1. Fisher, Cheryl EdD, RN

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As part of the National Institutes of Health Clinical Center Nursing Department (CCND), nurses are required to master specific competencies and gain an understanding of unique requirements when caring for research participants, as well as the clinical needs of our patients. We're specifically interested in retaining qualified nurses because of the intense training needed to work in a highly specialized research setting. This additional investment in staff training means that the cost related to turnover is of particular concern.

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Utilizing evidence to address retention, the CCND has operationalized a multifaceted approach to retention from onboarding with a newly revised orientation program to a residency program for new graduates and the development of a recognition program that celebrates and highlights employee accomplishments.


Onboarding with evidence

It's often said that retention begins at orientation. With the opportunity at hand to revise our orientation program, a new design has been incorporated that's learner centered and utilizes technology to facilitate easier access and opportunities for refreshing new knowledge. Because the orientation process is often overwhelming, the new evidence-based program capitalizes on interactive learning technology, increased efficiency with less class time, and specific opportunities for specialized learning at the unit level. This tiered approach allows newly hired staff members to quickly learn what's most relevant to them while completing the requirements of hospital orientation. Application of new content using case studies, themes around patient safety, the mission and vision of the CCND, and how it's different regarding protocols and patient populations are highlighted throughout the new program.


Additionally, the specialty of the clinical research nurse role has become central to the new orientation program, which focuses on unique responsibilities within the case study presentations and discussions as opposed to the "death by slide deck" model that characterized the previous design.1 An increased number of hybrid and online modules were developed, along with a revised orientation schedule that allows more time for direct practical application of the orientation content. New content has also been added, including a module on resiliency with a self-assessment.


Bring in the residents

Based on Benner's novice to expert framework, a new nurse residency program was developed to assist the newly licensed graduate nurse to move from nursing school to professional practice in the research environment. Using an evidence-based approach to the new design, the goal of the program is to enhance the transition of the novice nurse through learning experiences, teaching, coaching, mentoring, leadership building, improved communication, and evaluation to promote positive change and facilitate the retention of new nurses. The 12-month program emphasizes critical thinking, professional practice skill development, and clinical competency.2 It provides opportunities for new nurses to solidify their clinical practice through didactic classroom learning, skills lab training, and reinforcement of practice at the bedside with a preceptor. A leadership component helps the new nurse develop care management and delivery, resource management, communication, and conflict management skills.


Professionally, the new residents are eased into their role and provided with opportunities to develop evidence-based practice (EBP) presentations to share with their peers and the nursing department. This experience gives them the chance to walk through the EBP process, conduct a small project, and disseminate findings within the safe environment of the department. This type of transition program has been noted to reduce turnover in the first year of practice, promote professional growth of the new graduate with hands-on skill development, increase satisfaction, and, ultimately, impact retention.3


Professional recognition day

Recognition has been identified as one of the easiest and most cost-effective strategies to retain experienced nurses and, in some cases, influence whether a nurse stays with his or her current employer.4 Recognizing staff members can be as simple as a verbal acknowledgment, formal recognition in front of peers, or a written thank you for contributions. It has been noted that giving and receiving recognition heightens awareness of excellence among peer groups, thereby increasing job satisfaction, teamwork, and, ultimately, unit performance.5 Directing positive patient feedback to staff members can also help promote morale and motivation to continue providing high-quality care. It can make a world of difference to employees to know that, at the end of the day, someone noted their hard work.


To this end, we developed a new Nurse Recognition Day, focusing on nurses' length of service, awards for special accomplishments, certifications, academic achievements, and professional publications and presentations. This event is spearheaded by our retention and recognition committee, which is charged with engaging in activities that recognize nurses for their achievements. With opening remarks from department leaders, a poster session for display of the work that has been presented at outside conferences, and a small reception with light refreshments, the event offers a venue for staff members to receive recognition from nursing leadership within the department, in addition to recognition from their peers and colleagues in other areas of the hospital.


Duly noted

Retaining qualified nurses is a continuous challenge for hospitals, especially during these currently tight economic times.6,7 By utilizing several methods to focus attention on employee satisfaction and recognition, you'll be better positioned to achieve the desired outcome of nurse retention.




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