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NURS3514 Retention and Recruitment of New Grads


Marina S.

on 27 March 2014

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Transcript of NURS3514 Retention and Recruitment of New Grads

Lewin's Model of Change
NURS3514 Q Winter 2014
Retention and Recruitment of New Nursing Graduates

New Nursing Graduates
Key Factors
A Canadian Perspective...
Group Members:
Sophia Aosasogie,
Katelyn Breedon,
Helen Brown,
Rishae Campbell,
Dhikrat Durojaiye,
Aliya Edwards,
Arinola Ohwotsa,
Marina Samodova, &
Peyman Sharifi
Learning Objectives
1. Develop an understanding of current issues in the Canadian nursing workforce
2. Explore the importance of recruiting new nursing graduates & retaining them in the workplace
3. Identify and discuss factors that are key to recruitment & retention
4. Analysis of change in the context of Lewin’s Model of Change
5. Recommendations
6. Conclusion

The Workforce
Ontario hospitals have struggled with insufficient funding to cover the costs of inflation and population growth since 2008
In order to balance budgets, hospitals have cut many RN positions and are substituting RN positions with less-qualified staff
From 2012 to 2013, more than 1.5 million hours of RN care were cut from Ontario’s healthcare system

Ontario’s ratio of RNs is second-worst in Canada. Ontario has 6.99 RNs per 1,000 population
Significant gap in RN care for Ontario

(Ontario Nurses’ Association [ONA], 2014)
Workforce cont'd
Adding one patient to a nurse’s average work load in acute hospitals means:
23% increase in nurse burnout
15% decrease in job satisfaction

The workloads for RNs have increased exponentially. More patients to care for with fewer nurses means that patient assessments, medication administration, and care plans are affected.

Patient conditions are complex and such a high patient acuity requires RN care and treatment.
(ONA, 2014)
Workforce cont'd
RN workforce is aging
27% of Ontario’s employed RN workforce is eligible to retire in the next five to ten years
Plan of action: Fund hospitals to hire more than 17,500 RNs in Ontario to catch up to the rest of the country

(ONA, 2014)
RN Care
Higher RN patient care hours = Improved patient outcomes (ONA, 2014)
Improved patient survival rates
More rapid recovery & earlier patient discharge
Fewer pressure ulcers
Decreased incidence of UTI’s
Reduced nosocomial infections (e.g. pneumonia)
Reduced rate of antibiotic use
Creates medical savings

Additional RN Staffing = Protection of Quality Patient Care

(Image reference: http://nurseonlineph.blogspot.ca/2010/12/road-map-for-becoming-successful.html)
Retention & Recruitment
During current times of nursing shortages & under-staffing, new graduate nurses are a precious resource
Every effort must be made to ensure that the work environments of new graduate nurses are positive, promoting job satisfaction and a commitment to current place of employment
New graduates are
to sustaining the future of the profession

(Laschinger, 2012)
Nurse administrators are concerned about new graduate nursing retention and recruitment due to high turnover rates (Laschinger, 2012; Peterson, McGillis Hall, O’Brien-Pallas, & Cockerill, 2011)

Research findings suggest that the first two years (especially the first year) in the workplace are difficult for new graduates (Rheaume, Clement, LeBel, & Robichaud, 2011)
Many graduates consider leaving their place of work early in their career due to high stress levels

Recruitment Process
• Recruiters can benefit from hiring new graduates who have completed their consolidation on the unit, as this allows the employer to observe the student over time and better judge their potential (Blake, 2013)

• General atmosphere provided by organization (Blake, 2013)
Consider personality of new graduate and whether or not he/she would be a good fit for the unit

• Role clarification (Baxter, 2010)

New Graduate Nurse Experiences
The first months are the most difficult as new nurses are adjusting to heavy workloads, new professional relationships, and engaging in clinical decision making and critical thinking (Rheaume, Clement, LeBel, & Robichaud, 2011)
Physical health is affected – new graduates report headaches, stomach aches, and general exhaustion
New graduate nurses feel insecure, overwhelmed, and at times incompetent as they attempt to meet demands of the workplace (Rheaume, Clement, LeBel, & Robichaud, 2011)
Mastering clinical skills, time management, and organization are areas of difficulty (Peterson, McGillis Hall, O’Brien-Pallas, & Cockerill, 2011)

New graduate nurses have high levels of burnout (Rheaume, Clement, LeBel, & Robichaud, 2011)
Burnout is a “psychological syndrome of exhaustion, cynicism and inefficacy which is experienced in response to chronic job stressors” (Laschinger, 2012, p. 474)

