This guest blog post is directed to all my nurse leader colleagues that may be reading this in an effort to spark discussion about how best to retain our new nurses in the profession and in within our organizations. I hope that most of you are aware of the alarming statistics of how frequently new nurses are leaving their first jobs (17% within one year and 33.5% within two years)1. As nurse leaders, we are faced with many demands, but I believe that if we are going to improve the health of our patients and rise up to meet the challenges we face—patient satisfaction, staff satisfaction, improved nursing-sensitive indicators, financial well-being of units/organizations—we must invest our resources in strengthening our core (staff members). Through all the changes in health care and nursing practice, one constant is the need for hard-working, competent, and caring professionals2.
I am privileged to serve as the nurse manager of a 48-bed internal medicine inpatient unit at the University of Iowa Hospitals & Clinics and lead over 60 Registered Nurses. Our unit’s leadership team—like all of yours—must recruit, hire, develop, and retain competent staff to provide safe, high-quality patient care. New graduate nurses are not only a critical piece of our current staffing plans but they are also our future leaders and preceptors. Therefore, recruiting and retaining new graduates are major strategic initiatives for our unit and organization. Due to its demonstrated impact on improving the transition from student to professional, the Institute of Medicine recommended that all new nurses participate in a Nurse Residency Program upon entry into the profession3. While it is not always easy to approve and support time off the unit to complete their residency classes and quality project, we are fully-committed to providing, promoting, and supporting nurse residency programs as an initiative to improve our professional work environment for new nurses.
Some may ask how exactly nurse residency programs are going to help us meet our demands. The focus on professionalism, communication, resiliency, and quality/safety (to name a few) are important skills/knowledge that will serve new nurses well in their careers. This type of investment will no doubt impact their future practice—improved communication with the provider to remove an indwelling catheter sooner to prevent a CAUTI or reviewing new research and implementing the latest evidence to reduce risk of falls. Both examples will not only help us reach our goals of improved patient outcomes, but will benefit the organization’s financial health. As a nurse leader, one of my objectives is to help my team realize their impact and value on the microsystem. Employees who are engaged in their work and believe that they are making a positive difference in the lives of their patients and on the operations of the unit are more likely to stay in their positions4. By supporting new nurses’ participation in a Nurse Residency program, I am supporting their transition from student to valued professional. The long-term goal of implementing and supporting Nurse Residency Programs is to reduce the costs of recruiting and orienting new staff and to employ a strong core of experienced and successful professional nurses who are committed to the success of the unit/team.
As we continue to feel the impact of the nursing shortage and are forced to make difficult decisions regarding staffing on a daily basis, we must remain committed to maintaining education and training through nurse residency as a priority. Should we pull our new nurses out of their residency class this month to work on the unit? Should we pay staff overtime to cover patient care needs? Should we hire additional (and expensive) agency staff? Should we run the unit with less-than-ideal number of nurses? While some days we are tempted to take shortcuts and pull staff away from their residency program obligations, we have yet to do so. Our leadership team often steps into patient care or we offer incentive pay to our staff to cover the unit during those times to ensure that patient care does not suffer. We believe there is a positive return on our investment; as the cost of replacing a nurses has been estimated to be $92,000 and $145,0005. Additional strategies are to discuss the importance of residency programs with our entire staff—most notably our experienced nurses—so that they understand the residency’s value to the team and organization. We believe that this has been one of our strongest interventions because it builds buy-in and minimizes the chance that staff will negatively discuss the residency program. If their peers are speaking positively about the residency program, I believe they are more likely to fully-embrace the experience of the program. Lastly, we discuss our Nurse Residency Program in all of our interviews and have found this to be a competitive advantage when recruiting new nurses. In summary, promoting and supporting our organization’s nurse residency program has helped our recruitment and retention efforts at the unit level.
Dan Lose, DNP, RN, CNML
Nurse Manager, Inpatient General Medicine Unit
University of Iowa Hospitals & Clinics
daniel-lose@uiowa.edu
References:
1. Kovner, C.T., Brewer, C.S., Fatehi, F., & Jun, J. (2014). What does nurse turnover rate mean and what is the rate? Policy, Politics, & Nursing Practice, 15(3-4), 64-71.
2. Rhodes, M.K., Morris, A.H., & Lazenby, R.B. (2011). Nursing at its best: Competent and caring. The Online Journal of Issues in Nursing, 16(2).
3. Institute of Medicine (2010). The future of nursing: Leading change, advancing health. Retrieved from: www.nap.edu/read/12956/chapter/1#R1.
4. Dempsey, C. & Reilly, B.A. (2016). Nurse engagement: What are the contributing factors for success? The Online Journal of Issues in Nursing, 21(1).
5. Atencio, B.L., Cohen, J., & Gorenberg, B. (2003). Nurse retention: Is it worth it? Nursing Economics, 21(6).