The simultaneous need to retain today’s nurses while preparing to support and nurture the nurses of tomorrow has never been greater. We know that excellent patient care can be achieved with talented and knowledgeable nurses, but nurses are not always adequately trained and prepared for their increasingly challenging work. How can provider organizations bring new nursing staff up to speed? How can they prevent veteran nurses from being overburdened by tedious, unchallenging work?
In an advisory call sponsored by Elsevier Health and hosted by Becker’s Hospital Review, clinical nursing leaders discussed strategies for engaging and retaining both new and experienced nursing professionals to ensure optimal patient care and staff satisfaction.
For years, even prior to COVID-19, academic nursing programs have been testing students based on knowledge, not competency. This has bred a disconnect between academia and clinical practice such that many new nurses are entering the profession without the competencies they need. “Students pass their boards, get into the practice setting and have a hard time quickly adapting — they can’t recognize a problem and take it to resolution,” said a professor of nursing and clinical nurse specialist at an 18-hospital health system on the East Coast.
Aware of this gap, academic programs are shifting to competency-based education, while providers are adopting competency-based practice models. Organizations are also introducing nurse residency programs to provide on-the-job training for both new and experienced nurses who wish to develop their skills. Another approach providers are taking to bridge the gap between nurse experience and job complexity is by creating pre-skilling and immersion programs that transition student nurses into staff roles with sufficient support. “We see a very distinct difference among students who become nurses with us in terms of their comfort level and their ability to incorporate themselves into the environment,” said the vice president of professional development at an independent provider network in New Jersey. The chief nursing officer of an integrated healthcare network in the Midwest added that his institution has opened up additional resources and forums for new nurses to gain from the experience of senior staff.
There are many other ways providers are bridging the information gap: creating emeritus roles for retired nurses so they are able to pass on their knowledge to newer nurses, building virtual nurse networks to support patient flow, and leveraging predictive analytic tools to assist nurses at the bedside by surfacing patient risks that can be detected as the EMR ingests new information. The CNO of an academic health network in the Northeast said that since all its hospitals converged to the same EMR, it is exploring EMR-embedded AI to help bridge those gaps.
Ensuring the continuity of programs that strengthen clinical judgment beyond an onboarding or preceptorship period is also critical, said Robert Nieves, VP of health informatics at Elsevier Clinical Solutions. Elsevier partners with nurses throughout the entire career life cycle — from school to practice — and helps organizations develop workflows that facilitate clinical documentation, support decision-making and foster evidence-based best practices.
“The key piece here is making applied evidence practical for the clinicians,” Nieves said.
Healthcare organizations are also working to standardize evidence-based practice — a challenge related to both the experience-competency gap in new nurses and the accelerating trend of experienced professionals exiting the industry. To tackle that challenge, the CNO of an academic hospital network in the mid-Atlantic region said health systems need a permanent charge nurse or nursing leader available 24/7 to provide evidence-based expertise as needed. She added this would not only help keep patients safe, but also aid with reengaging and retaining seasoned staff.
Mr. Nieves noted that to retain veteran nurses, “one area that [healthcare organizations] also have to focus on is making sure that everyone is operating to the top of their license from a scope of practice perspective.”
This is especially relevant considering that veteran nurses with decades of experience, who may be a little more set in their ways, may not readily adopt evolving guidelines. To address this issue, Mr. Nieves said organizations can foster hunger for evidence-based practice information by providing such information in bite-sized pieces that are usable at the point of care. The CNO of a community hospital on the West Coast added that practicing emotional intelligence with senior nursing staff can also go a long way.
One of the reasons even new nursing staff are leaving the workforce is that hospitals often prevent them from getting exposure to different specialty areas, which helps them grow professionally. Another reason direct care nurses are getting burned out is that they are rarely given space and time to engage in non-direct care work they enjoy, such as in quality improvement and research projects.
“All of the literature says that if you don’t give people time, they can’t do this joyful work,” said the nursing leader from the East Coast. “And it’s that joyful work that improves the care at the hospital, helps nurses engage in the work of the hospital and helps them buy into the mission of the hospital.”
Provider organizations can help reverse those trends by empowering their professional development teams to codesign clinical programs that make fuller use of nurses’ talents, the VP of nursing education at a large health system in the Mid-Atlantic region said. She noted that nurse readiness can also be supported by having professional development teams codevelop the content of didactic programs at nursing schools or universities their institutions partner with.
The nature of clinical work is changing and only 50 percent of nurse leaders believe that new nurses are ready to practice.* Evidence-based practice and education help augment nursing practice, provide nursing students a solid base in preparation for their clinical careers and help novice nurses become patient-ready. At the same time, practicing nurses need options to upskill and reskill. Elsevier Health is an evidence-based partner for nurses that helps ensure that new nurses are practice-ready and helps existing nurses maximize their effectiveness and satisfaction.
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