QUALITY: On-the-Job Training Lowers Turnover Rate of Nurses

After decades of letting newly-licensed nurses sink-or-swim on the job, some hospitals are finally tossing their new nurses a life preserver. The goal is both better quality care—-and fewer newly-minted nurses who quit.

 According to the Los Angeles Times, a recent national study found that one in five newly licensed nurses quit within their first year of work. This is not what we need given our nursing shortage. Peter Buerhaus, of the Vanderbilt University Medical Center, told the LA paper that we could have a shortage of 500,000 nurses by 2025, due to increasing rates of retirement and the demands of the aging baby-boom generation. This shortage too comes at a time when nurses may actually have a larger role to play in a reformed health where we place more emphasis on primary care, care coordination, and management of chronic diseases.

Many nurses point to stress, lack of supervision, and poor on-the-job training as their reasons for leaving the field. Unlike medical school graduates, nurses have no formal residency in which they can get comfortable with their jobs, practice their skills, and gradually take on more responsibility for patient care. Most nurses are simply left to figure everything out on their own, a practice which strains their ability to deliver patient care.

In 2004, Childrens Hospital in Los Angeles started a program to help train new nurses and combat the high turnover rates. The Versant RN Residency, which has now spread to more than 70 hospitals across the U.S., pairs up new nurses with more experienced nurses. At first, the new nurse will just observe as she completes a lengthy checklist of competence in vital skills, but by the end of the 18-week partnership, the new nurse will be doing hands-on patient care work while the more senior nurse supervises.

Even though programs such as Versant cost about $5,000 per resident,  the cost of replacing a nurse, including recruiting, training, and covering for a short-handed staff, will usually cost about 10 times as much. The Versant program in particular has been successful for many hospitals; the Baptist Health South Florida in Miami reports that the nurse turnover rate has dropped from 22 to only 10 percent since the program was implemented a year and half ago.

We sometimes fail to appreciate the vital role nurses play, both in the direct care they provide for patients as well as their insights into how to improve care systems. For any new care model to be successful, the cooperation and support of nurses is necessary. They are playing a big role in programs to help ease patients from hospital to home. Nurses are very close to the day-to-day work of a hospital, giving them an excellent vantage point for spotting problems in care delivery and innovating solutions. So  nurse retention is good economics, and good medicine.