Lindsay Wiley Ferris State University Key Issue: Decreasing Health Disparities by Improving Nursing Retention Lindsay Wiley Ferris State University

Objectives The purpose of this presentation is to: Understand how nursing retention affects health disparities Understand what contributes to high rates of turnover Understand scope of the problem of nursing turnover and burnout Why retaining nursing staff is an urgent matter What can our staff do to promote retention among nurses

How does nursing retention affect health disparities? Overburdened/Overstressed Nurses Low and inadequate staffing Decreased quality patient care ANA's president discusses future of nursing, challenges and reform... Karen Daley, PhD., RN, MPH, FAAN. (2010). Vermont Nurse Connection, 13(4), 8

What contributes to high rates of nursing turnover? Increased stress and critical care burnout are very common feelings associated with working on a critical care unit Compassion fatigue is a form of stress that is unique and specific to healthcare workers as they are frequently exposed to illness and death (Smith, M., Wasilowsky, B., & Valeriano, L., 2012) Emotional walls are broken over time of exposure creating feelings of depression and anxiety, resentment to nursing duties and post traumatic stress disorder (Smith, M., Wasilowsky, B., & Valeriano, L., 2012)

Scope of the problem Nursing shortages continues to be an uphill battle and is predicted to increase Nursing retention is crucial as nursing is the cornerstone of healthcare It is estimated by the year 2020, the deficit of registered nurses is going to reach 285,000 (Cooper, 2009) Replacing a nurse can cost $92,442 to $144,000 (Sandau, et al., 2011).

Scope of the problem New graduate nurses leave the nursing profession within the first 2 years of graduating (Meyer, 2009) 30-61% of new graduate nurses change their place of employment within the first 2 years of graduating (Meyer, 2009) Healthcare organizations spend money indirectly on new nurses through advertising, recruitment costs, and travel nurses for replacement staff (Meyer, 2009) Costs may be underestimated as the cost of resources to orient new nurses, staff moral and patient satisfaction are immeasurable (Meyer, 2009)

Overview of problem on this unit Cardiothoracic Surgical Unit Critical Care floor that is acuity based Busy day shift, 2-4 open heart and/or lung surgeries per day Patients average length of stay is 7-10 days Seasoned nursing leaving secondary to increased stress, burnout, ethical issues, not feeling valued by surgeons

Overview of problem on this unit Young, inexperienced nurses come to day shift due to high rates of turnover of experienced nurses Young, inexperienced nurses may lack Quick decision making skills Focused on numerical values not the patient Rely on machines and computers

Please share your experience of high nursing turnover How did this impact moral on the unit? How did this impact patient care? What would improve nursing retention?

This is an URGENT matter!!! If we do nothing, this will result in: Continued turnover creating a less experienced unit Decreased moral results in feelings of apathy, lack of commitment Issues in patient safety Decreased patient satisfaction Increase length of stay

How can we impact change? Regain the sense of community on the unit Create a safe environment that nursing staff can work with other disciplines Create a supportive environment to encourage retention of new nurses Team effort among all staff Address key issues of cause of high turnover Stress and burnout Challenging relationships with physicians, lack of sense of value Ethical issues Communication

Plan for change My vision is to involve nursing, management, physicians, social workers and case managers to work together for a common goal Debriefing sessions after traumatic events Buddy system

Plan for change: Debriefing sessions Debriefing sessions after traumatic events such as codes or death Objectives are to create a nonjudgmental forum to express feelings of demanding needs of an intense, fast paced unit, feelings of not meeting patients needs, demanding families that have unrealistic goals (Smith, M., Wasilowsky, B., & Valeriano, L., 2012) Unit specific Invite other healthcare staff that were involved such as physicians, respiratory therapists, pharmacy and social work

Plan for change: Debriefing sessions No time limit Confidential Reassessment of feelings, follow up Limitations: When will this be done? Immediately after event or at a later time? Before/after shift or on another day?

Plan for change: Buddy system Preceptors are often self motivated volunteers and are expected to know how to train a new hire to the unit without formal training Orientation period should be extended into a transition period lasting 3-12 months Knowles Adult Learning Theory (1978) discusses how adults learn different from children (Cooper, 2009) Encourage professional development through advancement systems, committee work and certifications (Cooper, 2009)

Plan for change: Buddy System Reflective dialogue among peers Goal setting Activities within unit and hospital Increase in professional development Cooper, E. (2009). Creating a Culture of Professional Development: A Milestone Pathway Tool for Registered Nurses. Journal Of Continuing Education In Nursing, 40(11), 501-508.

Reflection The goal of todays presentation was for staff to: Recognize the need to improve nursing retention Understanding how nursing retention affects all disciplines of healthcare by sharing our experiences Identifying a sense of urgency, we need action immediately Develop a vision for change and a plan for the future

References ANA's president discusses future of nursing, challenges and reform... Karen Daley, PhD., RN, MPH, FAAN. (2010). Vermont Nurse Connection, 13(4), 8 Cooper, E. (2009). Creating a Culture of Professional Development: A Milestone Pathway Tool for Registered Nurses. Journal Of Continuing Education In Nursing, 40(11), 501-508. Marshall, E. (2011).  Transformational leadership in nursing: From expert clinician to influential leader. (1st edition).  New York: Springer Publishing Company. Meyer, M. (2009). Retaining the Next Generation of Nurses: The Wisconsin Nurse Residency Program Provides a Continuum of Support. Journal Of Continuing Education In Nursing, 40(9), 416-425. Sandau, K. E., Cheng, L., Zhenyu, P., Gaillard, P. R., & Hammer, L. (2011). Effect of a Preceptor Education Workshop: Part 1. Quantitative Results of a Hospital-Wide Study. Journal Of Continuing Education In Nursing, 42(3), 117-126. doi:10.3928/00220124-20101101-01  

References Smith, M., Wasilowsky, B., & Valeriano, L. (2012). A Proactive Approach to Stress Management in a Neuroscience Intensive Care Unit. Pennsylvania Nurse, 67(2), 12-18.

Thank you for your participation!

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