When Staffing with New Nurses Becomes the New Normal

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

Over the past 12 months, nurse leaders, especially in acute care settings, have anecdotally reported that a growing percentage of their staff are nurses with less than two years of experience. This is not by choice – it is almost impossible to find experienced nurses. These observations are supported by Epic researchers, who use the power of EHR data to look at changes in the nursing workforce. They studied 26 million shifts in 189 healthcare organizations in 2021 and 2022 and found the following:

• Between March 2021 and March 2022, median nursing tenure fell by 19.5%.
• Shifts covered by nurses new to the organization in the last 30 days increased in all regions.
• The number of 12-hour shifts filled by nurses new to the organization within the last year also rose by 55.5%.

These demographic changes in the experience level of nursing staff have profound implications for health systems. In his work on lost knowledge, Daniel Delong points out that “Knowledge gaps can be hard to pinpoint and diagnose at first because many work processes today are so intangible and complex.”

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 units. Many non-nurse executives falsely believe that a nurse is a nurse. Nothing could be further from the truth.

Based on a model suggested by David Delong, nurses possess four specific types of knowledge about their work. These include

1. Human Knowledge

Human knowledge is what individuals know or know how to do. This is the specialized knowledge and expertise 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 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, transmitting 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 simultaneously, 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 transfer structured knowledge is critical because health care systems are complex and highly regulated.

So, where do we go from here?

Safety and quality are at risk. A patient experience officer recently told me that the majority of complaints she now addresses involving nursing come from patient and family perceptions that no one knows what they are doing. Sadly, she shared with me confidentially that they were right. Her CEO thinks they are “adequately staffed, and this should not be happening,” but you can’t expect a team of new nurses to perform in the same way as a core group of staff with years of experience. It is why so many managers now feel exhausted and burned out. They no longer have that core staff group that can provide mentorship and leadership backup.

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. 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 amid a pandemic and severe labor shortages, I hear little about 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 you are already paying the price in your performance metrics. 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

Johnston Thayer, MBA, RNJoe ZillmerNeil SandbergAnna R. Miller, MSNPaul Nagel, MBAAlissa MacGibbon (June 2nd, 2022). Epic Research – The New Nurse is the New Normal.

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