Fostering excellence along the nursing journey

Nurse leaders strive to ensure nurses—from newly licensed to experienced—have the resources and support to excel in their practice. Yet, 50% of novice nurses commit errors in care [1] and nurse turnover rates are rising, especially among new RNs (23.9%) who often lack professional skills, competence, and engagement to deliver optimal patient care [2]. At the same time, nurse turnover costs $4.4–$7M per hospital annually [3]. With the experience complexity gap also on the rise, how can clinical leaders develop innovative ways to support new and experienced nurses in achieving clinical excellence? A panel of nurse leaders explored this topic during the Elsevier symposia, “Fostering Excellence Along the Nursing Journey,” at the Association for Nursing Professional Development (ANPD) Annual Convention 2021.

Led by moderator Robert Nieves, JD, MBA, MPA, BSN, RN, Vice President of Health Informatics at Elsevier, the panel presented key strategies and tactics for promoting readiness to practice and creating an environment where nurses not only want to work, but also want to stay. Below are highlights from the presentation.

Helping new nurses transition to practice

At the start of the nursing journey, the experience complexity gap is at its widest because new grads have the least knowledge and experience. For clinical leaders, there is a lot to tackle to ensure newly licensed nurses receive the right education, and support they need to make the important transition to practice. Orientation and residency programs are critical to the success of new nurses.

Raising the bar on orientation and residency programs

During the panel discussion, clinical leaders said their organizations offer new nurses a combination of orientation and residency programs as well as professional development and peer mentoring to reduce the experience complexity gap.

The panelists agreed that successful orientation and residency programs support:

• Competent and confident nurses

• Improved retention

• Improved patient outcomes and care

“We recently added more peer support into our residency program to create a healthier work environment,” said Elizabeth Fritz, PhD, RN, NPDA-BC® program manager, system clinical education at SSM Health. “In addition to standard orientation, we also offer specialty-specific programming for critical care, emergency, and medical-surgical departments to address some of the complexity gap,” she added. “It gives more assurance they are getting all of the key topics and the most evidence-based information as they go through and beyond their initial orientation period and that first year,” she said.

“We understand and see that complexity gap, and so we are looking at our orientation and our residency programs to see if we need to beef them up and work with our orientees to provide some of the skills they are not being afforded in their clinical programs in school,” said Linda Bub, MSN, RN, GCNS-BC, NPD-BC, regional manager, nursing education and professional development at Advocate Aurora Health. During the merger of Advocate Aurora Health, Bub said the system developed a comprehensive education department that supports its 25,000 nurses across their career continuum.

“This allows nurses to stay and become educated and experienced, which helps shorten the complexity experience gap,” Bub said. The system offers a consistent orientation program that meets the unit needs for new nurses coming on board. After that, nurses participate in an accredited nurse residency program, which offers a platform for additional professional development and support.

Helping preceptors thrive

Preceptors are also key to developing new nurses. These leaders play a critical role in helping improve the clinical experience, improve patient outcomes, and ultimately drive retention.

• 64% of nurses said their clinical experience improved due to their preceptor [4].

• 58% of clinical errors occur from inappropriate orientation. Guidance from prepared preceptors can help reduce clinical errors and improve patient outcomes [5].

• Effective preceptors can increase clinician retention by up to 50% [6].

The panelists agreed it is essential to provide preceptors with a strong, consistent system of training, support, engagement, and recognition. They also noted that their organizations offer basic to advanced preceptor programs, including everything from advanced CE to recognition programs. Dennis Doherty, PhD, RN, NPD-BC, senior professional development specialist at Boston Children’s Hospital, said the organization launched an advanced preceptor workshop last year. The one-day remote class picks up where the organization’s basic preceptor class leaves off. “Offering more development and personal growth opportunities for preceptors is important in helping them feel that they are valued. If we invest in them, that can go a long way,” he said.

“We make sure our more experienced staff receive more support, feel valued, and are empowered to stay up to date with current practices,” said Fritz with SSM Health. “We have done particularly well with that this year by overhauling our standardized preceptor program and embedding all of the latest evidence.” Fritz added that the organization also offers an advanced CE program standardized across four states, which includes virtual monthly classes on topics the candidates choose.

Likewise, Bub said Advocate Aurora Health offers a CE program for preceptors, which started before the pandemic. The program brought preceptors together in person to share stories and learn from one another. “Then the pandemic hit, and it was a little bit harder to do that,” said Bub. “But we had newsletters and ways for the preceptors to still communicate.” She added the organization is also exploring new CE opportunities post-pandemic. Both Advocate Aurora and SSM Health also offer additional support through preceptor recognition programs.

