Training and Retention: Establishing an Evidence-Based Transition to Specialty Practice Program in the Emergency Department

Training and Retention: Establishing an Evidence-Based Transition to Specialty Practice Program in the Emergency Department Inexperience with the varied and often complex patients and situations which present in the Emergency department (ED) challenges a nurse transitioning from student to practitioner status and from non-critical care to the critical care environment. Boyer, Valdez-Delgado, Huss, Barker, & Mann-Salinas (2017) received a grant to develop and implement an evidence-based residency program to transition a nurse with non-critical experience into a critical unit. They demonstrated that an orientation and residency program designed specifically for a specialty unit resulted in improved transition to that specialty for staff, as well as increased nurse retention. A residency or specialty training program constitutes a contract between the employer and new-toa-practice environment nurses. For nurses transitioning from a non-critical environment to a critical environment, a structured transition to specialty practice program (TSPP) creates defined activities and support and contributes significantly to the nurse’s success (AL-Dossary, Kitsantas, & Maddox, 2014). A 2014 study by Choi & Boyle revealed that EDs had the lowest mean years of tenure in addition to the lowest scores for quality and resource availability, as calculated at a unit level and measured by the Practice Environment Scale of the Nursing Work Index. The authors identified the high patient throughput, lack of conventional patient associations, and protocol use as a structure that weakens nurse autonomy. On-boarding programs which include a residency program focused on the specialty care offered in that unit provides a safe environment for both the nurse and the patient while the nurse is acquiring new knowledge and skills (Boyer, et al., 2017). TSPPs are well-documented to help new-to-specialty nurses to build relationships, increase competence and confidence, and increase retention rates (Africa, 2017

TRAINING AND RETENTION 5 ) particularly in specialty units such as the ED, has significant implications across the facility. The unit suffers from the loss of experience and knowledge, which may result in a reduction in quality patient outcomes. Morale suffers when staffing is not stable. The organization suffers from expenses related to new hire orientations and diminished performance (Van Osch, Scarborough, Crowe, Wolff, & Reimer-Kirkham, 2018). Nurse training programs are costly, especially in critical care areas. Becker’s Hospital Review (2016) identified an overall healthcare turnover rate of 13% annually. However, 43% of nurses leave their job within the first three years; with rates of 17.5% at one year and 33.5% at two years respectively. They cited the average cost of a nurse turnover as between $36,000 and $57,000 and annual cost to the average hospital at $4.9 to $7.6 million. Nurse turnover costs include the expense of using supplemental agency or overtime staff to fill the void until new staff is recruited and trained. It also includes the expenses of that recruitment and training. A training program such as a TSPP which decreases the orientee’s isolation and feeling of being overwhelmed can contribute to reducing that turnover, and therefore institution expenses (Morphet, Kent, Plummer, & Considene, 2015). Problem Statement Retention of new-to-specialty nurses is a common problem in EDs. Helbing, Teems, & Moultric (2017) cite 2014 Healthcare statistics of 14.2% turnover for nursing overall and 20.3% for ED nurses. Nurses new to the Emergency Department are subject to high levels of stress. These nurses are either transitioning from student to practitioner status, or from a lower level of care to a critical care status. Increasing acuity, high vacancy rates, and patients boarding in EDs add to staff dissatisfaction (Helbing, et al (2017). Retention of trained ED registered nurses (RNs) is required, Strategies to lessen new-to-specialty staff’s feeling of vulnerability and