- Email: [email protected]
Nursing Residency: Reversing the Cycle of New Graduate RN Turnover
Nursing Residency Reversing the Cycle of New Graduate RN Turnover Suzie Reinsvold, RN, MSN
A
nationwide nursing shortage that shows no signs of abating is creating a vicious cycle for hospitals scrambling to meet the demands of patient care. Today, many hospitals supplement their recruitment initiatives through increased financial incentives and workplace perks for nurses, but this is proving to be only a bandage solution to a retention problem that stems from deeper issues than salaries alone. More new graduate nurses are coming onto patient care units faster than ever before, yet many lack the requisite skills and experience to perform independently in 46 Nurse Leader
complex patient care situations. Not surprisingly, new nurses are leaving their inaugural jobs at alarmingly high rates within the first 2 years of service.1 As the direct costs of filling a vacated nursing position reach at least 100% of a new graduate nurse’s annual salary, new graduate turnover represents a substantial cost to hospitals.2 The better approach doesn’t lie in spiraling financial incentives; it lies in bridging the gap between the educational and clinical settings, providing new graduate RNs with the support, training, and professional guidance to excel, and in empowering nurses to provide December 2008
confident care to their patients. The answer also lies in simultaneously instilling and sustaining strong nursing leadership through quantifiable, outcome-driven education innovations. A top-down, organization-wide commitment to improving the skills and knowledge of the entire nursing staff can reduce turnover, lower staffing costs, improve morale, and increase the quality of patient care.
An Aging RN Workforce
THE RN WORKFORCE SHORTAGE: A PERFECT STORM
A Preparation Gap for Newly Graduated Nurses
Within 10 years, 40% of working RNs will be 50 years old or older, according to the international honor society of nursing, Sigma Theta Tau.5 While enrollments in baccalaureate nursing programs have increased in the past 25 years,6 there are not enough new-hire replacements emerging from nursing schools.
For hospitals and medical centers of almost every size Fifty years ago, most nurses received their education and location, addressing the increasing and critical shortthrough hospital-facilitated, 3-year programs that included age of skilled, qualified RNs is a top priority. An American regular 8-hour work shifts in the clinical facilities. As a Hospital Association report released in June 2001 notes result, newly graduated nurses were very well prepared that there are more than 168,000 vacant hospital positions to hit the ground running. In the late 1960s and 1970s, nationwide, 126,000 of which are for nurses.3 Unfortunatehowever, nurse education extended beyond the diploma ly, experts don’t foresee any easing of the problem in the programs into academia to foster a more well-rounded future. In fact a recent study by PriceWaterhouseCooper’s arts and sciences foundation. This shift resulted in a Health Research Institute reported “preparation gap” that hospitals have that the United States will face a since struggled to redress. Newer shortage of nearly 1 million nurses graduates are often better versed in As nursing professionals, and 24,000 doctors by 2020.4 theory, but lack the pragmatic skills we recognize that bringing they need to apply what they know What’s more, new graduate RN candidates in the door is in actual patient care situations. turnover is currently between 35% and 60% within the first 12 months only the first step toward of employment5 and 57% at 2 years Risks to Patient Care grooming capable, of hire,6 according to reports pubThe literature is clear in this respect: committed, and thriving lished in 2001 and 2005 in the low RN staffing in hospitals is directly Journal of Nursing Administration. related to adverse patient outcomes, nurse leaders of tomorrow. Those vacancies and churn rates including patient complications and stem from several factors: death.7 The difference between a RN caring for four to six patients at the Complex Patient Care Demands same time results in a 14% increase in likely death for those Today’s patient care settings are much more complex patients; a RN caring for eight patients simultaneously transthan those of even 10 to 20 years ago. Patients are often lates to a 31% greater likelihood of patient death.7 sicker, however, less time is afforded for in-patient care. Due to the exponential growth of the number of availDecreased Staff Satisfaction able pharmaceuticals, clinicians find it increasingly chalLarge patient-to-RN ratios were directly linked to highlenging to stay informed about drug side effects and er rates of job dissatisfaction by nurses, according to a interaction information. Additionally the rapid adoption 2002 University of Pennsylvania study.7 What’s more; of emerging technologies that are being integrated within nursing shortages create other staffing challenges, such as the clinical setting, including electronic medical records mandatory overtime and a lack of leadership succession. and Web-based clinical reference tools, compounds the These factors directly affect morale and lead to additional complexity of today’s clinical environment. A final factor turnover cycles. is the dramatic increase in patient load. While a nurse As nursing professionals, we recognize that bringing canmay begin her shift with five patients, due to admissions, didates in the door is only the first step toward grooming discharges, and transfers to the unit throughout the capable, committed, and thriving nurse leaders of tomorcourse of the shift, the nurse may end up caring for an row. The time is now for us to begin integrating a more entirely different group of five patients by shift’s end. As substantive and strategic approach that focuses on higher such, nurses today must develop the skills to optimize retention rates that are driven by optimized training initiatheir time and resources to successfully coordinate an intives, nursing leadership, and empowerment opportunities, creasingly complex patient care environment. as well as a deep commitment from senior level executives.
