Inadequate Nursing Orientation in Nurse Retention and Recruitment - Term Paper Example

 Inadequate Nursing Orientation in Nurse Retention and Recruitment. Abstract This paper explores the role of orientation training in nurse retention. It investigates certain studies which support the assumption that dropout rate is greater in nurses who lack orientation training. The paper also attempts to explore the types of training available for nurses and how it can be helpful in nurse retention in general. 1. Introduction According to the American Nurses Association, cited in Santiago (2010), Nursing is a title given to the optimization and promotion of health and prevention of illness. The main role of a nurse is to work in close proximity with the doctors and their key task is to understand and administer the treatment modality decided and identified by the doctor with whom the nurse is attached. 1.1 Nursing Degrees and Categories of Nurses According to the American Nurses association, to become a registered nurse and individual is required to attend either a degree, associate or diploma program from a state approved institute of nursing (Nurse Together, 2009). On completing one of the courses, the individual then has to appear in a state RN licensing exam, held under the National council Licensure Examination for Registered Nurses. The degree course in nursing is a four year comprehensive bachelors in nursing sciences program, while the associate program for nursing is a two year program on the similar lines. In addition, there is a diploma in nursing available in all nursing institutes associated with a hospital, duration for which is three years (Nurse together, 2009). A registered nurse who has some specialization in addition to the basic nursing degree falls under the category of APRN (Advanced Practice Registered Nurse). According to the data provided by American Nurses Association (2004), cited in Nurse Together (2009), types of APRN include:  Nurse practitioner (NP), certified nurse-midwife (CNM), Clinical nurse specialist (CNS) and Certified registered nurse anesthetists (CRNA).  1.2 Shortage of Registered Nurses Acute shortage of registered nurses has been reported in the USA during the last few years. According to the AACN fact sheet (2010), there are much more nursing vacancies available than there are number of enrollments in nursing institutes. Universities all over the country are struggling to expand the number of nursing student enrollments to recover this nationwide nurse shortage. 1.3 Nursing Orientation Nursing orientation means being familiar with and having a knowhow about the nursing profession so that it might be considered as a career option. At work level it means on the job orientation programs for nurses. There is some layout available for on job orientation of nurses to keep them abreast with new developments in the technology and techniques regarding their profession. These outlines were issued by the Division of public health (2008). The document stresses on individualized training for nurses to help them adjust in accordance with the specific public health setting in which they are recruited. The layout further states that opportunity for further enhancement of education must always be open for all nurses. 1.4 Nurse Retention Nurse retention means the rate at which the nurses are retained in hospitals and the rate at which they continue nursing degree education. Seago and colleagues (2001) provide a data sheet in their research article which shows that there have been periods of nurse shortages and excess in USA during past fifteen years. Different theorists view this phenomenon differently, and attribute it to different causes. Economists believe that this is due to the lag in wage increase that is present in the field of nursing (Friss, 1994; Cited in Seago et.al, 2001). Other theorists (Yett, 1975) cited in the same article view it as being consequent to the time gap that exists between pay raise and duration of required training to enter the labor force. It is also speculated that nurse shortage is due to distribution and specialization issues of nursing (Yett, 1974; cited in Seago et.al, 2001). Leaders in the field of nursing however, attribute the shortage of nurses to a general lack of nursing orientation, which implies that the image of nursing as a profession is weak and requires strengthening (Friss, 1994; Cited in Seago et.al, 2001). 1.5 Role of Inadequate Orientation in Nurse Dropouts and Lack of Recruitment Inadequate levels of nursing orientation throughout the country not only lead to less number of enrollments in the nursing schools but also enhance the number of nurses’ dropout during study as well as job (Jasper, 1996; Cited in Wahl, 2008). In addition to inadequate orientation, inappropriate ways of orientation may also lead to nurse drop out. In one study, Wahl (2008) found a positive relationship between burnout rates in nurses and number of preceptors with whom they worked during orientation. This shows that orientation is only effective if it is well planned and does not place too much pressure on the nurse students. It can be discouraging and may even lead to drop outs if not planned carefully. 1.6 Public orientation towards the Nursing Profession Poor public orientation towards the nursing profession is also a factor in shortage of registered nurses. Public in unaware about the real issues faced in nursing and thus the image of the career is malformed. The core activities which registered nurses are capable of performing and the importance of these tasks is underrepresented and it need to be highlighted to become common knowledge (Gordon, 2005). 