The Crisis of Lost Nursing Knowledge

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

Knowledge gaps can be hard to pinpoint and diagnose at first because many work processes today are so intangible and complex.” – David DeLong.

A seasoned OR nurse retires and is replaced by a new graduate. Both are nurses, but the knowledge gap between the two is likely to be vast. Today, there is much discussion about preparing new nurses to fill the gaps left by nurses retiring and resigning. There is less discussion about the years of organizational, clinical, and leadership knowledge that experienced nurses take with them when they leave. We are paying a heavy price for lost knowledge in organizations and on units. Many non-nurse executives falsely believe that a nurse is a nurse. Nothing could be further from the truth.

The Risks

Through time, nurses gain tremendous experiential knowledge, much of which is often neither documented nor shared. When nurses retire or resign, the knowledge, skills, and judgment leave with them. Organizations today find themselves vulnerable to increased errors, loss of efficiency, and a decline in the quality of care. In research that I conducted several years ago with perioperative nurses, the loss of the “perioperative nurse specialty brain trust” was cited as a major concern by perioperative nurse leaders. The situation has only worsened with the escalation of retirements as an outcome of the COVID pandemic.

Transferring Knowledge

The transfer of knowledge in an organization involves capturing and distributing the knowledge of experienced nurses to ensure that what they know will be available for future use. It is important to consider what knowledge may need to be transferred. Based on a model suggested by David Delong, there are four specific types of knowledge that nurses possess about their work. These include

1. Human Knowledge

Human knowledge is what individuals know or know how to do. This is the specialty knowledge and expertise that nurses develop over time and use in their work.

2. Social Knowledge

Social knowledge, also known as social capital, is developed by working with groups and teams of people over time. Relationships require trust and collaboration. Social knowledge is critical in nursing, where so much of care is a team effort. Understanding who to call and how to work effectively with an interdisciplinary team increases efficiency and effectiveness within organizations.

3. Cultural Knowledge

Cultural knowledge is understanding an organization’s cultural norms and how things get done. In nursing, the transmission of cultural knowledge is important so that work units work cohesively and help nurses new to the organization in their transition. When groups of staff leave at the same time, cultural knowledge can be lost, and units become unstable.

4. Structured Knowledge

Knowledge about an organization’s systems, processes, tools, and routines is considered structured knowledge. It is explicit and rules-based and is an organizational resource. Attentiveness in nursing to the transfer of structured knowledge is critical because health care systems are complex and highly regulated.

Strategy to Consider

So, where does this leave us? To bridge the gaps in this knowledge loss, I believe that nurse leaders should consider bringing back their recently retired seasoned nurses in part-time “coaching roles” to work with new nurses. Even 4-6 hours a day would be helpful. So many leaders have told me that they could have retained some of their older nurses if there had been any options other than full-time 12 hour shifts on their units. Even in the midst of a pandemic and serious labor shortages, I hear little about any creative staffing options. I am sure some of you may read this and say – yes, but this would cost money we don’t have. I would say that the price you are currently paying because of the knowledge gaps may be higher than you think.

Read to Lead

Delong, DW. (2004). Lost Knowledge: Confronting the threat of an aging workforce. Oxford University Press

Sherman, R. (2008). Lost knowledge: Confronting the challenges of an aging workforce. Nurse Leader, 6(5), 45-47.