An Aging Patient Population Patient populations are increasing as Baby Boomers march into retirement, resulting in greater demand for more nurses who can manage more complex cases. December 2008
RETHINKING THE RECRUITMENT/TRAINING PARADIGM In today’s competitive health care environment, most hospitals are operating with high nurse vacancies. As
Nurse Leader 47
care organizations seek. The Baldrige National Quality such, whenever new nurses are hired, administrators are Program Healthcare Criteria for Performance Excellence eager to deploy them as quickly as possible. As many includes: visionary leadership; patient-focused excellence; new nurse hires lack solid real-world clinical experience, organizational and personal learning; valuing staff and however, being thrown into an unexpectedly difficult partners; agility; focus on the future, managing for innoclinical setting sets the stage for rapid turnover. vation; managing by fact; social responsibility and comIn response, many hospitals have assembled homemunity health; focus on results and creating value; and grown orientation/training programs. While this is clearly systems perspective. An evidencea beneficial initiative, there can be based nursing residency successfully challenges with respect to the scope By making a commitment codifies quality measures that reflect of curriculum, and its uniform applito developing the such standards and optimize the recation to all incoming nurses. What’s tention, competence, and confimore, due to the “silo” approach to competence and confidence dence of new nurse hires. on-boarding new graduates found in of newly graduated nurses, Finally, the American Nurses’ Cremany homegrown programs, the a nursing residency dentialing Center (ANCC) awards level and quality of the orientation Magnet Status to hospitals that satisfy material often differs by department, achieves numerous a set of criteria–so-called “Forces of often creating duplication of effort important benefits and Magnetism”–designed to measure the and inefficient use of resources. Furadvantages. strength and quality of their nursing thermore, variation in content proservices. Magnet designation is an vided by training facilitators and important recognition of how the preceptors frequently exists. Most hospital values the contributions of its nursing staff and, often, outcome measurement of such programs is minias such, can be an important element of effective recruitmal or nonexistent. Make no mistake–homegrown orienment and retention initiatives (as well as improving outtation/training initiatives are very well-intentioned. comes and attracting patients). By measuring criteria such However, they quickly get outstripped by time conas quality of nurse leadership, leader empowerment, perstraints, divergent clinical instruction, and subtle misalignsonnel policies, nursing satisfaction, improvements in ments with standards of care. quality of care, consultation and services, autonomy, comA STRUCTURED NURSING RESIDENCY: munity relationship, teaching and leadership, and interdisCOMPETENCE AND CONFIDENCE ciplinary relationships, a quality nursing residency will In the face of such an intractable nursing shortage incorporate many of the leadership and empowerment stemming from a variety of causes, band-aid solutions–a principles of the Magnet program within the scope of its few more dollars here and a few days of ad hoc orientacurriculum and program structure. Metrics of quality and tion there–simply do not begin to infuse the systemic excellence described by organizations such as JCAHO, change that is needed. From the start of the recruitment Malcolm Baldrige, and ANCC can provide focus for measprocess through the first 2 years of a nurse’s tenure, hosuring the success and effectiveness of a nurse residency. pitals must adopt a holistic, leadership-focused, and evidence-based approach for attracting and retaining new A BETTER WAY FOR NURSES, HOSPITALS, nurses, one that reflects and embodies an intrinsic orgaAND PATIENTS nizational commitment to ensuring professional excelBy making a commitment to developing the compelence and personal satisfaction. tence and confidence of newly graduated nurses, a nursIncreasingly, a host of forward-looking health care ining residency achieves numerous important benefits and stitutions are implementing highly structured, repeatable advantages. First and foremost, it is designed to lower the nursing residency programs to support