Abstract WP43: Improving Nurse Retention Through Orientation Restructuring, Planned Professional Development, and Leadership-Employee Support: One Unit’s Journey

Abstract

Introduction: Increasing RN turnover rates are a noteworthy and nuanced problem for many nurse leaders. It is a particular challenge within specialty units, resulting in the loss of specialty nursing knowledge, assessment, and critical thinking skills relevant to specific patient populations. RN turnover rates increased over a two-year period on a stroke unit in a large teaching hospital that provides specialty care as part of a Comprehensive Stroke Center. Many of the RNs leaving the unit pursued critical care roles, and their knowledge was lost with their attrition. This prompted the nurse leadership to re-examine the orientation process, professional development plan, and leadership-employee support methods that were being utilized. Methods: Using the PDSA model, orientation was reorganized allowing new RNs to be trained solely on the stroke unit for 10-12 weeks then working independently on that unit for 6 months prior to training on the epilepsy monitoring unit, as opposed to training and working on both units from the start of their employment. Professional development plans that included one-on-one resource nurse training with the Assistant Nurse Manager and cross-training to the neuroscience stepdown unit after one year of employment were created for each RN. Each staff member was supported with mentorship check-ins by an assigned Clinical Leader and with bi-monthly check-ins with the Nurse Manager. Quarterly staff meetings were held to promote staff engagement and provide staff members with an opportunity to cascade information on their individual projects, councils, or initiatives to their peers. Results: These changes, including the training of 10 RNs to the stepdown unit, resulted in an 82% decrease in the number of RNs who left their job on the stroke unit in the first year. Conclusion: This process improvement plan demonstrated that thoughtful modifications to the orientation process, a structured professional development plan, and an organized leadership-employee support method can decrease RN turnover. It allowed the preservation of specialty stroke knowledge, thus ensuring that stroke patients continue to receive high-quality, specialized care and that specialty knowledge is transmitted to new staff as they start their careers.