Nursing Retention through Residency Programs: A Literature Review
Shannon G. Stone, MSN, RN, CCRN, SCRN
Texas Tech University Health Sciences Center School of Nursing
In partial fulfillment of the requirements of
NURS6330 Evidence Based Inquiry I
Jeannette Crenshaw, DNP, RN, LCCE, FACCE, IBCLC, NEA-BC, FAAN
September 27, 2015
Nursing Retention through Residency Programs: A Literature Review
A great cause for concern in today’s healthcare system is the shortage of nurses. The shortage of nurses will continue as society lives longer, albeit sicker, as technology advances. The chasm that exists between healthcare demand, available nurses and mid-level practitioner must be narrowed. Without a solution, healthcare disparities …show more content…
Literature Synthesis Over 12,000 journal articles were synthesized throughout the multiple searches. Limiting the research to 2015, there were just under 1,000 articles to look through for literature. Choosing to pick articles from multiple topics, new nursing residency programs were chosen in predominance. There was one article that focused specifically on the PICOT question discussing the difference in attrition rates when integrating a new nurse residency program versus continued use of a facility’s orientation program.
Nursing Retention An identified area in which healthcare managers are failing consistent effectiveness is in the retention of their nursing staff. With the need of nurses shaping the way many healthcare managers look at their staff, often it is the veteran nurse persuaded in staying. While in some settings this is truly beneficial, in others the cliché of nurses eating their young instills fear into new graduates; this fear and the lack of support ultimately leads to their exit (Rush, Adamack, Gordon, & Janke, 2014). With the associated costs of nursing attrition meeting rates of nearly $186,000 per registered nurse, it is imperative we institute nursing residency programs immediately and continually retaining staff and protecting healthcare institutions’ sustainability (Cubit, K.A. & Ryan, B., 2011; Lee, Tzeng, Lin, & Yeh, 2009).
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Registered nurses are an integral part of the healthcare system, and make up the largest number of healthcare professionals. According to the Bureau of Labor Statistics (2015) “The employment rate for registered nurses is expected to grow by 16% between 2014 and 2024”. This is more than double the average rate of growth for a profession. The rapid growth rate can be attributed in part to better management of chronic diseases and the baby boomer generation. The growth in the nursing profession is paramount, however the demographics of the nursing population does not mirror the demographics of the population served.
I believe that a lack of proper orientation can have a tremendous impact of nurse retention rates. With improper orientation the entire unit suffers. It correlates with a decrease in the quality of care, patient safety and satisfaction, as well as nurse confidence. Having all staff trained in an extensive and consistent orientation program brings about better continuity and higher quality of care, as well as an increase in positive patient outcomes. The lack of an extensive and consistent orientation program leads to a deficit in critical thinking skills and clinical knowledge. When a nurse is not fully prepared for her role within a unit, it directly translates into patient care practices. I believe it also leads to a decrease in staff satisfaction- for the new nurse as well as the seasoned nurses within the unit. This frustration can lead to burnout and ultimately a high turnover rate of nurses.
The publication from the institute of medicine has garnered much interest since its publication in 2010 focusing on the future of nursing and the implementation of this with in the nursing community. The nursing profession has over 3 million members and is the largest segment of the nation’s health care workforce. Working on the front lines of patient care, nurses can play a vital role in helping realize the objectives set forth in the 2010 IOM (Institute of Medicine). One of the recommendations is that of a nurse residency program for new nurses or nurses transitioning into new clinical practice areas. The area I work in is home health and this is a growth area the need for a residency program cannot be over stated home
The Institute of Medicine’s 2010 report on The Future of Nursing: Leading Change, Advancing Health acknowledges the changing healthcare sector in the US and describes future vision of healthcare and the role of nurses to fulfill that vision. The United States always strives to provide affordable and quality healthcare to the entire population of the country. In order to achieve this goal an overall restructuring of the healthcare system was necessitated. Nurses are considered to be the central part of the healthcare system to provide high quality and safe patient care. Nursing in the US is the single largest segment of the healthcare workforce with almost 3 million nurses working in different areas across the county. The changing
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.