Burnout leads to:
Reduced job satisfaction & poor performance
Reduced patient satisfaction
Back pain
Absenteeism due to illness
Higher intentions to leave current position

New graduates regularly worked overtime, which ranged from four to 24 hours every two weeks (Rheaume, Clement, LeBel, & Robichaud, 2011)
Novice nurses believe they do not have adequate time to spend with their patients and give them the care they feel is necessary
The rapid pace of care leaves little room for interventions such as patient teaching

Overall, new graduate nurses have a positive outlook on their worklife and are committed to staying in the profession (Laschinger, 2012)

The First Year...
What is Important?
Empowerment, work engagement and burnout are factors that affect turnover intentions of new nurses (Laschinger, 2012)
Turnover disrupts workplace communication and leaves nurses uncertain about their roles (Coutts, 2010)
Turnover adversely affects patient health outcomes

Empowerment relates to the degree of support, resources, and opportunities that the new nurse has to learn and grow (Laschinger, 2012)
Promotes feelings of autonomy
Affects mental and physical health
Healthy workplace environments are important!

Importance of Leadership
Effective unit leadership influences empowerment & workplace retention (Laschinger, 2012)
Transformational leadership is linked to positive working conditions (McGuire & Kennerly, 2006)
In mentoring staff, managers create a supportive climate where individual differences are recognized, two-way communication is promoted, and effective listening skills are valued (McGuire & Kennerly, 2006)
Creation of a shared vision for the unit
The follower’s positive sense of self-worth and value leads to enhanced job satisfaction, job performance, and organizational commitment

New Grad Orientation
Job satisfaction and turnover intention are linked to the quality of the orientation program that new graduates receive, and quality of experience with preceptor (Laschinger, 2012)
Job satisfaction with extended orientation programs
Job satisfaction due to improved clinical knowledge and technical skills, confidence and comfort in new nurse role

For many new graduates, orientation programs varied in length from 4 to 12 weeks (Rheaume, Clement, LeBel, & Robichaud, 2011)
Staffing shortages decrease the duration of orientation period even further

(McGuire & Kennerly, 2006)
“My first orientation to the unit. I was supposed to have 10 shifts of orientation, however, I had about five, and I am thrown in, alone on the department. Staffing shortage, everything is new, and there’s a serious bed shortage, and I am in the middle of all this alone.” (Rheaume, Clement, LeBel, & Robichaud, 2011, p. 88)
Reduced nurse’s judgment
Increases the risk of errors (e.g. med errors), falls, injuries
Poor patient assessments
Poor communication
Lack of continuity in care

Fatigue is multidimensional, being caused by:
Heavy workloads
Staff shortages
Shift work
Increased patient acuity
Decline in leadership
Little time for professional development

Fatigue is a “subjective feeling of tiredness that is physically and mentally penetrative” (Canadian Nurses Association [CNA], 2010)
Affects nurses across all practice domains
Fatigue-related impairments are similar to alcohol-related impairments

(Image reference: http://info.staffinsight.com/Portals/122580/images/very-tired-nurse.jpg)
(CNA, 2010)
(CNA, 2010)
(Image reference: http://www.web-books.com/eLibrary/Books/B0/B58/IMG/fwk-carpenter-fig07_013.jpg)
Underlying Reasons for Change
To solve a problem and to improve efficiency for new nurse graduates
New nurses report feeling overwhelmed by workplace demands, such as workload, staff shortages, and learning new workplace routines
High demands translate into high intentions to leave the job

: Healthcare institutions need to develop the new graduate nurse and build self-efficacy through implementation of
mentorship programs
extended orientation programs
e.g. Ontario Nursing Graduate Guarantee for new nurses

New nurses report increased self-efficacy as their confidence develops with experience and mentoring on the unit

(Peterson, McGillis Hall, O’Brien-Pallas, & Cockerill, 2011)
1. The Unfreezing Stage
The goal during this stage is to create an awareness of how the current level of acceptability is hindering in some way (Kelly & Crawford, 2013)
Old behaviours, ways of thinking, and structures should be re-examined
Communication is especially important during this stage so that employees can become informed of the imminent change & reasoning behind it
Knowledge dissemination leads to motivation & acceptance of the change

There is a great need to create a culture of compassion, mentorship, and education to support the novice nurse in the workplace and decrease burnout

It is important to identify the driving forces for change, as well as the restraining forces

2.The Moving Stage
The organization needs time to move into a new phase or new state of being (Kelly & Crawford, 2013)
This stage is marked by implementing the change
Healthcare organizations implement mentorship programs for new graduate nurses
Provide extended orientation & training programs (Laschinger, 2012)

