I work on a Labor and Delivery/Postpartum unit. I work the night shift for the past 19 years and I have seen the high rate of nurse turnover and struggle with nurse retention. Of the varied reasons for discord is the perception and role that the new nurses are expected to jump into after a harried orientation. I also see the inability to conform or endure the role of a night nurse on a very busy unit.
Expectations seem to be unrealistic and not well defined when progressing through the orientation process that begins on the “day” shift when a orientee is hired for a night shift position. According to Mazhindu, D. M., Griffiths, L., Pook, C., Erskine, A., Ellis, R., & Smith, F. (2016), the resilience and devotion to performing the job hired for is not clear or misinterpreted. Also the financial aspect of training or orienting nurses is always increasing. According to Colosi (2018), the 2018 National Health Care Retention & RN Staffing Report shows that the average cost of RN turnover ranges from $38,000 to $61,000 which translates into the hospital cost for turnover ranging from $4.4M – $7.0M.
I currently work in a sub-acute unit of a long term care center. The center has two units, the senior nursing facility (SNF) and sub-acute unit. My unit is very different from the SNF side because they all have tracheotomies, require total care, most of them have PEG tubes, and their acuity is higher. It is a 27-bed unit and each nurse is usually responsible for 6-8 patients over an 8 hour shift. The unit is divided into four different carts and some carts are more difficult than others. We are not only responsible for medication pass, but we also need to assist our CNAs with ADLs. A major problem the organization is facing is the high turn-over rate. I have only worked at the facility for a year and it took me about 4 months to finally get used to the unit. It is a very difficult unit to work on and many nurses have quit because they are not adequately trained. The length of training is only 1-2 weeks and at most 8 shifts total. Most of the time it is usually less until the nurse is put on the floor by themselves. Luckily, most of the nurses are very nice and helpful, but everyone is busy so it can be hard to stop what you’re doing to help the new nurse. The major problem is the inadequate training that new nurses receive.
Two implications for nursing involve adequately training nurses to improve retention. Providing adequate training to new nurses is vital because not only increases their chances of staying with the organization, but improves their competency in giving their patients the most appropriate care. Another implication is the cost for turn-over and according to Maryniak, Markantes, & Murphy (2017), the cost of turn-over for a clinical RN ranges from $37,700 to $58,400. Training new nurses is not only very costly, but also time consuming as well. Fixing the problem of inadequate training of nurses is vital because if a nurse feels overwhelmed, they are more likely to leave and find a place that prepares them better.
Comment 3 (Abigail)2 DQ 2
I think that the main issue that my organization is addressing is providing patient safety through quality care. There have been many in-services dedicated to making sure that we keep our patients safe by making sure we follow correct protocols in regards to moving and transferring. The also made sure that the residents that are a fall risk have an armband. Some of them even have mats placed by the bedside as well. According to van Gaal, Schoonhoven, Vloet, Minties, Borm, Koopman, & Achterberg (2010), educating staff and about proper interventions increases patient safety. They also mentioned that passive education (written material and large-scale educational meetings) is less effective than education that is personal and interactive. A great way for an organization to address and resolve patient safety and quality care issues, would be to require the employees to stay-up-to date on evidence-based practices. This can be accomplished by providing the information and requiring them to read the material, answer some questions based on the material, and go through a skills check off list and demonstrate how tasks should be completed. This way, the employee will read the information, be able to write or say the answers based on questions, and implement them in a clinical setting.