Director of Cardiac Nursing Children's Memorial Hermann Hospital Missouri City, Texas, United States
Abstract:
Background: Several factors have significantly impacted nurse recruitment in hospitals leading to staffing challenges. The COVID-19 Pandemic was an unexpected stressor that challenged the world of nursing. The aftermath caused burnout and fear which led many nurses to terminate their nursing career. The job market demand and competitive rates for contract nursing labor has increased nurse turnover in hospitals. As a result, hospital nursing is facing a shortage of core clinical bedside nursing staff leading to hospital diversion, surgical case cancellation, and program stasis due to the unavailability of staffed hospital beds in the Children’s Heart Institute. Currently, utilization of contract labor is an expensive solution that is unsustainable financially for the foreseeable future. We developed a recruitment strategy referred to as “Project All Hands on Deck” to rapidly increase nurse FTEs, support the increased patient acuity needs, and increase the number of available beds for the pediatric heart inpatient units. Our strategy uses several recruitment tactics to support the immediate needs of nursing and accommodate the current demands of our program.
Objective: Our objective is to utilize creative onboarding solutions to rapidly onboard nursing staff through a safe modified nursing orientation using team preceptorship, graduate nurses, experienced hires, cross-training, and identified resource roles in the Pediatric Heart ICU and IMU.
Method: A Team preceptorship approach is being piloted to address the lack of nurse preceptors. Preceptors will have 2 orientees simultaneously using a phased approach. A large cohort of graduate nurses will be onboarded using a “New Graduate Nurse Boot Camp” orientation. This modified orientation will have a huge focus on skills and bedside clinical training. Restructuring orientation time by 50% and providing clinical support post orientation will allow nurses to practice independently at the bedside sooner. The clinical orientation will focus on training in both intensive care and intermediate care units to allow for flexible staffing. Didactic and ongoing education efforts will continue post orientation over a 12- month period. The HERO (Help-Educate-Rescue-Observe) Nurse is a support role developed to provide an additional layer of support for the nursing staff with modified orientation. A unit level mentorship program will be implemented to provide peer support as well as an additional resource.
Results: Utilizing this staffing approach will nearly double RN FTEs within 6 months of implementation. Staffing challenges will improve with more appropriate nursing coverage and can potentially increase the number of opened staffed beds.
Conclusion: Implementing Team Preceptorship will allow units/departments to increase the number of nurse hires. Restructuring Graduate Nurse orientation will increase the number of nurses at the bedside within 3 months instead of 6 months. These combined efforts are an urgent solution to address a significant nurse deficit.
Future direction: Creative staffing using team preceptorship and restructured orientation can be a solution to rapidly staff inpatient units that may be experiencing a staffing crisis.