new nurse hires turnover rate for new nurse hires. The industry average for in the transition from student to professional. turnover in a newly graduated nurse’s first year is 35%. However, once a structured residency program is in place, THE ALIGNMENT OF A NURSING RESIDENCY some hospitals have seen that average drop to as little as WITH QUALITY PERFORMANCE STANDARDS 6%. As a result, hospitals can save millions of dollars in reMeasurement of clinical best practices is a vital elecruitment, retention, overtime, and temporary-nurse costs. ment for the successful alignment of a nurse residency What’s more, increased stability in the nursing workforce and overarching quality performance standards within the translates into a higher level of patient care. healthcare industry. The Joint Commission on AccreditaMany hospitals find that a comprehensive and struction of Healthcare Organizations (JCAHO), which evalutured nursing residency gives their institution a significant ates and accredits US hospitals on their ability to deliver recruiting advantage over other health care institutions quality and safety of care, serves as a baseline performcompeting for a shrinking talent pool. They attract more ance standard. The Malcolm Baldrige National Quality and higher quality candidates who seek the additional Award is another esteemed designation that many healthskills and training that a residency provides. 48 Nurse Leader
December 2008
Once they complete the residency, new nurses anecdotally report much higher levels of job satisfaction arising from the self-assurance that they have the skills and training they need to successfully meet their job challenges–and that their hospital is committed to their success. In fact, many nurse residency graduates have asserted that through the residency, they increased their mastery of essential critical thinking skills. This sense of empowerment may also encourage the new nurse to take on leadership responsibilities and positions within their organizations. Though the structure of a nursing residency can vary, some hospitals find that the mentoring relationships that often form can provide a valuable support network to new nurses coping with job stresses that inevitably arise—particularly in the critical early stages of one’s career—and help give structure to future career paths. In fact, recent data suggests that an effective mentor program significantly correlates with decreased nursing turnover. According to a recent study in the Journal of Nursing Administration, a mentor can be instrumental in the retention of new graduates by increasing their confidence, as well as serving as a model for professional nursing behaviors.8 For the hospital, a nursing residency program has a significantly favorable impact in the two areas that matter most: patient care and cost. Although the extended training period may create a lengthier on-boarding process, over the longer term, it dramatically accelerates the professional development of a newly graduated nurse. Nurses who complete the residency quickly surpass the skills and capabilities of their peers who don’t have the experience of a residency. A residency program reduces the variability of clinical practice and patient care across the institution. There’s a uniform method for training nursing skills and documenting evidence of their mastery. By onboarding all new graduates the same way, the new nurse and the entire healthcare team benefit, but the patient is the ultimate beneficiary of the hospital’s shared institutional knowledge. Collectively, the greater stability in the nursing workforce, improved competency and confidence, greater job satisfaction, lower costs, and potential for improved patient care present a compelling case for hospitals to bring greater structure to their new graduate nurse training programs through a comprehensive, institution-wide nursing residency. What’s more, a nursing residency creates significant opportunities for senior nurses to develop their leadership skills and for new nurses to identify and pursue a well-defined career path that provides opportunities for growth and leadership. References 1. 2.
Bland Jones C. The costs of nurse turnover: an economic perspective. J Nurs Admin 2004; 34:562. Department of Veteran’s Affairs, Office of the Inspector General. Evaluation of nurse staffing in Veteran’s Health Administration facilities. Aug. 13, 2004. Report No. 03-00079-183.
December 2008
3.
4.
5.
6.
7.
8.
