Critical care units most affected by lack of skills
Critical care units most affected by lack of skills
Many new grads not clinically prepared to step in
More and more nurse managers of all stripes are bemoaning an apparent lack of broad-based skills and experience in their new bedside staff. Throughout nursing, some experts say, the lack of good skills is a factor aggravating an already severe staffing shortage.
Not all nursing specialties, however, are similarly affected. But in critical care, where the stakes are high, the problem of marginally trained new nurses has become increasingly acute, say ICU veterans.
The lack of broad-based skills is not across the board, but is concentrated in specialties such as neonatal nursing, says Carole Kenner, DNS, RNC, FAAN, director, education and programs, National Association of Neonatal Nurses (NANN), Des Plaines, IL. "In other words, the shortage is not in sheer numbers, but in the numbers of nurses with specialty experience."
Kenner points to a national survey conduct- ed by the American Organization of Nurse Executives, the U.S. Department of Health and Human Services, the American Nurses Association, and the Society of Healthcare, Human Reserves Administration, which surveyed 388 hospitals on the nursing shortage issue.
The survey results also indicate that nursing educational institutions are contributing to the specialty shortage problem by not providing students with enough clinical experience before graduation.
Frances Strodbeck, DNS, RNC, NNP, director of the Neonatal Nurse Practitioner Program at the University of Cincinnati College of Nursing and neonatal nurse practitioner at Miami Valley Hospital, Dayton, OH, concurs. "The units want to have people with experience," she says. "When dealing with sick babies, there isn’t a huge margin for error."
With changes in health care and mainstreaming of hiring lines, less staff are available to orient new employees. "We don’t have the resources for orientation as we once did," says Strodbeck. "We need to hire people with experience, and one of the ways to do this is to help students get more experience while in school in order to make them more marketable for when they apply for a job."
In order to provide students with opportunities to gain experience prior to graduation, NANN is in the process of developing a mentorship program. "This will provide an exceptional opportunity for students to gain clinical experience, enhance their skills, and broaden their resources under the auspices of an experienced professional," says Strodbeck. "These are the qualities that will give a new graduate the edge over someone else."
With a mentorship program in place, NANN chapters will work collaboratively with area schools of nursing. "Everyone will benefit from this mentoring concept," says Strodbeck. "Hospitals will have higher-caliber students entering their workplaces, the patients will benefit from the quality of care provided to them, and graduates will feel more confident entering the workplace."
Students are also encouraged to volunteer in neonatal units as cuddlers. Cuddler programs encourage neonatal nursing students to rock and cuddle babies. "Through mini introductions’ to neonatal nursing units, such as with the cuddler program, students are able to experience aspects of nursing that they wouldn’t be able to in a classroom setting," says Strodbeck. "Many times students who make an effort to volunteer in a neonatal unit often have an edge over other candidates when looking for a position."
Management style key to retaining nurses
While many hospitals nationwide are experiencing nursing shortages and other related challenges, some are not feeling the crunch. One such site is Cincinnati-based Tri-Health, a partnership of Bethesda North, Bethesda Oak, and Good Samaritan Hospitals.
Leslie Altimier, RN, MSN, manager of Neonatal Services for Tri-Health ICU and Special Care Nurseries has a staff turnover rate of 2%. "We are very lucky to have a very low turnover rate and not be short-staffed," says Altimier, who is responsible for a staff of 200.
Altimier attributes the successful retention rate to the fact that everyone is treated as a valued employee. "We have found that the human element plays a significant role in keeping our nursing staff happy and willing to go the extra mile when necessary," she explains. "We allow fairness and flexibility and provide the same treatment to all staff members.
"One of the things that people say is that pay is the biggest issue facing staff across the country," she says. "In reality, there are many people that go to work Monday through Friday for less pay, but have flexible hours. We try to consider all of the factors that are important to staff, such as flexible hours, opportunities to attend conferences, and an opportunity to voice suggestions and ideas for improvement, among others.
"We try to provide a work environment that people want to return to on a daily basis, and our low turnover rate is one way of seeing that the staff do like it here," says Altimier.
To ensure continuity among the three hospitals, one physician group covers all the units while Altimier serves as manager. "We provide operational consistency for all three sites," says Altimier. "From a management perspective, we try to listen to the staff and treat everyone as individuals, not numbers."
Working collaboratively builds stronger staff
A good communication system is key to working collaboratively with your staff, nurse managers claim. "Instead of having a third party determine how to design our new neonatal unit at Good Samaritan, we asked the nurses to take the lead on it," says Altimier. "Usually, the units are linear in design, not here. We have an L’ shape that best meets the needs of the staff and patients.
The unit also includes improved acoustics, carpet/vinyl flooring combinations, cell phones instead of an intercom system, and a central vacuum system. "We have a beautiful unit in which everyone has taken ownership," she says.
The staffing shortage problem affecting specialty nursing cannot be solved easily. It requires a combination of trying harder to retain existing staff and opening doors to new students seeking mentors or opportunities to volunteer to gain firsthand experience.
To retain staff, Altimier advises having open communications with your staff. "You don’t want to be motherly. You want them to know that you will respond to them and act on their request," she says. "Having staff members take the lead on projects invites them to take ownership. They will be more willing to do the work if you give them the space to do so."
For nursing students seeking a mentor or volunteer opportunity, welcome them with open arms. "The bond you create with a new graduate could be a long-term working relationship that you wouldn’t have had otherwise," says Strodbeck.
"Because of the shortage, we don’t want graduates to be afraid to come in. We want them to feel comfortable and confident that they will be an asset to the existing team," she says.
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