Exhausted nurse
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Nurses need focused training and reliable support networks if the healthcare sector hopes to head off retention woes that are trending in a “dangerous” direction, a group of nursing experts said last week.

A National Council of State Boards of Nursing study released in April revealed that up to 20% of registered nurses could leave the industry within five years. Critically, this includes a large minority of younger nurses, at a time when a proposed federal staffing mandate for nursing homes could drive up RN demand considerably.

Maryanne Alexander, chief officer of nursing regulation at NCSBN, called the developing retention situation a “crisis” at a Nov 9 panel of experts hosted by NCSBN.

“We have seen something that we have never seen before,” Alexander explained. “Twenty-four percent of those nurses that want to leave nursing have less than 10 years of experience.”

Karen Lyon, PhD, CEO of the Louisiana State Board of Nursing and one of the NCSBN panelists, agreed.

“A nursing shortage like this, either because nurses are dropping out or young people aren’t coming into the profession, is a very dangerous trend for us,” said Lyon.

Fundamental retention problems

Panelists agreed on the fundamental problems facing the industry. 

“When everyone does the analysis of the workforce issues, they come up with two basic reasons,” for shortages, said Beverly Malone, PhD, president and CEO of the National League for Nursing. “One is not enough nurse educators and the second is not enough clinical placements.” 

One major problem in nurse education is the ability to find good placements for students. The quality of clinical placements are impacted by the stress and burnout of veteran care workers. New care workers who aren’t given the time and personalized training to succeed feel left behind. And, in turn, veteran nurses struggle without their own reliable and plentiful support.

“A huge percentage of education takes place in the clinical setting,” said Eileen Fry-Bowers, PhD, dean of the University of San Francisco School of Nursing and Health Professionals. “When [currently working] nurses are fatigued or burned out, their ability to work with our students is reduced and many of our clinical agencies then say that they’re not going to take more students.”

Potential solutions

Lyon emphasized the need to match new workers with established frontline nurses to ensure they have a reliable safety net in the initial months of their careers. 

More efforts need to be made to improve facility culture and teach leadership skills to nurses at all levels, added Lavonia Thomas, nursing informatics officer at MD Anderson.

“We engaged in nursing transformation efforts based on feedback from our staff nurses,” said Thomas. “First off focusing on those that were hired in the last three years — because they were hired during the pandemic and needed to focus some of their skills — and then moving forward to those with more experience, and then to all nurses, because all nurses are leaders in whatever job that they hold.”

Additional training also needs to be backed up with more support for nurses’ day-to-day care duties, the panel agreed.

Thomas discussed the hiring of 10 new virtual nursing workers at MD Anderson. Following feedback from frontline nurses saying they wanted more support, the remote nurses have been guiding them on admission and discharge processes. 

“But that’s just the beginning, there’s so much potential,” Thomas said. “Nurses feel very rushed in everything that they do. And so having that person to back them up — where they can think, ‘I’m not taking you away from another patient’ — has been well received.”

Aside from this more agile collaboration, adding virtual nursing to its care practices has allowed MD Anderson to hire nurses who need flexible work schedules.

Recruiting, employee retention and the added pressure to support overburdened care workers have been major areas of focus throughout the skilled nursing industry. 

“I would say it takes a village to raise a new nurse,” said Fry-Bowers. “It takes practice, education, regulation, our clinical partners and our communities all working together so that they can go out and serve the public in a safe and confident manner while not sacrificing their own wellbeing.”