structure from the ranks of
their co-workers. A supportive and consistent preceptor
increased the new nurse’s confidence and aided in the
new nurses abilities to func tion on th e unit. Having g oals
set by their preceptor with cons tant feedback allowed the
new nurse to feel prepared to practice on their own when
orientation was complete.
Much of the disappointment listed by these novice
nurses was related to inconsistent preceptors and lack of
communication with their managers. There was a need to
develop a routine and receive feedback on their perfor-
mance. Many described feeling “overwhelmed” by the
diverse routines of each new preceptor. Several described
preceptors who “did not care” and were “pessimistic
about their job” and others who would “not follow pro-
per policy and procedure”. Also, having a preceptor fun-
ction as the coach and charge nurse did not allow the
preceptor to “devote herself to teaching”, since she also
had the role of managing an entire unit. This lack o f role
clarity and adjusting to different routines and persona-
lities made orientation more confusing and complex. In-
consistent preceptors, to aid in their learning experience,
were a frustration voiced by many of the new graduates.
Defining roles and responsibilities was another struc-
ture based theme expressed by the Millennial new gra-
duates. They had difficulty knowing how to practice in
this new role, and thus how to make critical thinking
decisions. As students, they had the instructor to aid in
any decision making, but as new graduates they were
insecure in their judgment skills and expected a com-
prehensive classification of their roles and responsi-
bilities. Communication was lacking, as the nurses were
unsure how to make decisions in practice, and unclear
where to find the information.
Within the theme of seeking structure the new nurses
also expected an individualized orientation with a focus
on their specific specialty. Orientees would be allowed to
“work at their own pace” and “not feel rushed”. Nume-
rous responses from the survey mentioned specific time
frames that nurses were given to complete their orien-
tation instead of developing an orientation program
based on their individual needs. Also, needing “time to
sit down and discuss what was needed from our orien-
tation with the preceptor and manager”. Open communi-
cation between the manager, preceptor and new em-
ployee aided in individualizing the orientation for the
new hire and minimized the expectation of orientation
being set by a specific time frame. As many of the survey
respondents were employed in an ICU setting, the anti-
cipation of classes specific to their learning needs and
more time to orient in a specialty area was expressed.
3.2. Needing to Assimilate
The transition from student to RN was another theme
that emerged from the survey responses. Many of the
respondents wrote about adjusting to personalities and
finding their niche within the social ladder of the unit.
The graduates felt overwhelmed and anxious when faced
with the realities of their job and looked to their
colleagues for suppo rt and mentorship. Bo th positive and
negative experiences were voiced by the newcomers as
they navigated through the territory of the incumbent
nurses:

E. M. Riegel / Open Journal of Nursing 3 (2013) 461-466 464
“I learned a lot by asking my experienced co-workers
questions. Was definitely a scary experience, especially
not knowing who could be trusted. A couple older nurses
were very mean and did not treat young, new nurses
nicely.
Most of the nurses were supportive and willing to
teach, but I felt as if some of the more ‘senior’ nurses
would try to belittle the graduate nurses. It took a while
to earn the respect of some nurses.”
Participants also commented on the strong bonds they
had formed with other new graduates and their precep-
tors. These relationships enabled the new graduate to
connect to their unit and have a more successful tran-
sition into the culture. Several nurses expressed how the
support they received from their coworkers impacted the
success of transitioning from student to professional
nurse. These relationships allowed them to form bonds,
develop trust and adjust to the difficult realities of the
job.
Value conflict and disenchantment with their new role
as an RN were also expressed by the new graduates.
Many entered nursing with an id ealistic vision of the role
and must compare this view to the actuality of the occu-
pation. Graduates voiced their inner conflict with dif-
ficulties maintaining compassion and inability to control
patient outcomes.
4. DISCUSSION
The need for structure, guidance and extensive orien-
tation with formalized clinical coaching and feedback
has been highly valued by this generation [24] and was a
dominate theme expressed by these research participants.
Millennials have been accustomed to nurturing and con-
tinuous feedback from their parents, sports team coaches,
and teachers and have similar expectations in the work-
place [16], “This generation is able to integrate large
amounts of diverse sources of information and have little
tolerance for inefficiency or ineffectiveness” [8]. Lavoie-
Tremblay, M., Paquet, M., Marchionni, C., & Drevniok,
U. [25] found that this generation of nurses sees coa-
ching as a vital need; and coaching involves more than
guidance during the first days or weeks, but a long term
commitment. Nursing leadersh ip must also be visible and
transparent to this gen eration [6].
Preceptor matching is also a high priority to this
generation, and there is evidence that preceptors play a
significant role in the new graduate’s experience [10].
