Proposed Changes to the Nursing Orientation Program

Current research is showing that nursing education programs are suffering from a high turnover rate, also known as an attrition rate. As head nurse of one such program, this research paper will study possible ways to reduce the attrition rate of nurses from our program. The research will focus mainly on the orientation program, to perhaps make some changes to how the program is run, which will hopefully allow for greater opportunities for socialization among the nurses; a greater degree of cohesion among the members of the unit, new and old and a greater potential for the build-up of specialized expertise if the new nurses stay with their original unit after their orientation program. There are many potential benefits and costs to having nurses stay with the unit they were originally placed with, which will be thoroughly explored in the paper.

Outline of Plan

The costs of nurse turnover which arise both from a general shortage of nurses leading to nurses being spread over a greater area and from the decreased productivity time that results from the turnover (Jones & Gates, 2007) are, I feel, exacerbated by the nurses going through the orientation period and then leaving the program. Nurse turnovers can potentially mean a substantial loss for both that particular program (since the eighty-hour orientation is specifically listed as non-productive hours) and for any other program which accepts the nurses in the form of loss of the usual work level and an increase in mistakes made with patients. The entire cost of a nurse leaving, however, has a far more reaching impact than simply the time that the unit will have to spend on training and mentoring.

My plan to try and combat nurse attrition was to change how the orientation program functioned – the original program included several days during both weeks in which a student shadowed a single RN through the unit, and then one or two days at the end of the program when they went through a supervised shift along with the rest of the unit. My new version of the program keeps some of the time with an individual RN intact (and would also assign each student to an RN who they could go to and ask for help and advice) but increases the time spent in supervised shifts. The new changes would, I hope, encourage more teamwork and cohesion among the current and new staff, with the idea that the unity thus developed would translate into increased loyalty among the new nurses for the unit in which they received their orientation.

(Table omitted for preview. Available via download)

My ideas for the two-week orientation program (seen in the table above) involve less time spent strictly with one RN, and more time with the unit. Since, as I said in the previous paragraph, building a relationship with one specific RN could have value, a system could perhaps be put into place where each trainee is assigned a specific RN who they can go to if they have questions that need answering. Rather than have this relationship expanded to the extent of the original orientation program, I have chosen to limit the formal interactions of RN and student in favor of an approach that puts the new trainees in situations where they have the potential to interact with the entire unit. Not only will this help encourage cohesion between the unity, therefore potentially lowering the risks of attrition, it will also give the trainees a broader idea of the decision-making and communication skills of their colleagues (Marquis & Huston, 2012, p. 25) as well as allowing the trainees to experience a greater variety of work environments. While it could be argued that having trainees come to an RN of their own accord rather than having a set time for the two to work together could be seen as a danger because of the potential for interruptions during work hours (Sorenson & Brahe, 2014, p. 1274.), that potential is, in my opinion, canceled out by the cost benefits (Jones & Gates, 2007) that could be gained if the orientation program managed to increase the trainee productivity after the orientation.

these estimates may vary depending upon the human capital, e.g., the education, experience, and tenure of the nurse who leaves; the era during which the nurse departs, e.g., at the beginning versus the height of a nurse shortage; and other organizational and environmental factors, such as the local labor market and whether the organization is in a rural or urban location. (Jones & Gates, 2007)

The position of the nurse who left will have an obvious impact on finances – hiring someone with the same capabilities will potentially cost more because they will command a higher salary; also for any vacant position, there are the usual costs of advertising and training, among other things, to be considered.

The nursing orientation program can’t be hugely modified, for various reasons. It can be changed around to better suit a new form of orientation which allows for better communication among staff and trainees as well as more time spent ‘shadowing’ an RN and working under their supervision. The original orientation has the new trainees shadowing their assigned RN for two hours a day three hours a week, with that changing in week two, with trainees spending one eight hour shift with their assigned RN and a further three shifts under supervision, but my main idea for the orientation program is to expand on the time spent on shift work rather than simply shadowing an RN.

Benefits of Staff Retention

There is value in the original idea of having one specific RN take on responsibility for one specific (or perhaps a few specific, depending on the size of the orientation program) nurse trainee. Having someone to guide new trainees through the process of working in the nursing unit would be a great help, but I think that the original orientation program focused too much on working with an RN, to the detriment of the unit as a whole. My concern about the orientation was that it was suffering from trainee attrition, which I have in part attributed to a lack of cohesion among the members of the nursing unit. Having the new staff put into situations where they were working with all the various members of the unit instead of one or two main ones at the most would encourage socialization and cohesion within the group which would hopefully continue beyond the actual program itself on into the time when they begin work as full members of staff.

Attrition is a serious problem in nursing orientation programs, and the costs of training new nurses can rise quite steeply, particularly during times of nursing shortages. My idea was that attrition could be, if not eliminated, then at least reduced by changes made to the nursing orientation program. I suggest that by reducing the amount of time trainees spend with one single RN during orientation in favor of shift work with the entire nursing unit, we could increase the sense of loyalty to their original nursing unit that appears to be missing from nurses at the moment. I am in favor of keeping the original idea of having one specific RN work with a specific trainee but in the limited capacity of having one single RN the assigned person that a trainee can go to for advice. I am aware that this could potentially bring disruption to the RN’s work, but I believe that the potential benefits of the newly proposed system would outweigh the benefits.

References

Jones, C. & Gates, M. (2007). The costs and benefits of nurse turnover: A business case for nurse retention. Online Journal of Issues in Nursing 12(3). Retrieved from http://www.nursingworld.org/

Marquis, B. & Huston, C. (2012). Leadership roles and management functions in nursing: Theory and application (7th ed.). Philadelphia, PA: Lippincott.

Sorenson E. E & Brahe L. (2014). Interruptions in clinical nursing practice. Journal of Clinical Nursing 23(9-10): 1274-1282.