This past year has been a tough one for the healthcare industry. Hospitals have taken a hard look at the fiscal bottom line and reevaluated resources, including staff. The one silver lining in all this bad news: better staff retention. While there are some advantages to nursing turnover, such as new ideas and eliminating poor performers,1 the benefits seem to be outweighed by the disadvantages-lack of job satisfaction and compromises in patient safety and quality patient care. Unfortunately, there's a lack of research that investigates the relationship between nurse turnover/retention and quality of care.1
A positive change
A few of my colleagues were discussing the improvement of team dynamics in our section. Over the past several years, our section has had a solid group of core members but most of the remaining staff has transitioned to other positions or opportunities. My colleagues have noticed an improvement in teamwork and attribute this to a lack of staff turnover. The positive change in team dynamics supports the theory that nurse retention contributes to job satisfaction. It's not too big of a leap to say a culture of good teamwork leads to better patient care.
In our surgical division, the stabilized workforce has created new opportunities and dimensions for employees and managers, including increased trust among team members. With trust comes the freedom to challenge current practices and improve nursing practice through evidence-based changes and continuous improvement initiatives.
Retention leads to experience
With experience, perioperative nurses are able to move through Benner's stages of clinical competence: novice, advanced beginner, competent, proficient, and expert. They're able to work cohesively within the team, feel more comfortable in speaking up, and ultimately contribute to patient safety through the team model. As staff become more comfortable with their own practice, they develop ownership and accountability. A strong core group of perioperative nurses also guide new staff to a higher level of practice. Lastly, the leadership team is able to provide staff development and individual opportunities for staff who want to become more involved in committees and projects to achieve professional and personal growth.
Consistency is key
Consistent leadership provides the rudder for steering the team to an optimum work environment. In our division, the leadership team is considered the nurse manager, charge person (list runner), and the nursing education specialist. Changes within the leadership team can affect the dynamics of the section because it can take time to develop a leadership team as a cohesive group of individuals who develop and assimilate the same philosophies, direction, and purpose of service for perioperative staff.
While the economic crisis may be felt for months to come, and with healthcare reform on the horizon, continuous change can be expected. Change can bring unexpected gains. Recognizing and capturing the opportunities change presents can promote growth for the institution and the perioperative nurse.
Elizabeth M. Thompson, MSN, RN, CNOR
Editor-in-Chief Nursing Education Specialist Mayo Clinic, Rochester, Minn. [email protected]
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