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emergency department turnover rates increased sentara northern virginia medical center applicants new graduate registered nurses strength weakness opportunity threat analysis revealed 3 weaknesses regarding new graduate registered nurses emergency departments transition practice program necessary new graduate registered nurse competency needed progress rapidly retention rates needed improvement emergency department registered nurse transition practice pathway created address challenges retention statistics garnered new graduate registered nurses length employment improving retention rates sentara northern virginia medical center led expansion program 11 hospitals system selfreport surveys created later evaluate new graduate registered nursess satisfaction program perception clinical confidence using emergency department registered nurse transition practice pathway turnover rates sentara northern virginia medical center dropped 46 51 post expansion overall program retention rates 96 6 months 86 1 year 2year retention rate prior covid19 82 afterward dropped 65 surveyed new graduate registered nurses confidence level 25 less first day 17week orientation 54 reported confidence levels risen 75 within 6 months 81 reported 75 confidence 1 year 87 reported levels 75 100 2 years 100 reported confidence level 75 100 development emergency department registered nurse transition practice pathway resulted improved emergency department registered nurse retention confidence savings reduced turnover reduced temporary labor staffing achieved program implementation takes careful resource management ongoing analysis research validate return investment