The Impact of Preceptorship Program on Turnover Intention of Fresh Graduate Nurses in Hospital

Article history: Received: 10 September 2020 Accepted: 18 November 2020 Introduction: The transition period in the first year of nursing career is a difficult time for new nurses to adapt. The transition process for a new nurse is known as the Duchscher's transition shock model. Almost all hospitals worldwide have experienced difficulties with regards to the ability of new nurses to adapt to profession. The Preceptorship is a program designed to help new nurses adapt during the transition. This study aims primarily at exploring the impacts of the program to the turnover intention of fresh graduate nurses working in hospital. Methods: For this major purpose, a qualitative research with particular reference to phenomenology design was applied. Accordingly, this research applied in-depth interviews with active participation of 13 key informants. The informants are fresh graduate nurses employed in two private hospitals in Jakarta. Results: The results of thematic and cross-case analysis with N Vivo v.12 indicate four themes: preceptorship process, experiences in transition, problem arising during transition period and preceptorship program in helping nurse. Conclusion: It is found that nurses aged 22 years old and 7 months of working experience are the most likely to resign. The experience of new nurses undergoing to transition period affects 48% of their desire to leave work. This study recommends conducting further research on what kind of work environment is ideal for facilitating adaptation for new nurses.


INTRODUCTION
Nursing as a professional care provider based on nursing knowledge and tips, as providing patient care oriented. Regulation of the Minister of Health of the Republic Indonesia No.49 of 2013 requires that every hospital has to ensure that every nurse who provides nursing services is a competent nurse by a Nursing committee [1].
The results of a study conducted by previous scholars, showed that 10% of new nurses in Australia wish to leave nursing. Data in Western Australia 2010-2016 indicated that 7.6% of new nurses left the program for new nurses [2]. In several international journals, it is illustrated that this problem has become an international problem, such as in the United State of America (USA) with an average of 30-50%, possibly due to expectations of competence [3].
In 2016, in Taiwan, it was found that the number of nurses who worked in the first year was 28%. Taiwan's Nursing Board reported that the turnover rate for new nurses in the first year of employment was 57.7% and it reached its peak in the first 3 months of work at 32.1%. Rate for new nurses in Taiwan is 2-3 times higher compared to other Asian countries such as Hong Kong, Japan, Korea and Singapore [4]. Likewise, the nurses feel traumatic experiencing the real world of working as a nurse in the first year. In Canada it was found that 30% of fresh graduate nurses who graduated in the last 5 years have left their position as a nurse [5].
Fresh graduate nurses also experience feelings of dissatisfaction with the work environment, workload problems and feelings of worthlessness [6]. In Indonesia, from a qualitative study conducted on 5 students of the FKIK Unsoed Nurse Program, it was reported that professional relationships with other disciplines were felt as a separate pressure [7].
Turnover also has an impact on the cost of setting up the preceptor and decreasing the morale of the unit. It said a turnover or two could be a trigger for other nurses to leave.

Study Design
The method used in this research is  [13], [14].

Overview by Age
The age range in this study was 21-27 years and the most were 22 years old (30.77%).

Length of Work
The results of the analysis show that most participants have a work period of 6 months and more, namely as many as 92, 31%.

Scheme on Transition Period Sub-Theme
Participants' statements were normally distributed to all sub-themes of the influence of the receptive program in helping nurses through the transition period, experiences through the transition period, analysis of the preceptor process and analysis of problems during the transition period.

Interpretation of Data Analysis in Relation to the Preceptor Process
Based on the results of the data analysis, each participant gave a statement regarding the question on preceptor process.

Interpretation of the Analysis Results for Each Theme with Adaptation
Based on the results of data analysis, it was found that the experience of undergoing a transition period had.

Interpretation of Age Data Against Adaptation the largest percentage was 48% of adaptation
From the description of the results of analysis of demographic data according to age affect adaptation to the intention of new nurse turnover is 22 years old (31, 79%).

Interpretation of Data on Length of Employment on Transitional Experience
From the results of the demographic data analysis, the length of work affected the adaptation was at 7 months of work, it had an effect of 43, 98% on the adaptation of new nurses.        influence the transition period [19].

The Experience of New Nurses Undergoing a Transitional Period
There are four themes in this research,   responsibility, nursing and other professions collaboration, applying nursing care process, evaluation experience and coping mechanism.
Further research is needed to determine the ideal work environment for nurses who are newly growing and successful in adapting through the transition period.