Nursing Notes

December 30, 2009

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

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Since I began serving on the nurse retention committee at my hospital, I have become more aware of costs and of turnover rates.  As this article points out, it is expensive to lose a new nurse for the hospital.  But, I think it is expensive and unnecessary to lose any nurse at all.   While the focus of this article is on the new graduate nurse, I think if we expand the premise and come up with ways to nurture our experienced nurses by validating their concerns and responding to their calls for help.

Please read the article and let me know if you agree or if you disagree.


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.”

The original article can be viewed here

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  1. As a nurse recruiter, I have been surprised recently to hear many new grad nurses tell me that they are having difficulty finding jobs. How can this be, with the nursing shortage deemed at a “crisis” level? I learned that hospitals have been slashing their training, mentoring and education programs for new grads and hiring only experienced nurses. A cost-effective solution in the short-term, perhaps, but a long-term disaster-in-the-making.

    It is a common misperception that nurses come out of nursing school ready to take on a patient load. Graduation from nursing school is just the first step in making a competent, functional nurse. In reality, it takes a good six months of mentoring before a new grad nurse is truly ready to fly solo. I was lucky enough to have a great orientation program when I started in the NICU in 1988. I was never alone for the first three months, and had frequent contact with my preceptor for the first six months. I don’t remember EVER having turnover in our unit unless someone had to move out of town, and there was a waiting list of nurses who wanted to be hired.

    The HomeCare company where I work doesn’t hire new grads. This is traditional with Home Health agencies, since nurses truly must use independent clinical judgement in the home setting. Recently, I have found a trend of some offices requiring nurses to have previous Home Health experience as well, which leads one to wonder who is going to be training the upcoming HomeCare nurses? As nurses, we need to persuade healthcare leaders that it is in all of our long-term best interests to invest in the training, mentoring and ongoing education of new nurses.

    Comment by kitchrn — January 1, 2010 @ 5:08 pm | Reply

    • What a great response! Thank you for taking the time to leave such an informative comment. I, too, have seen the trend now in only hiring experienced nurses instead of new grads. I wonder what will happen when the experienced nurses retire? I have worked at several places with new graduate nurses and found them to be both motivated and excited about nursing–something that us experienced nurses seem to lose. It would seem to me that hiring a new graduate would be more cost effective in the long run. You could teach them what they need to know for your facility and they would be more satisfied in their jobs with continued support from administration. Also, the starting salaries of new graduate nurses are less than for a nurse with, let’s say, 10 years experience.

      Again, I welcome your comments and thank you for leaving such a good response. Please visit again soon and don’t hesitate to leave a response.

      Comment by Shirley Williams — January 1, 2010 @ 8:00 pm | Reply

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