An outcomes-based approach to improve registered nurse retention

An Analysis of Restructuring Orientation to Enhance Nurse Retention

The nursing shortage has received much media attention; however, something that contributes to it-nurse turnover-has not received the same attention. Facilities spend time and money to train new employees only to have them leave within a few months. Staff morale, money, time, and quality of care are all affected by nurse turnover. The fact that it often occurs so soon after one takes a position makes it pertinent to look at the process of transition into the new position, namely, the orientation program. This article examines the turnover statistics, costs, rationale, and orientation programs that have proven positive results. It is hoped that the findings can assist health care facilities to replicate successful orientation programs and reduce nurse turnover.

Formalising the precepting process: A concept analysis of preceptorship

AIMS AND OBJECTIVES

To elucidate the terminology associated with preceptorships, articulate an operational description of preceptorship that may be useful in formalising the precepting process and provide guidance for constructing a clinical environment where precepting can thrive.

BACKGROUND

Precepting facilitates the transition of nurses into new roles. Precepting may improve patient outcomes and safety, as well as enhance nursing satisfaction. Most research focuses on preceptor preparation and perceptions. A comprehensive operational description of what is required to formalise the precepting process is missing from the literature.

DESIGN

This concept analysis was completed using a combination of Walker and Avant's and Rodger's methods.

METHODS

Existing literature relating to preceptorship was reviewed. Critical attributes, antecedents, consequences and empirical referents were identified. Model, contrary, related and borderline cases were developed.

RESULTS

Preceptorships have the specific attributes of being (i) one-on-one relationships, (ii) embedded within formalised programmes, (iii) that evolve over set amounts of time, (iv) to systematically facilitate practical experiences. Antecedents include how precepting is triggered and organisational supporting activities that may facilitate effective precepting. Consequences include new hire preparedness, confidence and increased retention. Empirical referents are provided for assessing hands-on clinical expertise, individualisation of precepting programmes and the preceptor-preceptee relationship.

CONCLUSIONS

This concept analysis provides a holistic view of the precepting process that shifts the focus from the people or checklist to formalised preceptorships.

RELEVANCE TO CLINICAL PRACTICE

Continuity throughout an organisation's system streamlines the process of hiring new employees and transitioning nursing students to practice. Organisational policies, dedicated resources and engagement in systematically improving the precepting process are critical. Nurse managers must promote and support formalised preceptorships by providing preceptors and preceptees the time and space needed and fostering a culture that supports preceptorships.

An analysis of restructuring orientation to enhance nurse retention

The nursing shortage has received much media attention; however, something that contributes to it-nurse turnover-has not received the same attention. Facilities spend time and money to train new employees only to have them leave within a few months. Staff morale, money, time, and quality of care are all affected by nurse turnover. The fact that it often occurs so soon after one takes a position makes it pertinent to look at the process of transition into the new position, namely, the orientation program. This article examines the turnover statistics, costs, rationale, and orientation programs that have proven positive results. It is hoped that the findings can assist health care facilities to replicate successful orientation programs and reduce nurse turnover.

Case study: creating a healthy workplace in a surgical trauma intensive care unit

This case study describes the implementation of the Parsons' Healthy Workplace Theory and Intervention in a surgical intensive care unit in a level 1 trauma facility. This intervention and change strategy was the impetus for the creation of a more positive work environment by developing and empowering staff. The process led to shared decision making and development of action planning teams that subsequently became unit-based committees. The committees have focused goals, action plans, and timelines for achieving those goals. Transforming care and the enculturation of shared decision making at the bedside is essential for improving quality of patient care and for recruitment and retention of nurses.