By Rose O. Sherman, EdD, RN, NEA-BC
The following is a story I hear far too frequently today.
We hired a new graduate who wanted to work in critical care. When I asked her as part of our recent graduate residency program why ICU – she told me that it looked like exciting work from what she had seen on movies and TV. I asked her if she had rotated through a critical care unit during school. Of course, she had not. 80% of her clinical work was done in simulation. The critical care director was desperate, and we knew that if we did not give her a critical care assignment, she would go elsewhere. Now we are three months into orientation, and things are not going well. She is smart, but her skills are weak, and she has many challenges prioritizing care. The staff is upset with her lack of progress. She feels like a failure because, after all, she was a straight-A student up to this point. We will probably end up transferring her from the ICU – it is such a waste of resources. There has to be a better way of doing this.
Leaders in some organizations are now redesigning care by designating their medical-surgical units as Dedicated Education Units (DEUs). Every new graduate spends three months there before moving to their first choice specialty assignment. This plan has advantages, as new nurses today need much more intensive upskilling. It also allows the recent graduate to do shadow days on specialty units to assess whether it is a good job fit. These units are staffed with highly experienced Clinical Specialists, CNLs, Educators, and ARNPs who are there 24/7 to support the clinical care given by staff. Bringing back retired nurses with recent acute care experience as clinical coaches is also a program under consideration.
DEUs allow new nurses to gain confidence and learn about their strengths. It also allows experienced preceptors to work with them and assess work readiness to move into higher acuity units. Specialty training is costly, and a high turnover in these areas can significantly add to a workforce budget.
I worry about this year’s new graduates coming into turbulent environments with a need for intensive skill reviews. They have done so little clinical that they don’t have enough exposure to decide on a good specialty fit. If they fail in their first role, they are more likely to leave the profession and less likely to widen their options about other nursing careers.
Nurse retention begins at the point of recruitment. New graduates today need mentorship and coaching as an outcome of what has happened with their education during COVID. When nurse leaders ask me – how we deal with these intense nursing shortages, I always respond that we need to invest in our new nurses so they will stay in the profession.
© emergingrnleader.com 2022
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