The Journey to Better Staffing Continues: Supporting Novice Nurses (Part 2)

“I’ve got all these orientees,” “Night shift is all new nurses,” “I need a preceptor for my new hire, and the nurses are all just off orientation themselves.” Do these issues sound familiar?

In part 1 of this blog, I described programs that give nursing students an early start to learn critical care content as well as strategies to orient newly licensed nurses (NLNs) differently so that care is delivered safely when a large portion of the staff is new. Strategies to support preceptors and help NLNs after orientation can help ensure optimal patient care and stem high rates of turnover among staff in the first and second years of employment.

Supporting Preceptors

Support for preceptors is essential to create a healthy orientation process. AACN hosted Susan Bartos, an RN program coordinator, for “Enhancing Your Preceptor/New Nurse Support,” a podcast about common challenges for leaders and preceptors. She also shares tips for navigating these challenges to enhance the new nurse experience - including her famous “rose” method. A CSI Academy project describes “Turn Over Patients Not Staff,” which included revamping their preceptor program to improve preceptor support and contributed to reducing turnover! AACN offers “Fundamental Skills for Preceptors,” an elearning course for nurses new to the role of precepting. In a blog, author Rose Sherman describes ways that everyone who interacts with newer nurses can help coach critical thinking skills.

Beyond Orientation

A health system supported nurses in the challenging period right after orientation by creating a clinical mentor extender role. These system-level experienced nurses regularly round in the system’s hospitals to touch base with novice nurses. As an added bonus, many of the clinical mentor extenders also worked as faculty at local schools of nursing. Their experience supporting novice nurses after orientation has led to curriculum changes to support a smoother transition to practice.

Rose Sherman describes a number of innovative approaches to improve job satisfaction for NLNs that go beyond orientation. Improved job satisfaction has improved nurse satisfaction and retention:

• “Give Every New Graduate a Battle Buddy” describes how to mentor, encourage and support new nurses in their role.
• “What New Graduates Need from Nurse Leaders” describes strategies to improve job satisfaction for NLNs.
• “Ensuring New Graduate Professional Socialization” outlines strategies to help NLNs have a sense of belonging as they gain experience in their new role.

Staffing Solutions

AACN offers numerous resources related to staffing. “Navigating Beyond the Crisis: Using Tiered Staffing and a Novel Orientation Approach to Improve Care,” a 2022 NTI session, describes a unique approach for orienting new nurses to advanced cardiovascular devices. It includes a collaborative tiered-staffing approach for both progressive and critical care nurses to meet the staffing needs of critically ill patients with COVID-19.

Virtual Support for Staffing

Tele-critical care nursing and virtual nursing roles implement a variety of nursing interventions that improve outcomes, provide mentorship, and support and facilitate collaborative efforts to improve patient care. “AACN Tele-critical Care Nursing Practice: An Expert Consensus Statement Supporting Acute, Progressive and Critical Care 2022” identifies the essential elements that help organizations, leaders and nurses implement, evaluate and improve tele-critical care nursing practice. Virtual nurses in acute care settings are taking on admission histories and discharge teaching, mentoring NLNs and improving outcomes. Here is a list of resources that describe the use of virtual and tele-critical care nursing to support staffing and orientation:

• “Telehealth and Virtual Nursing: Solutions That Challenge the Status Quo” This symposium introduction describes the five articles included in the winter 2023 edition of AACN Advanced Critical Care’s Symposium on Telehealth and Virtual Nursing.
• “Solving Workforce Challenges in the Acute and Critical Care Work Environment”
• Virtual nursing webinar panel discussion
• In a 2023 NTI session, panelists describe their novel approaches to supporting NLNs. These approaches include an academic-clinician partnership using float pool nurses as preceptors, and leveraging virtual nursing.
• “Supporting Novice Nurses Post-Orientation Through TeleICU”

Conclusion

Supporting NLNs during orientation and throughout their first year of practice presents a unique challenge. They are not alone; nurses around the country report this situation as their reality. Rising to this challenge and finding novel ways to engage students in critical and progressive care roles to build effective orientation processes, and to support NLNs during and after orientation, is essential to build a path to appropriate staffing. Tell us about your solutions!