Almada, P., Carafoli, K., Flattery, J., French, D., &
Mcnamara, M. [10] used Benner’s model to guide a pre-
ceptor program in their institution which demonstrated
improved retention of new graduate nurses. “According
to Benner, new graduate nurses require the opportunity
to practice and ask unlimited questions in a safe and
supportive environment for an extended period of time”
[11] Lamp, K., Stratton, K., & Welsh, J. [7] found that in
addition to having consistent preceptors, it may be easier
for the new graduate of this generation to learn from a
preceptor with a similar communication style.
The desire for an individualized orientation was ex-
pressed frequently by the novice nurses in this research
study. Growing up in a global economy, this generation
expects multiple options and the ability to have custo-
mized alternatives [8]. They have attended public schools
and universities where the Individualized Education
Program is federally mandated to provide customized
education plans for children with learning disabilities
[26]. When they enter the workforce, the expectation of
personalized orientation program to match their needs
continues. In fact, new graduates of this generation with
opportunities to have input into their own orientation
have expressed an increased interest in their professional
development [7]. Scott, E., Keeher, M., & Swanson, M.
[14] found that new graduates, in general, who expe-
rienced a longer orientation that met all of their needs,
were more satisfied with their jobs.
The transition from student to nurse is experienced by
all new graduate nurses and was a strong focus in many
of the responses in this research study. It influenced both
immediate and long-term outcomes in the process of
becoming a nurse and orientation mark the most crucial
part of the transition [12]. It is been documented by
many studies that the first three months of employment
as a new graduate nurse represents the most stressful
time in a nurse’s career [12]. Differences between work
and school in terms of ideology and pragmatics are
quickly realized, and Delaney [12] discovered that work
presented different outcome objectives for the new
nurses when compared to school. Duchsher [27] revealed
feelings of disillusion with what the new graduate ex-
pected in their role as a professional nurse as compared
to the actuality of practice. Prior to employment as a
nurse, new graduates were found to be unprepared for
and had limited awareness of what the profession of
nursing entailed and had been shielded, as students, from
the full breadth of the role [13]. Olson [16] documented
in her research that the millen nial novice nurse conveyed
that the unfamiliarity with the acute care facility was a
barrier to incorporate new knowledge, and as nursing
students they did not have enough hours spent in an
acute care facility. All these studies speak to the reality
shock man y new nurses encounter as they feel overwh elm-
ed by their new ro le [11].
Many research studies connect conflict in the work-
place with retention of nurses. During transition into
practice, the achievement of some degree of attunement
with colleagues was an important part of being able to
function in the clinical setting [28]. The nurses in this
study connected their ability to function safely on the
clinical unit with the opportunity to seek assistance and

E. M. Riegel / Open Journal of Nursing 3 (2013) 461-466 465
ask questions. Zinsmeister & Schafer [29] completed re-
search on the transition into nurses first year of practice
and noted that participants indicated that a supportive
work environment contributed positively to their evo-
lution into the professional role of a nurse. New nurses
look to their colleagues for advice and questions about
practice; Dyess and Sherman [6] reported many instances
when new graduates received contradictory information
with too many opinions and no confirmed answers.
Millennials’ especially appreciate a team based collabo-
rative approach to work, since their educational expe-
riences were based on interdependence and networking
[30]. The new graduate of this generational cohort placed
significant value on relationships and “finding their
voice” [16].
The majority of the research participants in this study
oriented in a specialty nursing unit and anticipated edu-
cation related to patient management in their field. Dyes
and Sherman [6] described new graduates in the high
acuity specialty areas as needing not only extensive edu-
cation related to technology and disease management but
also emotional support related to intense patient situa-
tions that occur in these types of un its.
5. CONCLUSIONS
New graduates currently comprise greater than 10% of
acute care facilities nursing staff [16], and Millenials will
be a great part of this statistic. The costs associated with
training and coaching new graduates will be lost if
retention rates remain low. The goal of this study was to
understand the lived experiences of the millennial new
graduate nurse, while appreciating the diverse differences in
their expectations of training and education. “One size
fits all” orientation programs will not provide the edu-
cation needed by this generation and will contribute to
turnover. Managers and educators need to rethink current
practices and promote a team based environment while
providing open communication and consistent feedback.
Preceptor training and mentoring also needs to be a
priority. Visibility of the manager and coach, and the
influence of the unit’s culture are crucial to the success
of the new graduates first year [31].
Transition into practice, through residency programs,
has been endorsed by the Institute of Medicine’s Future
of Nursing “Campaign for Action” [32], and appears to
address the many of the issues confronting this new ge-
neration of nurses. Residency programs provide the struc-
ture and emotional support desired by this cohort while
preparing new graduates to practice in a complex envi-
ronment.
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