As nurse educators, we have all been involved in situations where RNs come to the organization and are provided with an orientation that includes competency assessment and management, the acquisition of new skills to meet patient population needs, and focused support to socialize into the organization and unit culture. After a year or two, some of these same RNs, who are considered the highest performers on the unit, are looking to leave the organization to expand their practice. Although often dispiriting, it bodes the question: How can the nursing professional development (NPD) practitioner contribute when it comes to RN retention?
With all the current predictions of a pending nursing shortage (Cox, Willis, & Coustasse, 2014), it is critical that the organization has a plan to advance RNs into new roles while retaining them in the organization or health system. We have also read the statistics on the financial challenges of losing experienced staff members and bringing in new ones. Li and Jones (2013) noted that the cost to replace one bedside RN ranges from $10,098 to $88,000. The National Healthcare RN Retention Report (NSI Nursing Solutions, 2016) noted the average national turnover to be at 17.1%, costing the average hospital $5.2 million to $8.1 million. They also noted that with each percent change in turnover, there will be a cost savings of an additional $373,200 (NSI Nursing Solutions, 2016). Not only is RN turnover a financial burden, it also has a negative effect on RN satisfaction and patient care. The constant flux of RNs coming and going creates a churn that can influence nurse-sensitive patient outcomes (Stalpers, de Brouwer, Kaljouw, & Schuurmans, 2015), job satisfaction (Han, Trinkoff, & Gurses, 2015), and productivity (Duffield, Roche, Homer, Buchan, & Dimitrelis, 2014).
As an organizational leader, the NPD practitioner is challenged to manage fiscal resources. Although this is often considered to align with “professional development activities and services, particularly the finances of an NPD department” (Golway, 2016, p. 170), the definition can be expanded to include other projects that influence nurse retention. The literature describes most NPD-based retention strategies in the form of implementing a nurse residency (Goode, Lynn, McElroy, Bednash, & Murray, 2013) or mentoring (Schroyer, Zellers, & Abraham, 2016; Twigg & McCullough, 2014).
The Professional Development Assessment Tool
After hearing many clients lament the loss of good nurses “that we trained!” an RN professional development assessment (PDA) tool was developed. The purpose of the PDA is to provide RNs with an opportunity to consider potential professional development career paths within the organization. Four possible career paths were identified that correlate with the needs of the organization or system. Potential practice areas include administration (e.g., charge nurse, clinical nurse manager, supervisor, and chief nursing officer); clinical expert (e.g., clinical ladder, specialty certification, clinical nurse leader, advanced practice RN); nursing education (e.g., NPD practitioner, academic faculty, joint academic/practice appointments); and research. Following organization-specific position descriptions, a brief overview of the role is provided. For example, the charge nurse description notes:
The charge nurse is responsible for the operations and management of a department or unit on a given shift. Responsibilities include patient care assignments, patient–family interactions, and additional administrative and managerial tasks.
PDA participants then complete a nine-item assessment that aligns with the four career paths (Table).
Sample PDA Questions
The results are then shared during a career goal-setting session that may include the nurse manager, director, NPD practitioner, or human resource specialist. Participants are informed that the PDA results reflect their professional inclinations at the time of the assessment, providing insight into potential areas of growth, as well as helping in early career goal setting. For RNs who want to grow professionally in their current roles, NPD practitioners can provide multiple learning and professional development opportunities. To support the clinical expert, the NPD practitioner may address basic knowledge in new disease processes or treatments with educational activities provided either within the organization, via online learning, or at conferences. For the RN seeking specialty certification, the NPD practitioner can provide guidance and encouragement. They may also support professional growth by offering development as preceptors, subject matter experts, and mentors.
As the participant moves along the chosen professional development path, they have the option of shadowing an experienced staff member in that role. This provides insight into the day-to-day work routines, the education needed, and an opportunity for additional mentoring.
The PDA may be given either one time or multiple times over the course of employment. For example, as part of an annual review, the nurse manager may want to reexamine the professional goals with the RN and see whether they can help in creating a plan for advancement. If the nurse manager or educator is concerned that an RN is looking for other employment opportunities outside of the organization, they may have the RN complete the assessment and discuss the results. Having that discussion may result in the RN recommitting to the organization; therefore, although it may mean they move to another area of practice, they do not leave the organization with their years of experience.
