1. Moffitt, Brenda MSN, RN, ARNP
  2. Moore, Stephanie MS, RN, ARN

Article Content

Statement/Significance of Problem

The current nursing shortage and nurse retention issues are contributing to poor patient outcomes. Reporting to the JCAHO since March 2002, shows staffing levels are a factor in 24 % of the sentinel events. Predictions are that the nursing shortage will continue. With that knowledge, hospitals will need to retain and develop the nurses they have.



CNSs facilitated the development of an orientation plan that is "nurse friendly" and increase retention of nurses. This project included enhanced preceptor and new hire training.


Description/Methods of the Project

CNSs were hired to develop and retain quality nursing employees. The orientation process was reviewed and deficits identified. The process of developing orientation plans was started. Individualized orientation/development plans were created for each new employee. Orientation classes were presented and facilitated by the CNS. The content of these classes focused on patient assessment, nursing theory, creativity, and critical thinking. A critical component of each content area was the opportunity for practical application of the theory content. CNSs began developing the preceptor training to meet the needs of the staff nurse. Content for the training included adult learning techniques, novice to expert theory, effective teaching strategies. This content was reinforced with practical application. The content was relevant to the current hospital initiatives (ie, medication safety).


Evaluation of Practice Change

Prior to beginning this project, orientation for each employee was dependent upon each unit developing an informal process whereby to orient the new employee. With this project, there has been interdisciplinary input into a formalized orientation program. Each unit is able to adapt the plan to include unit- specific criteria but is standardized.


Conclusions/Implications for Practice

This project has allowed a standardized orientation plan to be developed. Nursing staff on each unit now have a process to follow to ensure a quality, individualized orientation program. Preceptors and new hires have provided written and verbal feedback to confirm that the revised orientation plan is both beneficial and effective. Salina Regional Health Center had a turnover rate in 2000 (prior to CNSs) of 14.13%. As of April 2004, the turnover rate has decreased to 5.60%. (This turnover rate includes retirements, relocations, death, and PRN staff).


Section Description

This year's annual NACNS conference is planned for Orlando, Fla, March 9-12, 2005. Over 300 clinical nurse specialists (CNSs) are expected to attend, and as with past conferences, attendees will also include graduate faculty from CNS programs, nurse administrators, and nurse researchers. The theme of the conference, CNS Leadership: Navigating the Healthcare Environment Toward Excellence, was selected to showcase the many ways CNSs acquire and disseminate knowledge and innovative practices in their specialty areas. Two preconference sessions are scheduled. One session, sponsored by NACNS Legislative/Regulatory Committee, targets information for CNSs interested in understanding the legislative/regulatory process as it deals with the practice of nursing, and will also help build skills CNSs need to engage in the process. The second session, sponsored by NACNS Education Committee, focuses on CNS education issues, and as with the education preconferences of past years, anticipates informative dialogue and much sharing among CNS educators around curriculum design, teaching strategies, and indicators of quality in the curriculum that link to the NACNS education standards to program review and excellence. The conference planning committee is proud and pleased to have Jeanette Ives Erickson, MS, RN, CNA, Senior Vice President for Patient Care Services and Chief Nurse Executive of Massachusetts General Hospital as the opening keynote speaker. She will begin the conference by highlighting the importance of CNS practice on patient safety. The planning committee is equally proud and pleased to have NACNS past-president Rhonda Scott, PhD, RN, Chief Nursing Officer of Grady Health System as the closing speaker. Dr Scott will challenge attendees to use the information from the conference to shape quality care delivered in a safe environment and to advance the profession of nursing through direct care to clients, influencing standards of care delivered by other nurses, and influencing the healthcare delivery system to be to support innovative, cost-effective, quality nursing care. A total of 64 abstracts for podium and poster presentations were selected in addition to graduate student posters. The abstracts address the 3 spheres of CNS practice with a strong emphasis on clinical practice improvements. As you will note from the abstracts published in this issue of the journal, specialty practice areas represented in the abstracts include children, adults, and gerontological patient groups; hospital, outpatient, and home care settings, and community health. In addition, a wide variety of specialty topics including smoking cessation programs, end-of-life care issues, and protocols outlining nursing approaches to improved diabetes, cardiovascular and ventilator management. A number of the abstracts described hospital and healthcare system level innovations that resulted from CNS practice. Collectively, these abstracts reflect the breadth, depth, and richness of CNS contributions to the well-being of individuals, families, groups, and communities. The following abstracts are from those presenters who elected to have their work published in the journal so those who are unable to attend this year's conference can share in the knowledge of the conference. As you read each abstract, consider the talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to improved outcomes for patients and healthcare organizations. You may want to contact individual presenters to network, collaborate, consult, or share your own ideas about these topics. Watch for next year's call for abstracts and consider submitting an abstract for presentation at NACNS's next conference in Salt Lake City, Utah, March 15-18, 2006.