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Bring Nurses Back to the Bedside


By Jennifer Thew, RN

Editor's note: This is an excerpt of the HealthLeaders article Want to Keep Nurses at the Bedside? Here's How. This article appears in the March/April 2019 edition of HealthLeaders magazine.

There's more to building a strong nursing workforce than just filling open positions, and even in organizations with top-notch nurse recruitment programs, research has found there's no guarantee that nurses will stay put.

According to the recruitment firm NSI Nursing Solutions, Inc., the average national turnover rate for bedside RNs was 16.8% in 2017.

Additionally, Press Ganey's recent analysis of 250,000 RNs who participated in the 2017 National Database of Nursing Quality Indicators RN Survey found close to 21% of nurses planned to leave their current jobs within one year, including those retiring. When asked about their job plans over the next three years, 26% said they will pursue other options ranging from new positions in an organization to retirement.

The survey also found those at highest risk for attrition were newly licensed nurses and those who have been in practice for two to four years.

Claire M. Zangerle, DNP, MSN, MBA, RN, NEA-BC, chief nurse executive at Allegheny Health Network in Allegheny, Pennsylvania, says she and other nurse executives have seen similar turnover at their healthcare organizations.

"We're all feeling the pain of [nurses leaving organizations] within a few years and going to do travel nursing or to insurance companies," she says. "But some are just leaving practice altogether for reasons that we could probably address internally with some creative ideas."

The RetuRN to Practice Program at Allegheny Health is one creative initiative Zangerle is using to address some of these issues.

The program is designed to attract nurses who have stepped away from practice and want to return to bedside care, which helps reduce the workload of current staff and fill staffing gaps.

 
Flexible scheduling attracts RNs


The RetuRN program offers flexible scheduling opportunities in high-need clinical areas.

Participants must offer managers availability in a minimum of three-hour blocks at any time on a day, evening, or night shift, or on a weekend or holiday.

During their shift, the RetuRN nurses conduct "rover-type" duties, as Zangerle describes it. They cover other nurses' patient assignments during breaks or when staff has to do continuing education off the unit. Or they may come in to do admissions, discharges, or patient education.

"The [RetuRN nurses] know they won't know what they're going to do until they get to the unit," she says. "They're flexible, and they're there on the floor to be able to do that."

Because the RetuRN nurses have been out of practice for various amounts of time—Zangerle says one had not practiced in 20 years—there is an online nurse refresher course through the University of Delaware plus on-the-job clinical shadowing built into the program.

Additionally, there are resources dedicated to helping these nurses through the entire onboarding process, from getting their licenses verified to following up on their satisfaction levels after they've started on the unit.

"We have had a lot that have rushed in and said, ‘OK, I want to do this,' and then when they see all the things they need to do [to onboard], they get scared," Zangerle says. "So we have almost a concierge service–type support. It is worth every single nurse that we bring on board to do this program, to have that for them."

After an initial kick-off event, the organization hired 22 nurses ranging from 0.5 FTE status to 1.0 FTE status.

The retention rate of that group is 100%, Zangerle says.


Creative thinking pays off
 
For others interested in starting a similar program, Zangerle has suggestions on what nurse executives should consider.

First, nurse managers will have to adjust to scheduling three-hour blocks for the RetuRN nurses instead of the typical eight- or 12-hour shifts.

"We've engaged those nurse managers to say it's really a logistics exercise with scheduling," she says. "We're fortunate that we have electronic scheduling, and that's been helpful."

Once the RetuRN nurses start on a unit, the program easily wins converts among staff nurses and nurse managers.

"Once they get a couple of [the RetuRN] nurses on the unit, they hold onto them and they won't let go," she says. "If you educate the nurses on the unit about why [the RetuRNs] are there and solicit ideas from them on how we can enhance the program, it makes the program robust."

In fact, says Zangerle, current nurses can be a source of referrals to the program.

"They might have friends who left nursing to raise their children and now want to come back, or they left because the hours just weren't there," she says.

Hosting information sessions, connecting with academic partners that run refresher courses, and social media marketing are other ways to get the word out about RetuRN programs. She also recommends having one recruiter dedicated to the program to help it grow.

And, indeed, the program is growing. Between February and May 2019, three more cohorts of 10 RetuRN nurses each are slated to begin. The program has also been opened to retired nurses who have been away from the bedside for one year or less.

"A lot of nurses still want to practice but they don't want 12-hour shifts, or they don't want every other weekend," she says. "Then as time goes on, we'll certainly survey our RetuRN nurses to find out what we did right, what we did wrong, and how can we grow this program."


Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.