Nurse Retention

Orientation Stage—involves nurses learning about patients and they initial concerns and needs. Patents also learn about the role of the nurse. Patents are informed about the general purpose of taking with the nurse. The initial purpose is plainly: identifying a problem on which you want to work, helping you figure out what has been happening to you lately, or getting to know what has been bothering you. This first stage is about building trust first before moving on to your initial assessment. Afterwards the nurses job is to manage the patients emotions and providing support and structure to the pt.

The key learning points and insights learned is that in nursing, learning never ends. As the health care system continues to change, it is the nurse’s obligation to do the same. By reflecting on previous clinical feedback I realized that entering my first year of practice, I will be a novice nurse that will have a lot of personal and professional development to gain. The CNO style-learning plan will aid me in my first year of practice on a medicine floor.

With the prevalence of nursing shortages, more specialty units are now hiring new graduate nurses in positions that were once reserved for experienced nurses (Maiocco, G., 2003).

There are many challenges facing today’s nursing leaders and managers. From staffing and scheduling, to budget cuts and reduced reimbursements, today’s nursing leaders must evolve to meet the ever changing health care environment. Constance Schmidt, Chief Nursing Officer at Cheyenne Regional Medical Center (CRMC), identified retaining experienced registered nurses (RN) as one of the biggest problems she faces as a nursing leader. She went on to state “Nationally, most hospitals have more than 60% of their nurses with at least 5 years of experience. At CRMC, it’s the reverse. We have more than 60% of our nurses with less than 5 years of experience” (personal communication, March 28, 2014). The two largest factors affecting those numbers are the nursing shortage and nursing retention. The first, the nursing shortage, was identified years ago and has been researched countless times. Some projections indicate the number representing the gap between available registered nurses, and the positions needing to be filled, could be over a million before the end of the current decade. The latter, retention of nurses, is a problem in every health care facility in the nation. Nursing turnover results in both a significant financial cost to hospitals, and a significant impact on the community through its effects on patient outcome.

Across the United States, hospitals are experiencing a nursing shortage. Yet, according to the American Association of Colleges of Nursing, 63,857 students graduated from nursing school in 2015 alone and enrollment is increasing. It seems like a lot of new nurses to fill those vacancies, does it not? Studies show, however, that within a year, about thirty percent of those new graduates have voluntarily left their job (Hillman). Further studies have attributed the high turnover rate to new nurses’ lack of competency to handle conflict, make critical decisions, and function autonomously (Bratt). Many of the new graduates are disappointed with the hospital’s orientation, or lack thereof. Lack of knowledgeable preceptors and lack of nursing staffing in general has led to new nurses being thrown into autonomous function more quickly. Without proper training, these nurses must make sound clinical judgements and provide competent care to patients, which anyone can imagine is stressful. Today, Nurse Residency Programs (NRPs) are being instituted in numerous hospitals as a way to improve new graduate nursing skill, but research shows many other benefits to these programs. NRPs also reduce hospital spending costs, increase patient safety, and most importantly increase new nurse retention rates.

Staff satisfaction is empirical in retention of nurses in any healthcare setting. Although a slight turnover is necessary to maintain the diversity of ideas, too much of it causes instability that might affect patient and employee satisfaction negatively (Marquis & Huston, 2015). The planned change is to be executed at a small, private hospital (SPH) in Los Angeles with a 200-bed capacity, which offers emergency and medical-surgical services for adults. After a six-week hospital orientation, only 20% of new RNs hired at SPH in 2015 rated their confidence levels at >70% (Appendix A). Out of 32 new hires, 7 left during orientation, and 12 left before reaching 1 year- leading to 41% retention or a 59% turnover (Appendix B). The RN turnover of SPH is thrice the

Increasing acuity and rising complexity of acute-care patient populations, lack of a standard national nurse residency program, low job satisfaction scores of graduate nurses, and a high turnover rate of graduate nurses are a few of the important factors that led to the creation of the University HealthSystem Consortium (UHC) and the American Association of Colleges of Nursing (AACN) national nurse residency program (NRP).