Most people struggle with the reality of the change
Employees begin to learn the new behaviours, processes, and ways of thinking
Education, two-way communication, employee support, and time are significant for employees to become comfortable with the change
Nurses and other healthcare professionals should be reminded of the reasons for change and how it will benefit them

3. The Refreezing Stage
Analysis of Change
Reinforcing, stabilizing, and solidifying the new state after the change (Kelly & Crawford, 2013)
Efforts must be made to guarantee the change is not lost
Mentorship programs & extended orientation programs must be cemented into the organizational culture and maintained as the acceptable way of thinking and doing
Positive rewards and acknowledgment of individual/organizational efforts are often used to reinforce the change

Without refreezing, there is a high chance that employees will revert back to the old ways of doing things
Along with mentorship programs,
quality assurance programs
must be integrated into healthcare institutions (Coutts, 2010)
Assist novice nurses in providing safe, competent, and ethical care (CNA, 2010)

Joint Canadian Nurses Association [CNA] and Canadian Federation of Nurses Unions [CFNU] Position

It is “unacceptable to fund, govern, manage, work in or receive care in an unhealthy healthcare workplace.” (CFNU & CNA, 2006)

(Image reference: http://www.liberationfitness.ca/wp-content/uploads/2012/11/Stethoscope1.jpg)
Recommendations for Healthy
Workplace Environments
“A healthy workplace environment is a practice setting that maximizes the health and well-being of nurses, quality patient outcomes, and organizational performance” (RNAO, 2008, p. 13)

Healthy workplaces recruit and retain more nurses (RNAO, 2008)

(Image reference: RNAO, 2008)
Develop healthcare institutional policies across Canada to implement mentorship programs and extended orientation programs for new nursing graduates
Ontario Nursing Graduate Guarantee
Initiative: (Nursing Secretariat, 2011)
Designed to support every new Ontario nursing graduate in finding full time employment immediately upon graduation
This ensures that Ontarians have access to the right number and mix of qualified healthcare providers, today and for the future
Reduces new grad turnover and cuts the stress that leads to new graduate burnout

Provide graduate nurses with access to full-time, long-term jobs
The number one reason Canadian nurses are moving to the U.S. is in search of full-time work (Coutts, 2010)

Adequate staffing levels to match the workload (RNAO, 2013)
Hire more RNs to reduce the patient-to-nurse ratio and consequently improve patient health outcomes (ONA, 2014)
Manageable workloads = limited overtime

Allow novice nurses have more control (autonomy) over their practice, and independence to practice to their full legal and professional scope (Coutts, 2010)
Opportunities for involvement in the organization (e.g. serving on hospital committees)

80/20 Staffing Model
: 80% of nurses’ time is devoted to clinical practice, and the remaining 20% is set aside for professional development & continuing education (Coutts, 2010)
Higher nursing productivity
Significant decreases in overtime & staff turnover
Decreased patient falls
Improved job satisfaction
Improved patient satisfaction

Implement quality assurance programs
Report on the effectiveness of care (Coutts, 2010)

Health-care organizations promote a culture of safety by establishing a fatigue management policy and program: (CNA, 2010)
Establish safe scheduling policies for nursing staff that limit hours worked by a nurse
Limit of 12 hours/day
Limit of 48 hours/7-day period

Promote strong nurse leaders to management positions (Coutts, 2010)
Leadership strongly affects nurses’ feelings about their jobs
Hire Master’s prepared nurse leaders (RNAO, 2013)
Leaders incorporate key values such as respect, honesty, feedback, trust, and cooperation (RNAO, 2008)

Provide new graduate nurses with recognition, continual support, and psychological rewards (Coutts, 2010)
Nurses who feel adequately rewarded are less likely to burn out
New nurses especially expect to have their efforts acknowledged

Make occupational health and safety a priority on the unit
Acquire technologies and equipment that help to reduce injuries (e.g. safe-lift initiative)
Hazard awareness

Creating a culture where staff feel “psychologically safe” in order to advocate for their patients/families and to “whistle blow” if necessary to protect themselves and their patients

Supporting staff health and well-being via specific programs (e.g. social supports, employee assistance programs, health programs)

(RNAO, 2008)
(Image reference: http://www.clinicaltrialsmgt.com/templates/client/images/aboutus.jpg)
There is a great demand to recruit more RNs into the nursing workforce in order to drive the nursing discipline forward and impact patient care outcomes in a positive way
New graduate nurses require mentorship opportunities to help guide them in developing the professional nursing role
Provide safe, competent, and ethical care (CNA, 2010)
Meet College of Nurses of Ontario (CNO) standards and guidelines

