Ask any long-term care nurse or administrator. They all want to improve recruitment and retention of nursing staff. They understand that lower staff turnover rates lead to better care at lower costs.
It’s not that long-term care organizations don’t want to support their nursing staff in their professional growth. It’s that many organizations struggle to do so.
“In long-term care, you don’t have all of the support systems available to you in the hospital,” said Lisa McGlynn, RN, Director of Nursing Services at Attic Angel Place in Middleton, Wisconsin. “It’s a lot harder than people recognize. There are no doctors here. There are no specialists. It’s you. You are each specialist.”
A growing number of studies show that strong orientation programs are closely linked to nursing staff retention. Long-term care organizations with effective orientation programs tend to:
- Have administrative buy-in at all organizational levels;
- Have agreement among the Administrator, Director of Nursing, Staff Educator and Human Resources on what’s needed to adequately prepare nurses to work in their environment;
- Start new nurses with a slightly lower workload that increases gradually over several months;
- Designate an experienced nurse mentor who works closely with new nurses, providing them with timely feedback and professional socialization; and
- Foster a supportive culture where questions are seen as an opportunity for learning and growth, rather than a sign of inexperience or lack of skill.
McGlynn’s comparison to the supports available to nurses in hospital settings is apt. Many hospitals run nurse residency programs, which have been shown to be effective at boosting the confidence, skill and retention rates of new RNs.
Nurse residencies are ten-week to year-long transition to practice programs that offer targeted training and mentoring. Due to their size, staffing levels and tendency to hire multiple nurses at once, hospitals can often offer nurse residency programs.
The same isn’t true of long-term care organizations. Yet long-term care nurses’ wide range of responsibilities suggests that they could especially benefit from residency programs to support their transition to practice. (See our earlier article, “Nurse Residencies: Now Coming to Long-Term Care.”)
That’s why researchers at the University of Wisconsin–Madison School of Nursing’s Center for Aging Research and Education (CARE) developed an online residency program for nurses entering long-term care. Called Geri-Res, the program includes online curricula for nurses and their coaches, an implementation toolkit and a supported onboarding process for long-term care organizations. Geri-Res offers tailored tracks for three settings: nursing homes, assisted living and home health.
Attic Angel in Middleton piloted the Geri-Res nursing home track. Attic Angel’s Betsy Gerhardt, RN, who is a mentor in the Geri-Res program, noticed an impact on nursing staff morale.
“They appreciate that we’re investing in them,” said Gerhardt. “They’re noticing that we care. Even the seasoned nurses are appreciative of it.”
Geri-Res helps long-term care organizations better support and retain nursing staff by:
- Walking the organization through the development of their residency implementation plan, including how to enroll new nurses in the program, how to handle their scheduling and how to facilitate meetings between new nurses and their mentors;
- Supporting experienced nurses to develop mentoring skills; and
- Helping new nurses apply residency lessons immediately, through exercises like reviewing charts and identifying evidence-based recommendations, in ways that connect the nurses with colleagues throughout the organization.
Attic Angel’s Gerhardt and McGlynn were surprised that Geri-Res not only helped new nurses build skills and confidence, but also impacted others on the nursing staff, as well as the organization overall. They saw nurses talking with each other more and asking questions more readily. Some nurses wanted to know if they could participate in the residency program.
“It’s a good way for a nurse to have an impact and make change in the workplace,” said McGlynn. “How often do you really get to say that?”
Data from the skilled nursing homes that piloted Geri-Res suggests the program lowers nursing staff turnover while increasing job satisfaction. This further illustrates the power of committing to supporting and developing nursing staff at the organizational level.
“It is exciting to see these results,” said Barbara Bowers, PhD, RN, FAAN, CARE Director and UW–Madison School of Nursing Associate Dean for Research. “Our hope is that creating a work environment that elevates the professional development of long-term care nursing will not only reduce nurse turnover, but will also make the setting a more attractive career option for new nurse graduates.”
–Peggy Rynearson; photos by Alex Andre