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CNO Exchange: Nurse Executive Shares Promising Workforce Solution

Analysis  |  By Jennifer Thew RN  
   November 15, 2016

Attendees at the HealthLeaders Media 2016 Chief Nursing Officer Exchange shared their best peer-to-peer solutions to some of the biggest challenges facing the nursing profession.

More than two dozen top nurse executives from around the country gathered at the invitation-only HeathLeaders Media 2016 Chief Nursing Officer exchange from Nov. 2 to 4 at the Bacara Resort & Spa in Santa Barbara, CA, to discuss issues of concern to nurse leaders and to share viable solutions to these challenges including the nursing shortage.

"As I listened to our conference planning calls, it seemed like workforce, staffing, and scheduling issues just never go away," said Barbara R. Medvec, RN, MSA, MSN, NEA-BC, adjunct professor at the University of Michigan School of Nursing and executive at BRM Health Associates.

The Problem
One particular challenge nurse leaders are currently dealing with is difficulty finding experienced nurses to fill positions in specialty areas such as critical care.

During the event's popular Ideas Exchange breakfast, Medvec shared the specifics of an innovative specialty nursing orientation program that was put in place at a four hospital systems in Southeast Michigan.

Nurses in specialty units there were leaving for opportunities outside the organization or transitioning to advanced practice. Replacing them with equally experienced nurses had become a challenge. As during previous nursing shortages, one solution was to bring new nurses directly into critical care areas.

"The problem with that [was that] transition and turnover was very high, satisfaction was not there with our preceptors, and we certainly started to see an increase in preceptor burnout as well as our vacancy rates increasing," Medvec said.

"As soon as the discussions about sign-on bonuses and retention bonuses started, it was time to do some critical thinking."

The Solution
This led to the creation of the specialty immersion program—a detailed orientation into specialty areas using an academic/faculty model that provided in-depth specialty education, critical thinking simulations, and competency building experiences.

Participants had a 75-day immersion with the faculty and a 14-day unit-based orientation plus simulation and competency experiences. Education was based on existing curriculum from the American Association of Critical-Care Nurses and the Emergency Nurses Association and specialty certifications.

RNs with more than 12 months' experience could apply to the immersion program. They signed a transfer agreement to stay in the specialty area for 12 to 36 months depending on the specialty.

The Outcomes
Feedback from preceptors and unit staff members was positive.

"[Preceptors were feeling] like they had been orienting and orienting and orienting," Medvec says. "Some of their frustrations certainly had been the fact that sometimes they would orient and people wouldn't necessarily seem to fit."

Unit staff members were impressed with the critical thinking skills the nurses coming through the immersion program had developed.

"We've seen feedback from staff saying, 'Wow they're already critically thinking about what our issues are on this unit,' and 'It's like working with colleagues with many years of experience.'"

The staff who completed the immersion reported a decrease in fear about making a change into a specialty. They also felt they could contribute to the unit on their first day and their career transition was going to be positive.

The program has been in effect for 18 months and there has been a 30% decrease in orientation time because the new specialty nurses were coming to the units more prepared. There has been a 98% retention rate of nurses going through the immersion program.

A Boost for Both Internal, External Recruitment
"Internal for career transition and movement," Medvec says, "external recruitment primarily because our recruiters are bringing new nurses in knowing that if they have aspirations for any of these specialty areas they can make application to move into the immersion program within that first year or right after their first 12 months of their experience."

Medvec says the program is at minimum budget-neutral, but it is expected to save costs as a result of improved retention.

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.


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