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

2. 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

3. 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

4. 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)

5. 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).

6. 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)

7. 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

8. 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

9. 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?

10. 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

11. 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

12. 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

13. 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

14. 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?

15. 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)

16. 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),

17. 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

18. 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),
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),
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), doi: /

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

20. Thank you for your participation!

21. Questions?