The hospital workforce shortage: immediate and future. AHA Trendwatch. June 2001. Available at: http://www.hospitalconnect.com/ahapolicyforum/trendwatch/twjune2001.html. Accessed: September 20, 2007. PriceWaterhouseCoopers Health Research Institute. What works: Healing the healthcare staffing shortage. Available at: http://www.pwc.com/extweb/pwcpublications.nsf/docid/674D 1E79A678A0428525730D006B74A9. Accessed October 5, 2007. Buerhaus PI, Staiger DO, Auerbach DI. Is the current shortage of hospital nurses ending? J Health Affairs 2003;22(6):191198. The Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions. 2004 National Sample Survey of Registered Nurses. 2004:7. Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. J App Nurs Res 2002;228:16. Beecroft P, Santner S, Lacy ML, Kunzman L, Dorey F, New graduates’ perception of mentoring: six-year program evaluation. J Nurs Admin 2006;55(6):736-747.
Suzie Reinsvold, RN, MSN, is senior vice president of implementation and standards for Versant Advantage, Inc., in Los Angeles, California. She can be reached at [email protected].
1541-4612/2008/ $ See front matter Copyright 2008 by Mosby Inc. All rights reserved. doi:10.1016/j.mnl.2007.11.002
Teamwork, Teams, and Reality Continued from page 6 learning, and well-grounded experience. Using their skill level appropriately, while working with others to carry out tasks that do not require their expertise, is just common sense. I have maintained that inappropriate use of professionals is demoralizing as well as costly. It wastes their time and energy and is not motivating. My timing may have been completely off, but I still believe that continuity where team members work together is ideal, requiring the professional nurse’s leadership. In addition, implementation of essential processes to enhance information sharing, input, and appropriate and timely use of resources can only enhance success for the patient, professional, and organization. Ken Blanchard stated it well when he said, “None of us is as smart as all of us.” Editor in Chief Roxane Spitzer, PhD, MBA, RN, FAAN, can be reached at [email protected]. 1541-4612/2008/ $ See front matter Copyright 2008 by Mosby Inc. All rights reserved. doi:10.1016/j.mnl.2008.09.006
Nurse Leader 49
A
nationwide nursing shortage that shows no signs of abating is creating a vicious cycle for hospitals scrambling to meet the demands of patient care. Today, many hospitals supplement their recruitment initiatives through increased financial incentives and workplace perks for nurses, but this is proving to be only a bandage solution to a retention problem that stems from deeper issues than salaries alone. More new graduate nurses are coming onto patient care units faster than ever before, yet many lack the requisite skills and experience to perform independently in 46 Nurse Leader
complex patient care situations. Not surprisingly, new nurses are leaving their inaugural jobs at alarmingly high rates within the first 2 years of service.1 As the direct costs of filling a vacated nursing position reach at least 100% of a new graduate nurse’s annual salary, new graduate turnover represents a substantial cost to hospitals.2 The better approach doesn’t lie in spiraling financial incentives; it lies in bridging the gap between the educational and clinical settings, providing new graduate RNs with the support, training, and professional guidance to excel, and in empowering nurses to provide December 2008
confident care to their patients. The answer also lies in simultaneously instilling and sustaining strong nursing leadership through quantifiable, outcome-driven education innovations. A top-down, organization-wide commitment to improving the skills and knowledge of the entire nursing staff can reduce turnover, lower staffing costs, improve morale, and increase the quality of patient care.
An Aging RN Workforce
THE RN WORKFORCE SHORTAGE: A PERFECT STORM
A Preparation Gap for Newly Graduated Nurses
Within 10 years, 40% of working RNs will be 50 years old or older, according to the international honor society of nursing, Sigma Theta Tau.5 While enrollments in baccalaureate nursing programs have increased in the past 25 years,6 there are not enough new-hire replacements emerging from nursing schools.