2. Literature Review A lot of relevant literature and research articles on the subject were reviewed in order to obtain a detailed insight into the matter under study. The findings from the literature search are summarized below: Many researchers have explored the factors in nurse retention and the main reasons of burn out and drop out among nurses. A detailed analysis of factors in nurse retention was conducted by Wyngeeren (2010). According to Wyngeeren (2010), inadequate support during the initial months on the job and too much stress in the work environment commonly lead to new graduate nurse dropouts. The article explores and summarizes the nurse retention strategies applied by different institutions along with the outcomes of these strategies. Wyngeeren (2010) found out that most orientation programs for nurses that turned out to be effective in terms of nurse retention focused on two elements: Student to in-practice role transition and competency. To enhance these two processes, effective orientation plans focus on leadership skills, communication skills, coaching and collaboration, enhancing critical thinking and developing a sense of belongingness Wyngeeren, 2010). According to Pine & Tart (2007), Cited in Wyngeeren (2010), some nursing institutes now use the teaching period as a time to familiarize the nurse students with the hospital atmosphere and policy etc and this kind of student level orientation is also turning out to be effective in nurse retention. The role of preceptors in orientation of nurses on job is also of utmost importance in nurse retention. According to Lopez and colleagues (2010), mentoring plays an important role in nurse orientation and enhances nurse retention by many degrees. Wahl conducted a study in 2008 to investigate the relationship between nurse burnout rate and a number of factors. The results showed that the nurse burn out rate is higher when number of preceptors per newly graduated nurse is more than one. This study shows that an increased number on preceptors imply an increased pressure on the new graduate and leads to increased stress in turn (Wahl, 2008). In another study focusing the role of preceptors in effectiveness of orientation in nurse retention, Altmann (2006) found out that most orientation programs did not involve qualified clinical preceptors. Preceptors nowadays are very carefully selected. Clinical skills are not the only qualification against which they are evaluated (Altmann, 2006). Successful preceptors are those chosen on basis of their skills in leadership, patient care, nursing education and nursing administration. In addition to research exploring the factors in nurse retention, there has also been considerable research to find out what type of orientation for nurses is more effective in nurse retention. Morrow (1974), who witnessed a training program for health assistants conducted under the HOPE project devised by Dr. Laredo (1969), has produced a comprehensive article including a critical evaluation of his experiences during such a training program. According to Morrow (1974), this training of health assistants program sent the nursing students into a hospital for one semester’s credit hours after the completion of first semester. After this field based training experience, the students completed the remaining course. This plan proved to be quite effective and the employers of these undergraduates were quite satisfied with the performance of the students which was may be because of the participation of teachers in the on job training program (Morrow, 1974). Baumlein (2010), who is a well qualified registered nurse and dean of the MSN online nursing program, has expressed her concerns about the future of nursing in the US in an article published in ‘Minority Nurse’. She has stressed the need for orientation of nurses. According to Baumlein (2010), the current government has set aside a good amount from the budget for computerizing all the hospital records. This would bring many changes in the system and it will burden the nurses to quite an extent also. Nurses therefore need to be prepared for this change and this can be achieved by providing them with a detailed orientation regarding electronic hospital records (Baumlein, 2010). 3. Discussion The literature review has revealed a lot of information and research on the topic under study. Many researchers (Baumlein, 2010; Wyngereen, 2010 & Wahl, 2008) have identified the lack of orientation in the field of nursing. This lack of orientation is not only limited to the persons belonging to the nursing profession but also extends in general public which is projecting a false image of nursing and is in turn actually discouraging people from joining this profession (Gordon, 2005). There have also been some studies that specifically focus on the role of preceptors in orientation and mentoring in the field of nursing (Wahl, 2008 & Altmann, 2006). The preceptors chosen for nursing orientation programs must be skilled in leadership and communication skills (Altmann, 2006), and they must have the ability of mentoring through inspiring rather than having mere ability of teaching (Lopez, 2010). In addition to considerable focused research on the need of orientation, studies have also been conducted to explore different types of orientation programs and identify which ones are effective (Morrow, 1974). Most researchers have come to the conclusion that the orientation programs that involve more on the job training (Morrow, 1974 & Baumlein, 2010) and appropriate one to one type of mentoring (Altmann, 2006) turn out to be more effective in nurse retention than others. One study that was reviewed is quite futuristic in approach and it clearly states the challenges that the nursing industry is about to face. There is great need of immediate orientation to retain more nurses to combat the present and upcoming nurse shortage in USA (Baumlein, 2010). 