Development of a PDA supports discussion between the organization and the RN looking to progress in their career, so they are aware of the roles and positions available. The use of an organization-specific PDA could prove to be a NPD-based strategy to retain experienced staff looking to expand their current role. When used consistently as a basis for professional development conversations, the PDA can lessen an experienced RN's desire to leave by offering opportunities within the organization. Finally, by tracking the number of RNs who are retained by using this strategy in guiding the professional development of an RN, and then converting those saved RNs into retention dollars, the NPD practitioner can demonstrate the contribution to both the organization and the profession.
- Cox, P., Willis, K. & Coustasse, A. (2014, March). The American epidemic: The U.S. nursing shortage and turnover problem [Paper presentation]. Paper presented at the Business and Healthcare Administration Conference. , Chicago, IL. .
- Duffield, C.M., Roche, M.A., Homer, C., Buchan, J. & Dimitrelis, S. (2014). A comparative review of nurse turnover rates and costs across countries. Journal of Advanced Nursing, 70, 2703–2712. doi:10.1111/jan.12483 [CrossRef]
- Golway, M. (2016). Managing fiscal resources. In Smith, C.M. & Harper, M.G., (Eds.), Leadership in nursing professional development: An organizational and systems focus. Chicago, IL: Association for Nursing Professional Development.
- Goode, C.J., Lynn, M.R., McElroy, D., Bednash, G.D. & Murray, B. (2013). Lessons learned from 10 years of research on a post-baccalaureate nurse residency program. Journal of Nursing Administration, 43, 73–79. doi:10.1097/NNA.0b013e31827f205c [CrossRef]
- Han, K., Trinkoff, A.M. & Gurses, A.P. (2015). Work related factors, job satisfaction and intent to leave the current job among United States nurses. Journal of Clinical Nursing, 24, 3224–3232. doi:10.1111/jocn.12987 [CrossRef]
- Li, Y. & Jones, C.B. (2013). A literature review of nursing turnover costs. Journal of Nursing Management, 21, 405–418. doi:10.1111/j.1365-2834.2012.01411.x [CrossRef]
- NSI Nursing Solutions. (2016). 2016 National Healthcare Retention & RN Staffing report. Retrieved from http://www.nsinursingsolutions.com/Files/assets/library/retention-institute/NationalHealthcareRNRetentionReport2016.pdf
- Schroyer, C.C., Zellers, R. & Abraham, S. (2016). Increasing registered nurse retention using mentors in critical care services. The Health Care Manager, 35, 251–265. doi:10.1097/HCM.0000000000000118 [CrossRef]
- Stalpers, D., de Brouwer, B.J., Kaljouw, M.J. & Schuurmans, M.J. (2015). Associations between characteristics of the nurse work environment and five nurse-sensitive patient outcomes in hospitals: A systematic review of literature. International Journal of Nursing Studies, 52, 817–835. doi:10.1016/j.ijnurstu.2015.01.005 [CrossRef]
- Twigg, D. & McCullough, K. (2014). Nurse retention: A review of strategies to create and enhance positive practice environments in clinical settings. International Journal of Nursing Studies, 51, 85–92. doi:10.1016/j.ijnurstu.2013.05.015 [CrossRef]
- Versant Holdings LLC. (2015). Professional development assessment [Data file]. Retrieved from https://versant1.sharepoint.com/Versant%20II/_layouts/15/WopiFrame.aspx?sourcedoc=%7B9E5D9207-475C-47B2-895B-871D928576DB%7D&file=Professional%20Development20Assessment%20-%20FINAL%20-%20MAY%2020%202015
Sample PDA Questions
|When I listen to current health care events, I am most likely to:||Think about how the topic will affect the delivery of care and its influence on systems management and reimbursements.||Wonder about how this will affect the care I am providing for my patients and families.||Plan how I can share the information with my colleagues.||Find out more about the topic, read the latest literature, and plan to investigate how these events will influence care delivery.|
|Teamwork and Collaboration||Administration||Clinical Expert||Education||Research|
|When communicating with the interprofessional team, I am most likely to:||Communicate the shared vision of a project and how it relates to the interprofessional team.||Discuss the plan of care for the patient using an interprofessional approach.||Discuss how to ensure my colleagues have the best-practice information to care for a specific patient population.||Investigate proven interprofessional strategies and outcomes that I can share with those at the point of care.|