Start from the Beginning: Reducing Nurse Turnover By Improving Orientation

Nurse turnover packs a significant punch for any healthcare organization. Such turnover decreases patient and physician satisfaction, decreases staff morale, contributes to inconsistent patient care and imposes a financial burden on the organization.

When Maryview Medical Center in Portsmouth, Virginia, began experiencing a higher-than-usual turnover rate about three years ago, the medical center decided to improve staff retention by offering nurses a better orientation experience—one that provided gradual acquisition of knowledge and skills in a supportive environment.

As clinical educator for Emergency Services at Maryview, Antoinette Higgins, BSN, RN, CEN, took on this challenge. She set to work revamping Maryview’s emergency nursing orientation—not an easy task.

Providing effective orientation has become more difficult in recent years, particularly in specialty areas such as emergency nursing. At one time, only experienced nurses were hired into specialty areas. Today, hiring novice nurses directly into specialty units is routine. Therefore, the orientation programs of yesterday are just not up to the task of training novice nurses for today’s challenging nursing environments.

A Staged Orientation Program

Higgins proved up to the task. She and her colleagues developed a staged orientation program to help novice and advanced beginner nurses progress to a level of competency. The revamped Maryview Medical Center orientation program has four stages that allow the nurse to progress from novice to competent. Each stage consists of these identical focus areas:

  • Customer service
  • Safety
  • Assessment
  • Communication
  • Diagnostics
  • Emergency response
  • Medication administration
  • Equipment
  • Documentation
  • Professional practice
  • Professional development

Each stage is built on the previous one in terms of patient care complexity, workload and critical thinking requirements. The teaching strategy includes online training supplemented by didactic sessions and clinical rotations.

Central Focus Online

Higgins selected the Mosby’s eLearning course, ENA: Emergency Nursing Orientation (ENO), as the program’s central component. This collection of 45 lessons on emergency nursing topics ranged from assessment to drug calculations to head trauma.

Higgins chose ENO because of the quality of its content and because it significantly reduced the lecture time she would have to provide. Instead, she could devote more time to the orientees and support them in other ways. Preceptors have liked the ENO online course because it allows them to build on knowledge that orientees gained from the course by coupling it with the right clinical experiences.

A Successful Outcome

Initial feedback has been impressive. Both orientees and preceptors have returned very favorable reviews on the program. And so have managers and educators.

Although more data still needs to be collected, nurse retention has improved and turnover has dropped from 13% to 8%; and more than 85% of the nurses who have gone through the revamped orientation have successfully completed it.

Higgins published data on the orientation program’s success in “Anatomy of a Staged Orientation Process,” which appeared in the November 2009 issue of the Journal of Emergency Nursing. The program’s success also piqued the interest of local members of the Emergency Nurses Association and was recognized for exemplifying best practices.

Ultimately, the program’s effectiveness will be measured in reduced nursing turnover over time. But so far, it has proven to be such a success that senior management at Maryview Medical Center has approved the purchase of the ENA: Emergency Nursing Orientation course across the local system. Senior management has come to view the program not only as an effective retention tool but as a recruiting tool as well.

For details about orienting emergency nurses effectively, check out the Mosby’s eLearning online course, ENA: Emergency Nursing Orientation, or call 866-416-6697.

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