While nurses transition into their profession (new graduates) or move from one area of practice to another, there are many simultaneous moving parts. As new nurses are gaining the competence and confidence needed to become skilled clinical practitioners, they also are being socialized into their role or specialty area while being introduced to the culture of the organization at the micro (unit), meso (department), and macro (organization or system) levels.
The concept of professional socialization is not new. As early as 1956, sociologists were addressing role identification within the culture of a professional occupation (Becker & Carper), and in 1987, Edens defined professional socialization for nurses as “the process by which individuals acquire the specialized knowledge, skills, attitudes, values, norms, and interests needed to perform their professional roles acceptably” (p. 1). She also described how socialization impacts nurses' “self-image, role concept, attitudes, values, and personality” (p. 14).
The nursing professional development (NPD) practitioner fully appreciates the importance of early socialization as a method to promote engagement. Newhouse et al. (2007) noted the advantages to supporting socialization include increased retention, organizational commitment, and belonging. Conversely, early research by Hurst and Koplin-Baucum (2003) showed that when socialization is unsuccessful, “RNs voluntarily seek other employment if they are unable to assimilate socially and clinically within their first 12 months of work” (p. 176). For new graduate nurses (NGNs), turnover within the first year of transition is attributed to high levels of stress related to lack of experience, reality shock, poor socialization, and lack of peer support.
Strategies to Support Socialization
The NPD practitioner appreciates the values, beliefs, and experiences nurses bring to the practice environment and recognizes that these components impact how nurses in transition “fit” into the culture of the organization at all levels. This is addressed in Nursing Professional Development: Scope and Standards of Practice (Harper & Maloney, 2016) competencies for planning activities as NPD practitioners use learning concepts and instructional design principles specific to adults to create meaningful education. Recognizing the importance of socialization, NPD practitioners often build activities into educational programs that support early socialization. Chant and Westendorf (2019) recommend a “didactic component” that includes an “opportunity for peer socialization” (p. 190) that may be done in the form of an ice breaker or other activity where participants get to know each other in an unstructured way prior to learning.
For NGNs, Schipper (2011) identified that the most important component of a residency is “the ability to relate and receive support and, in turn, provide support to other newly graduated nurses. The trust established transcends into a socialization dynamic within the group.” (p. 217). It is this dynamic that contributes to a nurse's sense of belonging that aligns with higher levels of nurse and job satisfaction. This also is true for experienced RNs moving to a new area of practice, where they have to step back from their role of being an “experienced” RN in one area of practice to being “competent” in a new area.
The preceptor-preceptee relationship is key in introducing RNs to the culture of the organization at all levels. Shinners and Franqueiro (2015) identified key skills and characteristics of a preceptor that included the role of facilitator, noting the preceptor helps in the socialization of the transition nurse with “introductions to the health care team and by identifying and resolving issues as they arise, fostering integration into the work culture, building rapport, and seeking clinical opportunities” (p. 234).
The married state approach to precepting also supports the belonging of the nurse in transition as the preceptor-preceptee team work together as a pair for the entire time they are together. Shinners et al. (2018) noted that using this approach has positive effects for both the resident and the preceptor, and that key outcomes of the residency then focus on competency acquisition with “support, socialization, and recognition to enhance retention” (p. 518).
Supportive Components: Mentoring and Debriefing
Allen et al. (2017) noted the outcome of mentoring is socialization. They also suggested there is a reciprocal relationship between socialization and mentoring that contributes to the wellness of all of the participants involved. During the mentoring process, the transition nurse and mentee form a bond based on shared experiences and communications.
Clinical debriefing sessions on a variety of topics that speak to a nurse's concerns during transition help participants decrease stress and connect with peers. Shinners et al. (2016) noted well-run, facilitated debriefing session are vehicles that support the development of “communication and team building skills needed to face workplace challenges as they move forward in clinical practice, role transition, and professional development” (p. 217). They also noted “debriefing in the clinical setting encourages work-based learning, teamwork, and improved communication; all of which contributes to the development of teams and improved clinical outcomes” (p. 213).
The Lean Process for Performance Improvement
Six Sigma uses the Lean process technique for performance improvement (PI), which is a continuous process that focuses on eliminating, or at least reducing, waste. Research has shown a connection between the process of PI and the benefits of socialization. During the planning phase, the model uses socialization to exchange “tacit knowledge at the individual level through sharing experiences” (Zhang & Chen, 2016, p. 1268). This occurs during different communications such as team huddles, mapping, creative use of computerized communication, and group meetings.
Exemplar: Using Performance Improvement as a Socialization Strategy
Bakersfield Memorial Hospital is a 421-bed acute care hospital located in Bakersfield, California. The hospital has a 1-year NGN residency program that fosters excellence in nursing by initiating performance improvement (PI) projects that align with the hospital's mission, vision, and values by evaluating how frontline staff nurses can deliver compassionate, high-quality, and affordable health services. The NGN residency program PI projects facilitate socialization and organizational enculturation as nurse residents participate in unit-based councils throughout their residency.
