By Rose O. Sherman, EdD, RN, FAAN
My graduate students recently had an assignment to interview their Chief Nursing Officers asking a variety of questions related to challenges in the current environment. I was surprised at how many of them commented on their concern about recent changes in skill mix in their facilities. Unlike the historical skill mix arguments that we have had in nursing related to RN ratios, the concerns today are more about the experience skill mix. We have known for more than a decade that the demographics of the nursing workforce would eventually lead to shortages. Things did change with the economic recession and many nurse’s saw their retirement plans derailed. But the reality is that you cannot work forever. Many of our baby boomer nurses have either retired or are moving into nursing roles outside of hospital settings so they can continue working. We are starting to see the fallout from this in many settings which is knowledge and experience loss.
Our nursing research findings indicate that when their are more RNs in the skill mix and if they are BSN prepared, patient outcomes improve. There has been less research about the implications of having 80% of unit RN staff with less than two years of experience – a situation that some nurse managers are confronted with today. One CNO who was interviewed commented that her concern is for these new graduates who are assigned preceptors who themselves are inexperienced. She expressed concern about the potential for errors but also knows that an outcome of poor onboarding is high turnover..
We know from our leadership experience that a nurse is a nurse is a nurse is very flawed thinking. It take time to develop expertise. Nurses are knowledge workers who develop what has been described as “deep smarts” that develop from their experiential knowledge and embedded experience. To combat the problem, nurse leaders in many parts of the county are beginning to see large sign-on bonuses used as recruitment incentives to attract experienced nurses. They are reappearing after almost a decade of limited problems with nurse recruitment and retention. Transferring knowledge to new nurses is gaining traction as a high priority in nursing today.
Based on a model suggested by David Delong, there are four specific types of knowledge that nurses possess about their work that need to be transferred to new nurses. 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
Some best practices include: 1) 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. Many nurse leaders today are looking at innovative ways to use their experienced nurses who are retiring to mentor new staff while themselves working shorter shifts 6-8 hours. One CNO that I recently spoke with is placing an experienced clinical nurse leader, clinical specialist or nurse educator on each unit during the day and several in the hospital on the off-tours. There are no easy solutions to the skill mix conundrum. It will require careful planning and close evaluation to establish best practices when confronted with this new challenge.
Read to Lead
Bleich, M., Cleary, B.L., Davis, K., Hatcher, B.J., Hewlett, P.O. & Hill, K.S. (2015). Mitigating knowledge loss. Journal of Nursing Administration, 39(4), 516-520.
Delong, DW. (2004). Lost Knowledge: Confronting the threat of an aging workforce. Oxford University Press.
© emergingrnleader.com 2015
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