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blog 5.15.14

Onboarding Programs a Solution to the Growing Nurse Shortage

The Q1 2016 PX Advisor is focused squarely on nursing, on human resources and training challenges, in light of the changing healthcare environment. This post excerpts a Q&A with HealthStream’s Kimberley Herold, Director of Clinical Development Pathways. Subscribe to PX Advisor.

What is the role of onboarding in addressing the growing nurse shortage?

There is a bit of a perfect storm brewing, with experienced nurses leaving the field in record numbers at the same time that demand is rising due to an aging population, prevalence of chronic disease, and an increasing number of insured patients seeking care. This creates an “expertise gap” that will largely need to be filled by new graduate nurses. Currently, an average hospital has novice nurses filling 10-15% of nursing positions.

Why is onboarding such a critical career stage for nurses?

There are many challenges facing a new nurse trying to transition from academia into his or her first hospital position. Among them are fear, culture shock, lack of confidence, role confusion, and others. And, these are all on top of learning the key skills and competencies required to manage complex patients in an increasingly complex regulatory environment. By delivering an onboarding program that addresses all of these issues and that provides a well-rounded, mentored experience, we can help nurses transition in a way that leads to greater role satisfaction and confidence. That, hopefully, encourages professional growth and the development of nursing’s future leaders.  

What is a best case scenario for successful onboarding?

The literature supports a one-year onboarding program that includes an immersive preceptorship period, followed by ongoing educational support and mentorship. A program that offers a blended learning approach to address the unique learning needs of residents is essential to ensuring knowledge transfer. The inclusion of hands-on activities for simulated and live patients with a preceptor fosters knowledge application in a manner that is safe and conducive to learning. A strong mentorship experience benefits the new nurse by helping with cultural assimilation and competency development through reflection and coaching. Ideally, by the time a new nurse is taking patients on her own, she has progressed beyond a novice stage where task completion is the focus, to the advanced beginner phase, where she has a growing confidence in her place as a professional within an interdisciplinary team. Nurses in this position are able to apply critical thinking to daily practice.

What should we expect for the future of onboarding?

Our strategy is to develop pathways of learning that address other challenges in the healthcare workforce outside of Nurse Residency, in order to provide life-long career development for the professional seeking to grow skills and competencies, to achieve certification in his or her field of specialty, or even to move into a greater leadership role. For our customers, I think there is a growing awareness that change is needed, and a willingness to consider that the traditional mindset for development of clinical staff is no longer relevant given today’s unique challenges. By looking at nurse onboarding (and staff development in general) as an investment with important ROI rather than just as “non-productive costs,” hospitals can expect to see reduced turnover and improved quality of care.

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