Creating a culture of support for nurses

While orientation and residency programs are key to helping new nurses get off to a successful start, what comes next is just as important. It is essential to also create a work environment that fosters nurse and patient satisfaction.

The nurse leader panel offered four strategies to support nurses and motivate them to stay:

• Support new nurses in mastering the art and science of nursing by helping them learn critical thinking skills and new technical skills.

• Find simple ways to support the human being behind the license (especially during the pandemic), such as sending care packages to the home and creating “Zen Dens” on units.

• Make sure the broader work environment models what new nurses learn in orientation.

• Offer a clear path to career development based on skill and readiness.

“When we help our nurses develop critical thinking skills and learn new technical skills, we are helping them master the art and science of nursing,” said Fritz with SSM Health. “That is what helps drive an environment where people feel fulfilled and motivated in their work and want to stay,” she added.

“The pandemic exposed how much nurses take home with them and the emotional toll of being a nurse,” said Bub with Advocate Aurora Health. “You can have all the professional development support in the world, but if it is not a good and safe environment to be a human being, people leave,” she added, noting that the organization sends care packages to nurses and has created “Zen Dens,” for nurses who want to take brief breaks.

Doherty with Boston Children’s Hospital says it is also important to look at the work environments of new nurses. “Are they leaving because they are not confident, getting the skills they need, or is it a product of where they are working? We have an accredited nurse residency program, and we spend time teaching them communication skills, promoting high reliability practices, and ingraining patient safety in their work.” However, he points out, “if they are going into a practice area where they are not seeing these [skills] role modeled, then that is a problem.”

Developing leadership

Nurse leaders play important roles in developing future and existing leaders. Fostering nurse leadership also helps strengthen retention. The panelists said there must be a clear path for preparing nurses to take on increasing roles of responsibility. “We need to think critically about how we are preparing our nurses to take on expanded roles in our healthcare settings,” said Doherty with Boston Children’s Hospital. “If you are a great clinical nurse and you are awesome at the bedside, that doesn’t mean you will be a great preceptor, charge nurse, manager, or educator.”

At the same time, Fritz, with SSM Health, pointed out that often frontline workers only see managers as leaders, when in reality leadership is an important competency for all nurses. “We must empower our nurses to see themselves as leaders by giving them the language and naming their behaviors as leadership,” she said. “For example: ‘Hey, Katie, great leadership there stepping in to talk to that patient’s family members.”

Nieves, with Elsevier, agreed. “It is so important to foster that sense of empowerment and confidence that they are able to do this. When you use the words constantly and reassure them they are leaders, you are speaking it into existence. This is critical if we want to impact our culture.”

Bub, with Advocate Aurora Health, said in addition to clinical leader onboarding and orientation tools, organizations should be looking to informal leaders at the bedside when creating a succession plan. For example, developing nurse professional development (NPD) practitioners is another way to foster leadership because they are the ones who will help build the practice on their unit or at their hospital, she added. “We are starting a transition of practice for our NPDs, so that they can see that they are informal and semiformal leaders on their units and that they can build that leadership potential.”

While the panel was optimistic about the changes their organizations are making to support the nursing journey, they agreed that nurse leaders must continue these important conversations and plans for developing short and long-term solutions that improve the transition of new practitioners, reduce the experience complexity gap, develop nurse leaders, and create work environments where nurses want to stay.

Evidence-based, online nursing education from Elsevier will support you in achieving your goals. To learn more, visit https://www.elsevier.com/clinical-solutions/nurses.

References

1. William J. Muntean. Nursing Clinical Decision-Making: A Literature Review, 2012.

2. 2021 NSI National Health Care Retention & RN Staffing Report, NSI Nursing Solutions, Inc., March 2021.

3. Jennifer Thew, RN, HealthLeaders. Want to Keep Nurses at the Bedside? Here’s How, March 27, 2019.

4. David Kaniaru, Elijah Nyagena, Nebart Kathuri, Alex Chebor. Perception of Preceptor and Student Nurse Partnership on Clinical Teaching and Learning. American Journal of Nursing Science. Vol. 5, No. 4, 2016, pp. 141-145. doi: 10.11648/j.ajns.20160504.13 opens in new tab/window.

5. Baggot DM, Hensinger B, Parry J, Valdes MS, Zaim S. The new hire/preceptor experience: cost-benefit analysis of one retention strategy. J Nurs Adm. 2005;35(3):138-145.

6. Lee, T., Tzeng, W., Lin, C., Yeh, M. Effects of a preceptorship programme on turnover rate, cost, quality and professional development, J. Clin. Nurs., 18 (8) (2009), pp. 1217-1225.