Development of healthy workplace environments is key to decreasing nursing overtime, burnout, patient care errors, and turnover in the workplace

(Image reference: http://nursing.med.nyu.edu/nursing-nyuhc/departments-and-unit-profiles/maternal-child-services/pediatric-service/9-east)
Recruitment Recommendations
Healthcare organizations should increase the content and specificity of information about available nursing positions
Employers should provide information about the work environment:
Model of Care
Nurse-to-patient ratio levels

Employers should provide educational opportunities for new nursing graduates and inform new grads about opportunities during recruitment process (e.g. education subsidies)

Related housing and child care options should be made available

(McGillis Hall et al., 2013)
Baxter, P.E. (2010). Providing orientation programs to new graduate nurses.
Journal for Nurses in Staff Development
(4), 12-6. Retrieved from CINAHL database.

Blake, N. (2013). Creating a healthy workplace: Appropriate staffing for a healthy work environment.
Advanced Critical Care
(3), 245-248. Retrieved from CINAHL database.

Canadian Nurses Association [CNA]. (2010, October).
Taking action on nurse fatigue
. Retrieved from https://www.cna-aiic.ca/~/media/cna/page%20content/pdf%20en/2013/07/26/10/39/ps112_nurse_fatigue_2010_e.pdf

Canadian Federation of Nurses Unions [CFNU] & Canadian Nurses Association [CNA]. (2006, November).
Practice environments: Maximizing client, nurse and system outcomes
. Retrieved from http://www.cna-aiic.ca/~/media/cna/page%20content/pdf%20en/2013/09/04/16/27/2%20-%20ps88-practice-environments-e.pdf

Coutts, J. (2010, September).
Experts & evidence: Opportunities in nursing
[Electronic book version]. Retrieved from http://nursesunions.ca/sites/default/files/Experts%20and%20evidence_Inside_Sept%207.pdf

Kelly, P., & Crawford, H. (2013).
Nursing leadership and management
(2nd Cdn. ed.). Toronto, ON: Nelson Education Ltd.

Laschinger, H.K.S. (2012). Job and career satisfaction and turnover intentions of newly graduated nurses.
Journal of Nursing Management
, 472-484. doi: 10.1111/j.1365-2834.2011.01293.x

McGillis Hall, L., MacDonald-Rencz, S., Peterson, J., Price, S., Lalonde, M., Andrews, G., Johnson, S., & Harris, A. (2013, March).
Moving to action: Evidence-based retention and recruitment policy initiatives for nursing
. Retrieved from http://www.cfhi-fcass.ca/Libraries/Reports/Moving-to-Action-McGillis-Hall-E.sflb.ashx

McGuire, E., & Kennerly, S.M. (2006, July). Nurse managers as transformational and transactional leaders.
Nursing Economic$
(4), 179-185. Retrieved from CINAHL database.

Nursing Secretariat. (2011, January).
Guidelines for participation in the nursing graduate guarantee for new graduate nurses
. Retrieved from http://www.healthforceontario.ca/UserFiles/file/Nurse/Inside/ngg-participation-guidelines-jan-2011-en.pdf

Ontario Nurses’ Association [ONA]. (2014, January 16).
2014 Pre-budget consultations to standing committee on finance and economic affairs
. Retrieved from http://www.ona.org/documents/File/politicalaction/ONA_2014PREbudgetsubmission_20140116.pdf

Peterson, J., McGillis Hall, L., O’Brien-Pallas, L., & Cockerill, R. (2011). Job satisfaction and intentions to leave of new nurses.
Journal of Research in Nursing
(6), 536-548. doi: 10.1177/1744987111422423

Registered Nurses’ Association of Ontario [RNAO]. (2013, July).
Developing and sustaining nursing leadership best practice guideline, second edition
. Retrieved from http://rnao.ca/sites/rnao-ca/files/LeadershipBPG_Booklet_Web_1.pdf

Registered Nurses’ Association of Ontario [RNAO]. (2008, February).
Healthy work environments best practice guidelines: Workplace health, safety and well-being of the nurse
. Retrieved from http://rnao.ca/sites/rnao-ca/files/Workplace_Health_Safety_and_Well-being_of_the_Nurse.pdf

Rheaume, A., Clement, L., LeBel, N., & Robichaud, K. (2011). Workplace experiences of new graduate nurses.
Nursing Leadership
(2), 80-98. Retrieved from CINAHL database.
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