For hospitals and medical centers of almost every size Fifty years ago, most nurses received their education and location, addressing the increasing and critical shortthrough hospital-facilitated, 3-year programs that included age of skilled, qualified RNs is a top priority. An American regular 8-hour work shifts in the clinical facilities. As a Hospital Association report released in June 2001 notes result, newly graduated nurses were very well prepared that there are more than 168,000 vacant hospital positions to hit the ground running. In the late 1960s and 1970s, nationwide, 126,000 of which are for nurses.3 Unfortunatehowever, nurse education extended beyond the diploma ly, experts don’t foresee any easing of the problem in the programs into academia to foster a more well-rounded future. In fact a recent study by PriceWaterhouseCooper’s arts and sciences foundation. This shift resulted in a Health Research Institute reported “preparation gap” that hospitals have that the United States will face a since struggled to redress. Newer shortage of nearly 1 million nurses graduates are often better versed in As nursing professionals, and 24,000 doctors by 2020.4 theory, but lack the pragmatic skills we recognize that bringing they need to apply what they know What’s more, new graduate RN candidates in the door is in actual patient care situations. turnover is currently between 35% and 60% within the first 12 months only the first step toward of employment5 and 57% at 2 years Risks to Patient Care grooming capable, of hire,6 according to reports pubThe literature is clear in this respect: committed, and thriving lished in 2001 and 2005 in the low RN staffing in hospitals is directly Journal of Nursing Administration. related to adverse patient outcomes, nurse leaders of tomorrow. Those vacancies and churn rates including patient complications and stem from several factors: death.7 The difference between a RN caring for four to six patients at the Complex Patient Care Demands same time results in a 14% increase in likely death for those Today’s patient care settings are much more complex patients; a RN caring for eight patients simultaneously transthan those of even 10 to 20 years ago. Patients are often lates to a 31% greater likelihood of patient death.7 sicker, however, less time is afforded for in-patient care. Due to the exponential growth of the number of availDecreased Staff Satisfaction able pharmaceuticals, clinicians find it increasingly chalLarge patient-to-RN ratios were directly linked to highlenging to stay informed about drug side effects and er rates of job dissatisfaction by nurses, according to a interaction information. Additionally the rapid adoption 2002 University of Pennsylvania study.7 What’s more; of emerging technologies that are being integrated within nursing shortages create other staffing challenges, such as the clinical setting, including electronic medical records mandatory overtime and a lack of leadership succession. and Web-based clinical reference tools, compounds the These factors directly affect morale and lead to additional complexity of today’s clinical environment. A final factor turnover cycles. is the dramatic increase in patient load. While a nurse As nursing professionals, we recognize that bringing canmay begin her shift with five patients, due to admissions, didates in the door is only the first step toward grooming discharges, and transfers to the unit throughout the capable, committed, and thriving nurse leaders of tomorcourse of the shift, the nurse may end up caring for an row. The time is now for us to begin integrating a more entirely different group of five patients by shift’s end. As substantive and strategic approach that focuses on higher such, nurses today must develop the skills to optimize retention rates that are driven by optimized training initiatheir time and resources to successfully coordinate an intives, nursing leadership, and empowerment opportunities, creasingly complex patient care environment. as well as a deep commitment from senior level executives.
