Nursing Notes

November 3, 2010

Stop Losing Experienced Nurses

THORNTON - FEBRUARY 24:  Registered nurse Susa...
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Here is a great article about the need to retain experienced nurses on the floors.  With aging and health issues arising, we are losing our experience from our nursing ranks.  The high stress levels, the increased patient to nurse ratios, the addition of technology, and the many new hats placed on a nurse’s head due to cutbacks–all increase the loss of our older and more experienced nurses.  It’s a shame, too.  These are the nurses who work tirelessly for the patient; who worry about subtle signs and speak to physicians as equals.  We need them as much as they need us.

Please read this article entirely, as I have only posted a part here.  So, please click over to finish reading.  This article is from Health Leaders Media and I find many really relevant and interesting articles at that site.  Let me know what you think about this article, won’t you please?


Rebecca Hendren, for HealthLeaders Media , October 26, 2010

There’s no substitute for experience, especially in nursing. Experienced nurses accomplish all their tasks in a shift and somehow their patients never know how busy they are. They still find time to check in, offer support, and even a shoulder to cry on.


Nurses who know the ropes understand  how the system works. They can communicate ably with physicians, pharmacists, nursing assistants, patients, and families and are the glue that holds “multidisciplinary care” together. They can take one look at a patient and know “something’s just not right,” fixing a problem  before it degenerates.

Finally, nurses with experience are role models and mentors for new nurses, helping the next generation become experts and passing along their wisdom. So it behooves healthcare facilities to retain these nurses as long as possible.

But experienced nurses are aging and exiting the workforce. According to data recently released from the latest National Sample Survey of Registered Nurses—which has been conducted by U.S. Department of Health & Human Services Health Resources and Services Administration every four years since 1977—the average age of licensed RNs is 47. Nearly 45% of RNs were 50 years of age or older in 2008, a dramatic increase from 33% in 2000 and 25% in 1980.

Because of this looming crisis as experienced nurses retire, the Robert Wood Johnson Foundation launched a national program in 2006 called Wisdom at Work: Retaining Experienced Nurses. The idea was to find out what will keep experienced nurses in hospital settings and find out what effect existing interventions have on the work environment for older nurses.

Through this program, 13 initiatives were evaluated that were intended to retain experienced nurses, which fall into three categories:


  • Ergonomic projects, such as lift teams and anything that reduces the physical burden of nursing
  • Human resource strategies to improve organizational culture
  • Strategies that involved employee wellness, clinical technology, or leadership development

While no single initiative or strategy has been identified as a silver bullet, the program has found several strategies that when combined with an organizational culture that values experienced workers and leadership support create an environment that encourages experienced workers to stay.

Successful strategies include:

  • Closed staffing: A model that keeps nurses on their home units rather than assigning them to other units as needed.
  • Giving experienced nurses more control over patient flow, discharge and admission..
  • Staffing for frequent peak occupancy rather than average occupancy.
  • Wellness at work programs that promote wellness through incentives, fitness center memberships, and other components.
  • Virtual ICUs that allow experienced nurses to use computers to monitor ICU patients at multiple sites .
  • Renewing and reframing older nurses’ practices, such as the three-day, off-site educational experience that rewards experienced nurses with an opportunity to renew their nursing practice.
  • Patient lifting devices and other labor-saving technologies
  • Centralized workstations and decreased need to walk long hallways
  • Increased scheduling flexibility
  • Developing new career paths

The hospitals that retain experienced nurses are the ones that include ….[read more]

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October 11, 2010

Commentary: To Improve Health Care, Broaden the Role of Nurses

Here is an interesting article about the future of nursing.  I believe this study caused an immediate response from the AMA to point out quite clearly that nurses are not doctors.   I, for one, don’t have any desire to be a doctor.  I don’t want to diagnose or prescribe.  All I have ever wanted to do was help my patients get better by giving them good care and assisting them to do for themselves so they could return to their own lives and live unencumbered by an illness.

I get tired of the misconception that nurses are simply frustrated doctors.  NOT!  Nurses deal with patients totally different from doctors.  Nurses know more about their patients than most doctors do.  Nurses are trained to observe and to intervene only when necessary.  Nurses don’t believe that they know everything and can do anything.

Okay, enough of my soap-box.  Please read the article and then let me know what you think.  Be sure to click over and read any of the other thought provoking articles to be found at Health News Digest.  Leave them a comment or leave me one, please.


By David Goodman, M.D.
Oct 9, 2010 – 4:41:18 PM

DMS faculty member David Goodman, M.D., was a member of a committee asked by the Institute of Medicine to study the role of nurses in the health-care workforce.

( – Lebanon, N.H.—In a rapidly changing health care environment, the nation’s 3 million-plus nurses can and should play a much greater role in delivering care, according to a new Institute of Medicine report. David C. Goodman, MD, MS, of The Dartmouth Institute for Health Policy and Clinical Practice, a researcher known for his expertise on issues involving the health care workforce, is a member of the Committee that authored the report.

“Nurses already are central to high quality care. Of any member of the health care team, they have the most enduring relationship with patients and are the most trusted professionals in health care.” said Dr. Goodman, who is also a Professor of Pediatrics and of Community and Family Medicine at Dartmouth Medical School and a practicing physician at the Children’s Hospital at Dartmouth-Hitchcock Medical Center.

The report, The Future of Nursing: Leading Change, Advancing Health, was authored by the 18-member Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. Over two years of analysis and deliberation, including five meetings, workshops, three public forums, and numerous site visits, the Committee considered its charge to “examine the capacity of the nursing workforce to meet the demands of a reformed health care and public health system.”

Among its recommendations, the Committee concluded that to fully take advantage of the skills and commitment of nurses, they must have expanded educational opportunities, and be freed from “scope of practice” regulations that limit the care they can provide. Further, it recommends that nurses be given a greater role in health care redesign and improvement efforts.

“We believe the search for an expanded workforce to serve the millions who will now have access to health insurance for the first time will require changes in nursing scopes of practice, advances in the education of nurses across all levels, improvements in the practice of nursing across the continuum of care, transformation in the utilization of nurses across settings, and leadership at all levels so nurses can be deployed effectively and appropriately as partners in the health care team,” write the authors.

The nursing population represents the largest portion of the U.S. health care workforce. Yet, it faces many challenges to being integrated as fully as it could be in the provision of care, according to the report. Among these are a lack of diversity in race, ethnicity, gender and age; insufficient education and preparation to adopt new roles; restrictions on scope of practice, limitations by insurance companies, and in some cases “professional tensions” that make it difficult or impossible to practice to their full potential.

“Producing a health care system that delivers the right care–quality care that is patient-centered, accessible, evidence based, and sustainable–at the right time will require transforming the work environment, scope of practice, education, and numbers of America’s nurses,” the report states.

“This report will advance the nursing profession to the center of leading change and improvement in health care systems as the nation seeks higher value in patient care,” said Dr. Goodman.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education.

The Robert Wood Johnson Foundation is a non-profit philanthropic institution, founded in 1936, whose mission is to improve the health and health care of all Americans.

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December 30, 2009

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

WASHINGTON - OCTOBER 05:  Risa Lavizzo-Mourey,...
Image by Getty Images via Daylife

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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