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Every year, thousands of newly licensed nurses step into hospitals and clinics ready to serve. They arrive well-educated, highly motivated, and deeply committed to patient care. Yet within 12 months, a striking number of them will leave their first job, or the profession entirely. This is not a pipeline problem. It is a transition-to-practice problem, and one we can fix. Lisa Wagner, Regional Nursing Director for Western Governors University’s Leavitt School of Health, weighs in on the problem, and solutions.
Q: What are the most common misconceptions students have about what nursing work will actually be like?
Lisa Wagner: One of the most persistent misconceptions about nursing is that it is largely task-based: administering medications, completing assessments, following orders. Nursing is a high-stakes role of constant prioritization and clinical judgment. New nurses must simultaneously monitor multiple patients, interpret rapidly changing conditions, coordinate with interdisciplinary teams, and make time-sensitive decisions that directly impact outcomes. The gap between expectation and reality is profound, and it contributes to what researchers call “transition shock”, a period marked by stress, self-doubt, and emotional fatigue.
Q: What should the public better understand about the challenges nurses face early in their careers?
Lisa Wagner: The public often sees nurses as resilient professionals. Newly licensed nurses move almost overnight from supervised learners to fully accountable clinicians. They care for sicker patients in increasingly complex systems, often while navigating staffing shortages and heavy workloads. Unfortunately, about one in four new nurses leave their first position within a year, and workforce data continue to point to burnout and workload as major drivers of dissatisfaction.
Q: How can nursing programs better prepare students for the emotional and mental demands of the profession?
Lisa Wagner: If we are serious about stabilizing the nursing workforce, we must start by better preparing nurses, not just clinically, but emotionally and psychologically, for what awaits them. Nursing education has made tremendous strides in simulation, competency-based learning, and academic, practice partnerships. But the evidence is clear: technical preparation alone is not enough. New nurses need structured support as they transition into practice. Simulation can assist in preparing nurses in every aspect needed to better prepare them clinically, emotionally, and psychologically. It is exciting to see the learning going on in WGU’s new state-of-the-art Learning Lab and Simulation Center in Indianapolis.
Nurse residency programs are also highly effective tools, and we are seeing more of them within our Hoosier healthcare systems. These structured, evidence-based programs extend orientation, provide mentorship, and create space for reflection and skill development. Studies show they improve confidence, competence, and retention among new graduates. Making residency programs the standard, not the exception, would be a meaningful step forward in tackling that first-year turnover in new nurses.
Q: What do you see as the biggest factors driving this early turnover?
Lisa Wagner: We need to consider the environment we are sending new nurses into. Even the best-prepared graduate will struggle if a workplace is characterized by poor staffing, lack of support, or a culture that tolerates incivility. Organizational culture matters. New nurses are not leaving because they are uncommitted; they are leaving if the conditions of practice are unsustainable.
Q: What role does mentorship, or the lack of it, play in first-year retention?
Lisa Wagner: Mentorship is a critical determinant of whether a new nurse stays or leaves. When new nurses have consistent, supportive mentors, they are more likely to build confidence, develop sound clinical judgment, and feel a sense of belonging within their organization. When they do not, they are far more likely to feel isolated and overwhelmed. Research demonstrates that structured mentorship can significantly improve retention outcomes and reduce early turnover. WGU values mentorship by providing each student with a program mentor upon enrollment. What makes WGU’s mentoring program so effective is that it’s tailored to each student’s needs and schedule. Mentoring is the secret to student success at WGU.
Q: Are there habits or experiences students can adopt during clinical hours that make a measurable difference in readiness?
Lisa Wagner: Preparation does not begin on day one of employment, it begins in clinical education. Students who actively engage in clinical reasoning, seek feedback, and immerse themselves in team-based care enter the workforce better prepared. Those who are encouraged to reflect on difficult experiences and develop coping strategies are better prepared to encounter the emotional realities of practice. In short, readiness is not just about what students know; it is about how they think, adapt, and respond under pressure.
Q: What gives you the most hope about the future of the nursing workforce?
Lisa Wagner: There is reason for optimism. Healthcare systems and academic institutions are strengthening partnerships to better align education with practice. There is growing recognition that nurse well-being is not an individual responsibility but a shared organizational priority. Workforce data suggest signs of stabilization following the pandemic, and innovations in education, particularly flexible and competency-based pathways, are expanding access to the profession. WGU is a pioneer in offering an alternative pathway for non-traditional learners through competency-based education since 1997.
The future of nursing will depend not only on how many nurses we educate but also on how well we support them once they graduate and begin practicing. We cannot afford to lose a quarter of our new graduates in their first year. The solutions are evidence-based and within reach: structured residency programs, strong mentorship, realistic clinical preparation, and healthier work environments. As we implement these solutions, we will retain more nurses and strengthen the entire healthcare system.