As the new head nurse, it is important to balance management and staff expectations. Of major concern is the attrition rate among the nursing staff. According to the 2007 report by the College of Registered Nurses of Nova Scotia ([CRNNS], 2007), outcomes regarding the job satisfaction and retention of nurses are directly correlated with an adequate orientation process” (Kuhrik, Laub, Kuhrik & Atwater, 2011, p. 115). As requested, the Human Resources (HR) Department has provided an overview of employees who have either transferred or terminated employment from this unit. The overview designates the hire date, termination or transfer date, and the exit interview synopsis from those employees. As noted in the overview, it is clear that this unit does not provide the orientation that nurses need and/or expect. Key points and trends are noted on the Strengths, Weaknesses, Opportunities, and Threats (SWOT) Analysis. Marquis & Huston (2012) state, “performed correctly, SWOT allows strategic planners to identify those issues most likely to impact a particular organization or situation in the future and then to develop an appropriate plan for action” (p. 144). The orientation process needs to be modified and new strategies integrated, based on the findings of the HR Department report. This paper will represent a plan for restructuring and strengthening the orientation process of this unit.
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Outline of Plan
With the SWOT Analysis, current orientation schedule, and hopeful anticipation, the restructuring of the Orientation Program begins. It is important to be aware of obstacles and successes that other facilities have encountered, and utilize that knowledge. “Pressures to move new [Registered Nurses] RNs rapidly toward full productivity and independence are inherent in the employer-employee relationship given the current economic climate” (Bevelacqua, 2012, p. 12). Bevelacqua continued by warning against new employees moving through orientation too quickly; instead, he encourages focusing on a quality transition. Based on research by Cockerham, Figueroa-Altmann, Eyster, Ross & Salamy (2011),
At the completion of a successful precepted orientation, the [newly hired nurse] NHN independently functions on the unit with the support of a resource nurse for 2 weeks. If the nurse continues to show the ability to safely and independently care for patients during these 2 weeks, orientation is complete. At this point, the NHN [who demonstrated difficulty integrating pathophysiology, critical thinking, and nursing theory into the clinical setting] would start the [Post Orientation Education Program] POEP, designed as an additional educational experience for the 10 weeks that follow standard orientation. (p. 233)
Building the nurses’ confidence, skill set, and bolstering relationships are essential in job satisfaction. The initial 2-week orientation will include a unit tour and introduction to staff; preceptors will be assigned to each new nurse, for the 2 week period of orientation. The classroom schedule, for orientation, will include didactics as well as simulation and case scenario approaches, motivating the nurse to actively exercise critical thinking and evidence-based knowledge. An education/orientation handbook will be given to the nurse to use as a reference to facility and unit policies, specific procedure or skills instruction, and any handouts or notes made by the nurse. The establishment of the Leadership Team is organized with nurses who have at least 3 years of experience in nursing and 1 year of experience within the unit. These team members should display the qualities that reflect the unit’s mission, as well. Members of this orientation leadership team will be partnered with newly hired nurses who have been identified as needing additional support and training. Based on the NHN’s needs, an individualized plan will emerge and a leadership member will be assigned to guide the NHN’s extended orientation. The team leader is given a sample set of weekly assignments and team leader questions to stimulate building a relationship, and finally the post-orientation evaluation, pre/post test questions to help guide the process. Weekly, 30 minute, one-on-one meetings with a leadership leader will be conducted to provide the individualize oversight. The 10 week on-the-job orientation process will navigate the NHN through a pre-designed set of expectations established by the orientation leadership team. Key components include unit specific patient populations, most common diagnoses, relationship building skills and assessment, critical thinking skills and assessments, and integration into the unit culture. Preceptors will submit a weekly update to the leadership team that reviews of the clinical skills, safety issues related to medication administration, time management, and documentation opportunities and experiences from the past week. To assess and strengthen the knowledge-base, NH will be assigned unit specific diagnoses to research and bring evidence-based information to the following weekly meeting. The NHN will also be given pre and post tests and a program evaluation, to assess the effectiveness of the program (Cockerham, Figueroa-Altmann, Eyster, Ross & Salamy, 2011, p. 235).
Cost-Benefit
There is historical significance to substantiate the importance of evaluating costs related to nursing turnover. In a 1992 article, the cost of nursing turnover ranged from approximately $1,200 up to $50,000 per RN (Jones, 1992, p. 39). Jones continued to follow the cost of nurse turnover and in 2005, a new article reports, “per RN turnover cost estimated in this study ranged from approximately $62,100 to $67,100” (2005, p. 43). Jones & Gates (2007) reported, “Recent studies of the costs of nurse turnover have reported results ranging from about $22,000 to over $64,000 (U.S.) per nurse turnover” (p. 7). The reported costs of turnover between the 2005 and 2007 articles may reflect the trend to decrease orientation hours, thereby altering the reported costs. Nonetheless, there is an exorbitant cost of nursing turnover. Health care organizations (HCO) are challenged with providing the fiscal responsibility of reducing nonproductive hours as well as providing needed education and training. “Turnover and retention are distinct concepts; however, the costs and benefits of both are interrelated, and in some cases it may be appropriate to assume that the benefits of retention are the costs of nurse turnover avoided” (Jones & Gates, 2007, ¶ 10). Jones & Gates developed cost-benefit tables that compare and contrast nursing turnover and nursing retention issues. Key points related to cost of nursing turnover are the expenses related to recruiting applicants, accelerated pay for overtime or agency nurses, orientation and training, and the effects related to vacant positions on the floor. Staff morale is impacted when nursing positions are not maintained. Benefits related to turnover include salary and reductions of departing staff member, and is thought to be an effective means of eliminating staff that are poor performers. Costs related to nursing retention include specific program costs, such as mentoring, residency, or extended orientation programs; expenses related to enhanced salary and benefit packages, ongoing educational opportunities, and enhanced staffing strategies. Nurse retention benefits include fewer staff position openings, decreased recruitment and orientation expenses, maintained or improved productivity, fewer patient errors and increased outcomes for patients, proactive recruitment. (Jones & Gates, ¶ 5-10)
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Conclusion
“Shortages of trained nursing staff, as well as the large number of nurses leaving the profession and the high cost of recruiting and training new staff, means that it is vitally important for nurse managers to reduce staff turnover” (Duffield, Roche, Blay & Stasa, 2011, ,p.30). The restructured orientation program will provide the newly hired nurse with a strong base of knowledge regarding the leading population types cared for within this unit. Collaborative effort between the NHN, preceptor, orientation team leader, and the head nurse will establish a strong network of experience and promote open communication. Weekly one-on-one meetings with the orientation team leader will provide ongoing feedback to the nursing unit management regarding the NHN’s transition into the unit. All nurses, whether newly hired, preceptors, team leaders, etc have a vested interest in retaining and maintaining quality nursing staff. The cost-benefit analysis demonstrates the fiscal responsiveness of units who are able to retain nurses. Adequately trained staff helps to reduce stress and risk for burnout.
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