4. Recommendations for Enhancing Nurse Retention According to Seago and colleagues (2001), most researchers suggest that the solution to nurse shortage issue is to increase the supply of registered nurses in the field. But other researchers (Cited in Seago et.al, 2001) have found that factors like autonomy, significance of task, increased pay rates, job satisfaction etc are very effective in reducing the dropout rate. In light of literature review and above discussion, following are some suggestions that might be helpful in nurse retention: Orientation programs must be introduced at student level in all nursing institutes for nurses to familiarize them with hospital rules and regulations in advance. Public awareness regarding the importance of nursing profession must be spread around. The nurses’ contribution in a patient’s healing process must be highlighted so that more and more people are inspired and motivated to take up nursing as their career. The first on the job year must be as stress free as possible. Continuous training and well planned orientation must be made available during this period to all new nurses. The preceptors assigned to new nurses must be well trained in mentoring. More than one preceptor must not be assigned to each nurse in the beginning. The first year schedule of nurses must be carefully chalked out so as not to over burden them with much work in the beginning top avoid burnout. Some inspiring true stories of how nurses made a difference in the lives of different patients must be recorded or written and spread around to encourage more students to join nursing. 5. Suggestions for further Research The literature review revealed some under focused areas in the field in where more research is required to fill gaps in the knowledge about nurse retention. These areas include: Role of preceptors in nurse orientation, training needs of newly graduated nurses, wages of nurses, motivation and vocational guidance related to nursing at high school level, dignity issues in nursing profession and general image of nursing in public. 6. Conclusion In light of the above review and discussion, it can be summed up that the decreased nurse retention in the hospitals all over USA can be attributed to the lack of nursing orientation. This lack of orientation is existent not only at nursing student level but also at on-job level. Nurse retention can be considerably enhance by devising and implementing, well planned and orderly chalked out on the job orientation plans as well as orientation for students. General public awareness about nursing also needs to be enhanced in order to encourage more retention in the profession. Further research in this field is definitely required to identify other measures that can be taken to enhance nurse retention in the hospitals across USA. References AACN Fact sheet. (2010). Nursing shortage. American Association of colleges of nursing. Retrieved from: http://www.aacn.nche.edu/media/factsheets/nursingshortage.htm on November 10th, 2010. Altmann, T.K. (2006) "Preceptor Selection, Orientation, and Evaluation in Baccalaureate Nursing Education," International Journal of Nursing Education Scholarship: Vol. 3 : Iss. 1, Article 1. Baumlein, G. (2010). Bridging the gap: Preparing nurse leaders of tomorrow. Minority Nurse. Fall Issue. Retrieved from: http://www.minoritynurse.com/bridging-gap-preparing-nursing-leaders-tomorrow on November 10th, 2010. Division of Public Health. (2008). Nurse protocols for registered professional nurses. Health state. Retrieved from: http://health.state.ga.us/pdfs/nursing/Protocol%20Manual/05.0%20Orientation,%20Training%20and%20QA.pdf on November 9th, 2010. Gordon, S. (2005). Nursing against all the odds. New York: Cornell University Press. p.214-217. Lopez, K.B. (2010). The effect of mentoring on minority nurse recruitment. Minority Nurse. Fall 2010 Issue. Retrieved from: http://www.minoritynurse.com/effects-mentoring-minority-nurse-recruitment on November 11th, 2010. Morrow, R.C. (1973). The training of health assistants. Health services reports. Vol.88, No.7, p.588-590. Nurse Together. (2009). Types of US nursing degrees. Nurse together. Retrieved from: http://www.nursetogether.com/tabid/118/itemid/78/Types-of-Nurses-and-Nursing-Degrees.aspx on November 9th, 2010. Santiago, A. (2010). Nursing Career Profile. About.com. Retrieved from: http://healthcareers.about.com/od/healthcareerprofiles/p/Nursing_Career.htm on November 2nd, 2010. Seago, J.A; Asch, M; Spetz, J; Grimbach, K& Coffman, J. (2001). Hospital registered nurse shortages: environmental, patient, and institutional predictors. Health services research. Vol.36, No.5, p.831-852. Wahl, S.E. (2008). Registered nurse preceptor ship orientation. Grad works. Retrieved from: http://gradworks.umi.com/3310908.pdf on November 9th, 2010. Wyngeeren, K.V. (2010). Increasing new graduate nurse retention. RN Journal. Retrieved from: http://www.rnjournal.com/journal_of_nursing/increasing_new_graduate_nurse_retention.htm on November 9th, 2010. Read More