The nursing shortage in healthcare has been a highlighted issue for many years. With the ever-growing health care system, hospitals and healthcare facilities often find themselves searching for ways to acquire new nurses and retain their very own. Throughout the years, the number one solution to this problem remains the same: decreasing nurse turnover, and increasing nurse retention. This paper discusses the causes of high nurse turnover rate, the negative effects on health care, and ways to improve the turnover rate.

Nursing shortage and nursing turn-over cannot be addressed through a single intervention because there are multiple reasons for the shortage and turn-over. Nurse managers and leaders play a major role in solving this problem by different approaches. Many different strategies are available to address these issues and they are described as follows.

In addition to hands on experience, clinical rotations are a great opportunity for students to witness nurses using delegation and supervision first hand.

Many people believe mandatory residency programs for newly licensed nurses are long overdue. The knowledge needed to practice nursing has grown to include health policy, ethics, public health, research, healthcare delivery improvements, as well as leadership skills. Nurses are part of the multi-disciplinary team and must work together with healthcare providers who possess masters or doctoral degrees. Nursing school prepares nurses with the basic information they need to know in order to practice safe nursing. However, modern nurses are faced with ever increasing demands. New nurses must know how to collaborate with the healthcare team, manage their priorities, stay organized and recognize life-threatening situations. Many new grads are overwhelmed with the demands of nursing, which can lead to compromised patient care and safety. Formalized, supervised guidance will improve patient care and retain nurses. The study also recommended doubling the amount of nurses with a masters or doctoral degree by 2020 in order to provide an adequate supply of nurses who are able to assume nurse faculty, primary care providers, and researcher positions.

The ongoing instability evidenced from the high mobility of qualified nurses in the nursing workforce has raised many questions about the issue of nursing shortage and nurse turnover (Gates & Jones, 2007). The paper below discusses the issues of nursing shortage and nurse turnover. The paper also describes how leaders as well as managers in the nursing fraternity and other leaders can resolve those problems effectively and the different applicable principles, skills, roles of the leader, and theories of leadership and management.

The purpose of orientation is to motivate employees, reduce turnover rates, and to lower the new employee anxieties (Ragsdale, 2005). Nurses have a great responsibility regardless of the positions and roles they play. The orientation program is needed to help nurses understand the responsibility of the position and to build the confidence they need to succeed. Whether a nurse has experience or not, transitioning into a new position can be thrilling or threatening (Dellasega, 2009). Nurses transitioning to an advanced practice role or specialty roles may require more support. The goals of the nurse manager orientation are to orientate managers to the mission and values, provide overview of the structure, decision making bodies, and key functions, and to articulate specific expectations about performance and responsibility for compliance (New Manager Orientation Program).

In the orientation role, the nurse and patient spend time getting to know each other. In the identification phase, the nurse helps the patient identify his or her needs. The patient begins to focus on new goals in the exploitation phase, and finally, in the resolution phase, the nurse and the patient collaboratively agree the patient has met his or her goals.

I am excited to write about my experience of community health clinical orientation because I feel the students’ opinions are considered and value in order to continue to better the nursing program. The online orientation was great because many times, having orientation all day on campus can be draining and many students do not focus towards the end of the day. I was concerned about the lack of communication and organization; however it is understandable, there are many changes in the beginning of the semester. I liked having an audio in one of the power points because it provided more information since in my opinion the power points did not contain enough information to guide us into the semester as well as what professors are expecting from students. The videos required to watch also formed stress in all the students because they were not available and many did not know who to reach out to for help due to the lack of communication. I was able to only get through fifteen minutes of one of the videos before it stopped working and I enjoyed those few minutes because community nursing has an important history. The quiz provided was a good strategy to make sure students studied the power points and I believe this type of orientation should continue because it allows students to focus more and it’s an encouragement to read the information.