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Success in the Windy City: Hospitals Tackle New-Nurse Turnover

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By Claire Brocato, contributor 

Dec. 18, 2009 - For new nurses entering the profession, a number of challenges and frustrations can lead to high turnover rates, which has become a major issue at many hospitals nationwide.  Two Chicago-area hospitals are investing their time and resources in finding the solution, and helping set the standard for the rest of the nation to follow.

The Nationwide Problem

The median voluntary turnover rate for first-year nurses is 27.1 percent, according to a 2007 report from PricewaterhouseCoopers’ Health Research Institute, while further research shows that the turnover rate for newly graduated nurses jumps to 57 percent in their second year.

This kind of turnover can put a strain on hospital staff, as well as its finances. The estimated cost to replace just one new graduate nurse is $88,000 as reported in the January 2008 issue of the Journal of Nursing Administration.

So why are they leaving? In a 2007 study funded by Robert Wood Johnson Foundation, researchers found that newly licensed RNs often encounter frustration with their new positions, citing workload demands, unexpected situations, a relentless pressure for speed and lack of respect as the most challenging aspects of their new jobs.  While anecdotal evidence indicates that the current recession may have cut the turnover rate temporarily, the underlying problem continues to plague hospitals.

In an effort to ease the transition for new RNs and to prevent these nurses from leaving, an increasing number of hospitals have begun implementing programs aimed at providing new graduate nurses with the support and guidance they need as they enter the workforce.

Two Chicago Success Stories

With a turnover rate hovering near 30 percent for their first-year nurses, Children’s Memorial Hospital in Chicago, Illinois, knew that they could do more to address the needs of their novice nurses. After interviewing their new graduate workforce and incorporating research from other organizations, Children’s Memorial launched their New Nurse Internship Program—and saw their new graduate turnover rate drop to 12.3 percent.

“We’ve had excellent feedback about our internship program from our graduate nurses,” said Barbara Keating, RN, MS, director of clinical learning and innovations at Children’s Memorial Hospital. “Our nurses really appreciate the learning experiences it offers.”

The hospital’s New Nurse Internship Program focuses on five key elements, including: (1) an individualized preceptor orientation that offers a one-on-one relationship with an experienced nurse within the same unit; (2) ongoing classroom instruction that focuses on practical, hands-on situations; (3) transition sessions that offer novice nurses a safe environment to voice their concerns or frustrations; (4) clinical exchange opportunities that allow new RNs to learn about other areas of care within the hospital; and (5) clinical mentors, who serve as counselors and advisors to the new nurse.

“Our internship program has also been very successful as a recruitment tool,” Keating added. “Student nurses hear about the program from our new grad nurses and they want to work at a hospital that offers that kind of support when they enter the workforce.”

Launched in June 2008, Weiss Hospital in Chicago, Illinois, has found similar success with their Nurturing the New Grad Nurse program, a 12-week course that focuses on clinical and professional development.

Once a week, the new nurses meet in the classroom to hear physicians, nurse leaders and other hospital personnel present aspects of their jobs, and gain support in their transition to the hospital workplace.

“The curriculum is based on realities of practice” explained Stella Hatcliffe, RN, MS, vice president of patient care services and professional development at Weiss Hospital. “It provides our new RNs with the tools they need to grow and to build collaborative relationships with other staff.”

During the weekly sessions, the new graduates also have the opportunity to network with each other, to share their experiences from the previous week, to voice any frustrations and to reflect upon what they have learned.

“Providing our new nurses with this kind of peer support has been one of the most successful elements of the program,” said Hatcliffe. “It’s comforting, as a new nurse, to know that others are going through the same experiences as you and that they understand your situation. They have an entire peer group they can turn to for support.”

Other important elements of the new graduate program include partnering the new RN with a senior nurse for the first 12 weeks, and allowing the new nurse to visit other departments for the day and to shadow various hospital personnel—including respiratory therapists, unit clerks and patient care technicians—to learn about workflow and how each department operates.

“We are continually improving the program, based on the feedback we receive from our nurses,” said Hatcliffe, “but most importantly, we know from our high retention rate that it eases the transition and gives our new nurses the confidence they need to practice their skills and to deliver quality patient care.”

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