An Aging Patient Population Patient populations are increasing as Baby Boomers march into retirement, resulting in greater demand for more nurses who can manage more complex cases. December 2008
RETHINKING THE RECRUITMENT/TRAINING PARADIGM In today’s competitive health care environment, most hospitals are operating with high nurse vacancies. As
Nurse Leader 47
care organizations seek. The Baldrige National Quality such, whenever new nurses are hired, administrators are Program Healthcare Criteria for Performance Excellence eager to deploy them as quickly as possible. As many includes: visionary leadership; patient-focused excellence; new nurse hires lack solid real-world clinical experience, organizational and personal learning; valuing staff and however, being thrown into an unexpectedly difficult partners; agility; focus on the future, managing for innoclinical setting sets the stage for rapid turnover. vation; managing by fact; social responsibility and comIn response, many hospitals have assembled homemunity health; focus on results and creating value; and grown orientation/training programs. While this is clearly systems perspective. An evidencea beneficial initiative, there can be based nursing residency successfully challenges with respect to the scope By making a commitment codifies quality measures that reflect of curriculum, and its uniform applito developing the such standards and optimize the recation to all incoming nurses. What’s tention, competence, and confimore, due to the “silo” approach to competence and confidence dence of new nurse hires. on-boarding new graduates found in of newly graduated nurses, Finally, the American Nurses’ Cremany homegrown programs, the a nursing residency dentialing Center (ANCC) awards level and quality of the orientation Magnet Status to hospitals that satisfy material often differs by department, achieves numerous a set of criteria–so-called “Forces of often creating duplication of effort important benefits and Magnetism”–designed to measure the and inefficient use of resources. Furadvantages. strength and quality of their nursing thermore, variation in content proservices. Magnet designation is an vided by training facilitators and important recognition of how the preceptors frequently exists. Most hospital values the contributions of its nursing staff and, often, outcome measurement of such programs is minias such, can be an important element of effective recruitmal or nonexistent. Make no mistake–homegrown orienment and retention initiatives (as well as improving outtation/training initiatives are very well-intentioned. comes and attracting patients). By measuring criteria such However, they quickly get outstripped by time conas quality of nurse leadership, leader empowerment, perstraints, divergent clinical instruction, and subtle misalignsonnel policies, nursing satisfaction, improvements in ments with standards of care. quality of care, consultation and services, autonomy, comA STRUCTURED NURSING RESIDENCY: munity relationship, teaching and leadership, and interdisCOMPETENCE AND CONFIDENCE ciplinary relationships, a quality nursing residency will In the face of such an intractable nursing shortage incorporate many of the leadership and empowerment stemming from a variety of causes, band-aid solutions–a principles of the Magnet program within the scope of its few more dollars here and a few days of ad hoc orientacurriculum and program structure. Metrics of quality and tion there–simply do not begin to infuse the systemic excellence described by organizations such as JCAHO, change that is needed. From the start of the recruitment Malcolm Baldrige, and ANCC can provide focus for measprocess through the first 2 years of a nurse’s tenure, hosuring the success and effectiveness of a nurse residency. pitals must adopt a holistic, leadership-focused, and evidence-based approach for attracting and retaining new A BETTER WAY FOR NURSES, HOSPITALS, nurses, one that reflects and embodies an intrinsic orgaAND PATIENTS nizational commitment to ensuring professional excelBy making a commitment to developing the compelence and personal satisfaction. tence and confidence of newly graduated nurses, a nursIncreasingly, a host of forward-looking health care ining residency achieves numerous important benefits and stitutions are implementing highly structured, repeatable advantages. First and foremost, it is designed to lower the nursing residency programs to support new nurse hires turnover rate for new nurse hires. The industry average for in the transition from student to professional. turnover in a newly graduated nurse’s first year is 35%. However, once a structured residency program is in place, THE ALIGNMENT OF A NURSING RESIDENCY some hospitals have seen that average drop to as little as WITH QUALITY PERFORMANCE STANDARDS 6%. As a result, hospitals can save millions of dollars in reMeasurement of clinical best practices is a vital elecruitment, retention, overtime, and temporary-nurse costs. ment for the successful alignment of a nurse residency What’s more, increased stability in the nursing workforce and overarching quality performance standards within the translates into a higher level of patient care. healthcare industry. The Joint Commission on AccreditaMany hospitals find that a comprehensive and struction of Healthcare Organizations (JCAHO), which evalutured nursing residency gives their institution a significant ates and accredits US hospitals on their ability to deliver recruiting advantage over other health care institutions quality and safety of care, serves as a baseline performcompeting for a shrinking talent pool. They attract more ance standard. The Malcolm Baldrige National Quality and higher quality candidates who seek the additional Award is another esteemed designation that many healthskills and training that a residency provides. 48 Nurse Leader