Projects are selected by the hiring managers to align with nurse satisfaction and direct patient care to prepare residents for success by achieving stakeholder buy-in from their department peers assisting them in the development of their project. NGNs work with peer nurses, educators, and nurse leaders in different departments to collaborate and innovate PI projects by evaluating processes within the organization and applying evidence-based practices to develop their project.
An example of a PI project in pediatrics is a project in which the NGN residents identified barriers in accurate intake and output documentation of their patients and implemented a form consistently placed in all patient rooms. Implementation required teaching of staff and care partners, allowing continuity and participation in the care of pediatric patients. The results of the project noted an improvement from 8% documentation completion to 100% completion over a period of 19 months.
At the end of the NGN residency program, resident alumni present their PI projects to the upcoming NGN residents during a “Passing of the Torch” ceremony (Figure 1). Passing of the Torch signifies that residents have achieved the milestone of moving from NGN residents to professional nurses as they share their PI experience with their cohort and the emerging novice nurses in residency. By observing their colleagues, who were in their position exactly 1 year ago, present their projects, the nurse residents learn what their respective departments are working on to improve patient care outcomes.
H. Kaur and C. Granadoz presenting their project at a performance improvement luncheon.
During a luncheon with nurse leaders and preceptors from the organization, resident alumni are recognized, and the NGN residents are welcomed and informed of the expectations of professional nursing practice. Through dialogue and the sharing of experiences, NGN residents are instilled with a sense of belonging in the organization, are inspired to develop a strong project to promote patient outcomes, and are excited to work among their new peers in their hiring departments. Participation from the resident alumni in the on-boarding of NGN residents provides a sense of personal achievement, re-commitment to the organization, and mentorship to the newest nurses of the hospital.
Socialization into the practice setting is an important component for the nurse in transition. For NGNs, the first year of practice is both a transition from academia as well as an awakening to the unique culture of health care within a given organization. The NPD practitioner has the opportunity to impact transition nurses' experiences by offering activities that enhance socialization while ensuring the development of a competent professional RN. For both NGNs and experienced transition RNs, the role socialization plays is critical for laying the foundation to promote nurse satisfaction, organizational commitment, and ultimately, retention.
- Allen, T.D., Eby, L.T., Chao, G.T. & Bauer, T.N. (2017). Taking stock of two relational aspects of organizational life: Tracing the history and shaping the future of socialization and mentoring research. The Journal of Applied Psychology, 102(3), 324–337.
- Becker, H.S. & Carper, J.W. (1956). The development of identification with an occupation. American Journal of Sociology, 61(4), 289–298.
- Chant, K.J. & Westendorf, D.S. (2019). Nurse residency programs: Key components for sustainability. Journal for Nurses in Professional Development, 35(4), 185–192.
- Edens, G.E. ( 1987, January. ). Professional socialization in nursing. Presented at the Annual Research in Nursing Education Conference. , San Francisco, CA. . https://files.eric.ed.gov/fulltext/ED282008.pdf
- Harper, M.G. & Maloney, P (Eds.). (2016). Nursing professional development: Scope and standards of practice (3rd ed.). Chicago, IL: Association for Nursing Professional Development.
- Hurst, S. & Koplin-Baucum, S. (2003). Role acquisition, socialization, and retention: Unique aspects of a mentoring program. Journal for Nurses in Staff Development, 19(4), 176–180.
- Newhouse, R.P., Hoffman, J.J., Suflita, J. & Hairston, D.P. (2007). Evaluating an innovative program to improve new nurse graduate socialization into the acute healthcare setting. Nursing Administration Quarterly, 31(1), 50–60.
- Schipper, L.M. (2011). The socialization process of newly graduated nurses into a clinical setting: Role of the clinical nurse educator. Journal for Nurses in Staff Development, 27(5), 216–219.
- Shinners, J., Africa, L., Deasy, P. & Franqueiro, T. (2018). The married state approach to precepting. The Journal of Continuing Education in Nursing, 49(11), 514–518.
- Shinners, J., Africa, L. & Hawkes, B. (2016). Debriefing as a supportive component for registered nurses in transition. Journal for Nurses in Professional Development, 32(4), 212–218.
- Shinners, J.S. & Franqueiro, T. (2015). Preceptor skills and characteristics: Considerations for preceptor education. The Journal of Continuing Education in Nursing, 46(5), 233–236.
- Zhang, L. & Chen, X. (2016). Role of lean tools in supporting knowledge creation and performance in lean construction. Procedia Engineering, 145, 1267–1274.