1. Lockhart, Lisa MHA, MSN, RN, NE-BC

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Q: Many of my frontline nurse colleagues are leaving the bedside for advanced practice roles in community settings. What can we do to retain our clinical nurses in the hospital environment?

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A: Reviewing the literature, I've seen comments such as, "Being a frontline nurse is no longer a destination but rather a stepping-stone to something else" and "Nursing has not dealt with the long-term consequences of pulling nurses away from the hospital and traditional point-of-care roles." Although advancing education and practice is one reason nurses are leaving the bedside, frontline nurses may also be moving away from hospital care due to the hospital work environment itself. Advanced practice roles in community settings may be seen as more desirable because they offer increased autonomy and support for professional practice.


How do we change this perception and create an environment that fosters bringing the knowledge base of advanced practice to the bedside? Empowering nurses through shared governance and providing avenues for advancement at the bedside and throughout the organization are key actions. Shared governance brings nurses' voices to the forefront in workflow management, care pathway creation, and the development of advanced practice nursing roles. It's critical that nurses are involved at every level of patient care. Advanced practice nurses must have an avenue to grow and develop themselves within the organization. There are many hospital roles that utilize advanced practice nurses to manage care collaboratively with healthcare providers, such as in critical care, oncology, palliative care, and emergency medicine.


The reality is that if the shift away from the bedside isn't addressed, quality of care may be affected. It isn't uncommon for the experience level on a nursing unit to be 1 to 2 years. Nurses with more time in the clinical setting begin advancing away from the bedside and sometimes out of the organization completely. The average clinical nurse turnover rate is 17.2% nationally, and 43% of new clinical nurses leave their first job within 3 years. According to the 10-year national RN Work Project study, 17.5% of new nurses left their positions within 1 year, 33% within 2 years, and 60% within 8 years. This affects the organization financially as well. The average cost to replace one clinical nurse is $40,300 to $64,000.


It's crucial that we maintain clinical nurse expertise at the bedside while supporting the work of advanced practice nurses in hospital roles. The quality of patient care and the art of caring for patients in the hospital environment depend on leadership in this area.




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