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Industry View: Stemming the tide of nursing turnover

Monday, 29 April 2019  
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Picture: Elsevier vice president of Health Informatics, Clinical Solutions Robert Nieves


Industry View: Guest column by Robert Nieves, Elsevier


Improved education, training and digital empowerment are key to keeping nurses on the job – critical at a time when demand for their services is on the rise.


A rising demand for healthcare in New Zealand due to factors such as ageing and increased life expectancy has raised concern about the future size, skills and attributes of the nursing workforce.


When also factoring in an ageing nursing workforce and an increase in nursing pay rates that has just been agreed by the national registered nurse organisation and the New Zealand Government (thereby improving household finances and leading to expected reduction in hours and earlier profession exits) there is an increased likelihood of a drastic workforce shortage.


Nursing Council of New Zealand data predicts a shortage of 15,000 nurses by 2035, while a separate New Zealand study showed that 22.6 per cent of RNs surveyed plan to leave work altogether due to burnout and low work engagement.


If these predictions come true, hospitals will experience a major crisis in their ability to deliver high quality and safe care.


Need to retain experienced staff


Too often, policies that seek to address the nursing shortage issue focus primarily on recruiting new staff, overlooking retention of senior, experienced nurses. The former is much harder and more costly to achieve – a study found that the average cost to providers in New Zealand was $23,711 per full-time position turned over, for several reasons.


First off, employing new graduate nurses is expensive, and the onboarding of new nurses is a relatively long process.


Further, there are unmatched expectations between NGNs and employers, where NGNs are not trained sufficiently to transition into the role, while employers expect much more – causing dissatisfaction on both ends. As a result of theory-to-practice gaps, NGNs often feel that they are lacking skills in key clinical areas, and do not always feel ready to be wholly responsible for patient care in their first year of employment. 

As we look at the various levels of nursing, one of the biggest causes of dissatisfaction for enrolled nurses is the inability to practice to the full scope of their training and qualifications.


Factors influencing this include organisational policy (including individual ward/unit policies), and the understandings and attitudes of RNs and others in the healthcare team in their areas.


Ways to stem the turnover tide


While not much can change overnight with these circumstances, there are three ways to progressively stem the turnover tide:

  1. Raising the quality of nursing education

    It all begins with nursing education – knowledge can bridge theory-to-practice gaps and enhance nursing workforce performance. Nursing education should classify and frame nursing knowledge in ways that prepare graduates for complex nursing practice to safeguard the public.

    A good example is Box Hill Institute, an Australian nursing faculty that adopted evidence-based training and referenced online solutions to transform and raise the quality of its nursing programme. Leveraging these resources, Box Hill Institute standardised theory and skills across its three campuses and gave their nursing graduates more confidence in practicing their skills. Faculty staff and students could also access learning materials from multiple devices. 

    Additionally, clinical placement experiences are crucial as they help to expose students to different health settings and facilitate both professional and personal growth. A study involving students from four Australian universities recommended that appropriate sequencing of clinical practice in relation to theory, consistency of venue and preparation for the health setting were important in providing quality clinical placements. The Australian Nursing and Midwifery Federation further supports these findings. 

  2. Providing training to onboard new nurses

    In the same vein, healthcare organisations need to look into raising the quality of on-the-job training to equip new nurses with the necessary skills to be workforce ready. However, nursing education should not stop with the onboarding process. 

    To ensure a highly competent workforce, organisations must institute and invest in evidence-based competence programmes to ensure that nurses are practising according to the latest evidence and organisational standards that will build up both individual competence and integrated competencies. Nurses with integrated competencies should understand how nursing practice works in collaboration with, and alongside, other interdisciplinary team members. Evidence clearly shows that when nurses are enabled and supported to do the job they were trained in, they are less likely to leave the profession.

  3. Empowering the nursing community, including students, to use digital technology

    Nursing students and nurses alike need to understand the benefits of digital health and be confident and efficient in using technologies that continue to evolve. As electronic health records are now a common addition in many healthcare settings, organisations must take advantage of EHR technology to support nursing knowledge and decision making at the point of care. 

    The clinical nursing leadership must take ownership of the clinical workflows and processes that are implemented in the EHR, such as the care planning process. Increasing adoption of clinical decision support tools that are evidence based and aligned with the care planning workflow are also an effective mechanism to turn an everyday activity into a dynamic process that empowers the nurse with actionable knowledge. 

    Training on nursing informatics is therefore paramount to help current nurse leaders, staff nurses and nurses in training to be better equipped to manage the demands of the increasingly high-tech nursing environment.
Stemming the nursing turnover tide requires a systemic approach to addressing burnout among nursing professionals. Efforts must be made to elevate the level of nursing education to close knowledge gaps. Coupled with the adoption of digital tools to drive workflow efficiencies, providers can enable nurses to perform at their best, thereby directly impacting the quality and sustainability of the nation’s healthcare.


Robert Nieves is vice president of Health Informatics, Clinical Solutions for Elsevier, a global information analytics business that provides digital solutions and tools for the nursing and health industry.


Read more views:

Kevin Ross: Industry View: Are we prepared for AI in the health sector

Siobhan Bulfin: Industry View: Where healthcare needs to be five years from now

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