Knowledge Transfer on High Turnover Units

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

The national bedside nursing turnover rate increased in 2017 to 16.8%, a 2% increase in one year (NSI, 2018). Much of this nursing turnover continues to occur in the first three years of practice. The overall vacancy rate for RNs in the US is now 8.2% nationwide with some geographic areas experiencing severe shortages.

High levels of unit turnover is often described as causing organizational whitewater. Even units that were once well oiled machines can become very chaotic when turnover increases. When nurses retire or resign, the knowledge, skills and judgment that they possess leaves with them. Without a strategic plan to quickly transfer knowledge in this type of environment, organizations may find themselves vulnerable to increased errors, loss of efficiency and a decline in patient care.

The transfer of knowledge in an organization involves capturing and distributing the knowledge of experienced nurses to insure 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. For nurses, this is the specialty knowledge and expertise that they 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 a period of 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 with 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 teams 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.

Strategies

Nurse leaders need to be strategic in the knowledge transfer process to avoid knowledge loss. Some best practices include: 1) rapid cycle structured mentoring experiences, 2) job overlap, 3) establishment of communities of practice and knowledge and 4) the utilization of technology for knowledge capture and storage.

David Delong in his book Lost Knowledge recommends story telling as a way to encourage nurse to share information about how things get done and to pass on the history, culture and values of the organization. A key to success in knowledge transfer regardless of the strategy selected is to create the sense of urgency among all staff that knowledge transfer needs to happen more rapidly today.

Read to Lead

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