By Felicia Sadler, MJ, BSN, RN, CPHQ, LSSBB – VP Quality, Relias
The nursing workforce has declined significantly in the wake of the pandemic. Stress and burnout have pushed nurses to their breaking point, with nearly a third of registered nurses in the U.S. expressing a desire to leave their current direct-patient-care role. In order to meet the growing demand for care providers, action must be taken to alleviate the burden on existing nurses; however, it’s more important than ever to focus efforts on welcoming newly licensed registered nurses (NLRN) to the workforce and ensuring they’re set up for success. With an effective, efficient, and engaging onboarding process in place, organizations can equip NLRNs with the tools and attitudes they need to thrive from day one and build the foundation for a productive career.
In a perfect world, the process of welcoming a new nurse into an organization is the beginning of a long relationship. The onboarding process should be approached with this in mind. Nurses are healthcare professionals who should be active participants in their own training, partnering with educators to transition into their new roles in a way that benefits both the organization and their own professional growth.
The content of a training program should be personalized for each individual NLRN and the unique skill set an NLRN brings to the table. Offering relevant education and training through blended learning models can strengthen engagement. Customized programs, while tailored to each nurse, should focus on patient-centered care, quality improvement principles, communication, teamwork, technology, professional practice, and applying evidenced-based practice (EBP) principles. Educators can place extra focus on any of these areas where they identify gaps in a nurse’s knowledge and skill set, and place less emphasis where they identify exceptional strength.
Organizations have the opportunity to demonstrate their commitment to new nurses by making a concerted effort to learn about their preferences and desired goals. Setting aside time to engage with nurses before and during the onboarding process can be incredibly impactful and mutually beneficial. Nurses are given the opportunity to express their goals and expectations, and educators can adjust their programs accordingly. A strong structure, tailored to each individual, will make them feel heard, supported, and understood, and will keep them engaged long after the onboarding process is complete. This creates a solid foundation for future growth and organizational commitment.
While the onboarding process should be treated with great care, successful organizations consistently look for ways to improve process efficiency. There is ample opportunity to streamline certain elements of nurse onboarding without sacrificing individual attention or engagement.
Organizations should examine the overall onboarding process and eliminate any duplicate steps. Beyond reducing obvious repetition, they can consider which steps are actually yielding effective outcomes. Each step should be assessed for its real value to both the organization and the NLRN. Any redundancies or inefficiencies should be pared, as they hinder efficiency by increasing unnecessary burden for all parties.
When providers are bogged down by cumbersome processes, their time is focused on inefficient process steps that are labor intensive processes and provide little value. Excess comes not only in the form of duplicate procedural steps, but in the form of educational materials that are too general and not specialized. If NLRNs sit through inefficient training that simply echoes what they have already mastered in nursing school, they may become disengaged, bored, and frustrated. Nurses who participate in personalized learning demonstrate higher satisfaction, improvements in critical thinking, and overall better knowledge than those who do not. Time can be used more efficiently and effectively when the onboarding process is meeting the learner where they are: other NLRNs may require additional education in areas where others are better versed, simply due to variations in nursing school curricula and allocated clinical hours. For example, some NLRNs may have had more clinical training in complex care situations than others. By making an effort to understand each new nurse’s knowledge/skill set and curate their training accordingly, organizations can demonstrate that they value their staff’s time and improve the efficiency of the onboarding process, significantly reducing orientation time.
Measure and Improve Efficacy
An effective onboarding process can have a direct impact on turnover rates: in one case study, implementing pre-hire assessments led to an 81% reduction in nurse turnover, because nurses could then be properly placed during onboarding. According to the Society for Human Resources Management, nearly one-third of all new hires quit their jobs within the first six months, which can be attributed to a dissatisfactory onboarding experience. Perhaps nowhere is onboarding more important than in healthcare, where clinicians and nurses need to make clinical decisions that have life or death consequences for patients. While it’s relatively clear when to remove extra steps and improve process efficiency, it can be challenging to measure the entire process’s efficacy.
Metrics to determine effectiveness can be mined through engagement/feedback surveys, job performance assessments, evaluations, retention, engagement, clinical outcome alignment, and much more. Once measured, these metrics should be compared against desired outcomes. By aligning the two, organizations can begin measuring efficacy, and continually revisit as an ongoing process improvement effort.
Nursing staff retention is a systemic challenge, and there is no straightforward solution. An investment in a strong foundation for new nurses is an investment in the structure of a healthcare organization and a step toward success in the long term. Newly licensed registered nurses, while a crucial group, make up just a small piece of the puzzle. Assessment-driven, evidence-based, personalized learning can benefit all care providers in an organization, guided by best practices that prioritize their best interests and position them to thrive.
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