From Turmoil to Success: Facilitating the Future for Nursing

Abstract

The neurology/neurosurgical intensive care/step-down is an eight-bed intensive care and six-bed step-down (SD) department. In June, the department had a 45% vacancy rate, a newly hired department director, and five registered nurses (RNs) who were RN IIIs and RN IVs on the clinical ladder. The department was in need of leadership. The newly hired department director had 35 years experience in management, all on cardiac/intensive care departments. She was limited in her neurological experience, yet she was excited and up for the challenge. She started off like gangbusters, hiring experienced and new graduate nurses so rapidly that she went from a 45% vacancy rate to a 0% vacancy rate in 6 months. Of the staff hired, 15 were new graduate nurses, and only 3 had previous clinical experience in intensive care, yet, this was a great accomplishment to achieve a 0% vacancy rate, because this department always had a greater than 20% vacancy rate, and the department directors had turned over every 2 to 3 years. Due to the high turnover of leadership, the staff learned to adapt and work on their own, and small silos were formed. This led to many informal leaders on many different shifts. The physicians became close to the staff, especially those who were vocal about the good, the bad, and the ugly when it came to issues and concerns of the department.