December 2008
Once they complete the residency, new nurses anecdotally report much higher levels of job satisfaction arising from the self-assurance that they have the skills and training they need to successfully meet their job challenges–and that their hospital is committed to their success. In fact, many nurse residency graduates have asserted that through the residency, they increased their mastery of essential critical thinking skills. This sense of empowerment may also encourage the new nurse to take on leadership responsibilities and positions within their organizations. Though the structure of a nursing residency can vary, some hospitals find that the mentoring relationships that often form can provide a valuable support network to new nurses coping with job stresses that inevitably arise—particularly in the critical early stages of one’s career—and help give structure to future career paths. In fact, recent data suggests that an effective mentor program significantly correlates with decreased nursing turnover. According to a recent study in the Journal of Nursing Administration, a mentor can be instrumental in the retention of new graduates by increasing their confidence, as well as serving as a model for professional nursing behaviors.8 For the hospital, a nursing residency program has a significantly favorable impact in the two areas that matter most: patient care and cost. Although the extended training period may create a lengthier on-boarding process, over the longer term, it dramatically accelerates the professional development of a newly graduated nurse. Nurses who complete the residency quickly surpass the skills and capabilities of their peers who don’t have the experience of a residency. A residency program reduces the variability of clinical practice and patient care across the institution. There’s a uniform method for training nursing skills and documenting evidence of their mastery. By onboarding all new graduates the same way, the new nurse and the entire healthcare team benefit, but the patient is the ultimate beneficiary of the hospital’s shared institutional knowledge. Collectively, the greater stability in the nursing workforce, improved competency and confidence, greater job satisfaction, lower costs, and potential for improved patient care present a compelling case for hospitals to bring greater structure to their new graduate nurse training programs through a comprehensive, institution-wide nursing residency. What’s more, a nursing residency creates significant opportunities for senior nurses to develop their leadership skills and for new nurses to identify and pursue a well-defined career path that provides opportunities for growth and leadership. References 1. 2.
Bland Jones C. The costs of nurse turnover: an economic perspective. J Nurs Admin 2004; 34:562. Department of Veteran’s Affairs, Office of the Inspector General. Evaluation of nurse staffing in Veteran’s Health Administration facilities. Aug. 13, 2004. Report No. 03-00079-183.
December 2008
3.
4.
5.
6.
7.
8.
The hospital workforce shortage: immediate and future. AHA Trendwatch. June 2001. Available at: http://www.hospitalconnect.com/ahapolicyforum/trendwatch/twjune2001.html. Accessed: September 20, 2007. PriceWaterhouseCoopers Health Research Institute. What works: Healing the healthcare staffing shortage. Available at: http://www.pwc.com/extweb/pwcpublications.nsf/docid/674D 1E79A678A0428525730D006B74A9. Accessed October 5, 2007. Buerhaus PI, Staiger DO, Auerbach DI. Is the current shortage of hospital nurses ending? J Health Affairs 2003;22(6):191198. The Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions. 2004 National Sample Survey of Registered Nurses. 2004:7. Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. J App Nurs Res 2002;228:16. Beecroft P, Santner S, Lacy ML, Kunzman L, Dorey F, New graduates’ perception of mentoring: six-year program evaluation. J Nurs Admin 2006;55(6):736-747.
Suzie Reinsvold, RN, MSN, is senior vice president of implementation and standards for Versant Advantage, Inc., in Los Angeles, California. She can be reached at [email protected].
1541-4612/2008/ $ See front matter Copyright 2008 by Mosby Inc. All rights reserved. doi:10.1016/j.mnl.2007.11.002
Teamwork, Teams, and Reality Continued from page 6 learning, and well-grounded experience. Using their skill level appropriately, while working with others to carry out tasks that do not require their expertise, is just common sense. I have maintained that inappropriate use of professionals is demoralizing as well as costly. It wastes their time and energy and is not motivating. My timing may have been completely off, but I still believe that continuity where team members work together is ideal, requiring the professional nurse’s leadership. In addition, implementation of essential processes to enhance information sharing, input, and appropriate and timely use of resources can only enhance success for the patient, professional, and organization. Ken Blanchard stated it well when he said, “None of us is as smart as all of us.” Editor in Chief Roxane Spitzer, PhD, MBA, RN, FAAN, can be reached at [email protected]. 1541-4612/2008/ $ See front matter Copyright 2008 by Mosby Inc. All rights reserved. doi:10.1016/j.mnl.2008.09.006
Nurse Leader 49