It is likely that most people have heard about the nursing shortage for years now, and perhaps they believe it’s been fixed. However, the nursing profession is experiencing a reoccurring deficiency. According to Brian Hansen, (2002), there was a nation wide shortage in 2001 of 126,000 full-time registered nurses, but the shortage will surge to 808,000 by 2020 if something isn't done. This pattern is a persisting cycle of high vacancies followed by layoffs and a high over supply of registered nurses. Various factors contribute to the lack of nurses within the health care facilities, but today’s shortages are a little different. Many feel that this scarcity is severe and long-drawn-out. The four major issues contributing to
With the ongoing changes in the healthcare field, nursing workforce retention presents itself as one of the greatest challenges facing healthcare systems today. According to the American Nursing Association, nursing turnover is a multi-faceted issue which impacts the financial stability of the facility, the quality of patient care and has a direct affect on the other members of the nursing staff (ANA, 2014). The cost to replace a nurse in a healthcare facility ranges between $62,100 to $67,100 (ANA, 2014). The rising problem with nursing retention will intensify the nursing shortage, which has been projected to affect the entire nation, not just isolated areas of the country, gradually increasing in its scope from 2009 to 2030 (Rosseter,
Have you ever thought about the role a nurse has between his or her client? A nurse’s role is more than just helping clients when they are not feeling well. In 2007 there were a reportedly 12 million nurse’s employed (Bureau of Labor Statistics, 2009). That is a large amount of nurse’s that are employed in the world. A nurse protects, promotes, optimizes health and ability, prevents illness or injury, alleviates suffering through treatment and diagnosis of human response, and advocates in the care of individuals, families, communities, and populations (Amercian Nurses Association, 2012). A nurse stands for many good qualities but, why is there a big shortage of nurses?
Being a registered nurse affords one the option of working in many diverse healthcare settings. In any practice setting the climate of health care change is evident. There are diverse entities involved in the implementation and recommendation of these practice changes. These are led by the Robert Wood Johnson Foundation (RWJF), the Institute of Medicine (IOM), nursing campaign for action initiatives, as well as individual state-based action coalitions. Nurses need to be prepared and cognizant of the transformations occurring in health care settings as well as the plans that put them at the forefront of the future.
Nurse turnover is defined as “the number of nurses changing jobs within an organization or leaving an organization within a given year” (Baumann 2010). Retaining nurses is one of the most important issues in health care as its effects range from challenges in human resource planning, to high costs in financial and organizational productivity (Beecroft et al, 2008), to workgroup processes and morale, to patient safety and quality of care (i.e. patient satisfaction, length of patient stay, patient falls, and medication errors) (Bae et al, 2010). Nursing Solutions Inc (NSI) reported the national average turnover rate for hospitals increased from 13.5% in 2012 to 14.7% last year. Nurses working in Med/Surg had more turnover
through the wound care being performed and missed a major step in caring for that patient, leading to infection. The effect of increased nurses to patients has been shown many times to improve patients’ outcome.
According to Paller (2012), the nursing shortage in different countries for example the United States tends not to be the only growing problem, but has also become a complex one. Nursing shortage and nurse's turnover has become the worsening predicament in the health care industry in the United
There are many stakeholders involved in the healthcare system including healthcare administrator, healthcare professionals, hospitals, primary care, and patients. Burrows, Suh, and Hamann (2012) states that the Association of American Medical Colleges believes that by the year 2025 there will be a shortage or at least 124,000 full-time doctors and the Council on Graduate Medical Education believes that by the year 2020 there will be a shortage of 85,000 doctors which is 10 percent of the doctors in the healthcare field today. The need for nurses is increasing because there is already a shortage of nurses. But this need will become even more urgent as nurses retire. According to Burrows, Suh, and Hamann (2012) over 51 percent of nurses today are 40 years old and 50 year old nurses make up 40 percent. So, when these nurses retire there will be a shortage and an urgent need to fill the vacancies of these nurses.