Supporting and creating a space for nursing professional development (NPD) practitioners in our organizations in turn supports nurses new to practice. At UPMC St. Margaret, NPD practitioners (NPDPs) are integral members of the nursing leadership team; the NPDPs collaborate to ensure that nurses feel valued, heard, and cared for, which in return, improves engagement and overall retention of nurses new to practice. 
In 2021, following the height of the COVID-19 pandemic, our organization was experiencing, as most of the nation, a turnover rate of 49.8% of nurses with less than one year of experience. Organizational leaders recognized that the NPD department held expertise to impact retention through the improvement of the transition to practice period for our nurses new to the profession. 

This was an opportunity for the NPD department to become change agents in our organization by creating a collaborative relationship that would demonstrate measurable outcomes, therefore expanding the organizational impact of the NPD department. As a nurse leader, my first step was to strengthen the NPD department internally by providing professional development opportunities that provided the NPDs with the skills and tools needed to influence and drive outcomes. All the NPDPs were provided with preparation for the NPD certification exam, group study sessions, and 1:1 mentoring. The expectation was that all become certified in nursing professional development. The NPDPs were then challenged to redesign orientation and onboarding to standardize, replacing the traditional lecture-based programs with asynchronous and simulation learning, while ensuring flexibility in training scheduling in consideration of off-shift staff. 

The NPDPs were each assigned several nursing units, where they partnered with unit leadership to create strategies for improving the onboarding process and retention of nurses new to practice. One strategy was to implement monthly meetings that were coordinated by the NPD practitioner, termed as “triad” meetings. These meetings included the unit leadership, educator, and the quality coordinator. There was a standard agenda for each meeting, which included unit quality indicators, new education, professional development of existing staff, and discussion of each new nurse’s progression and transition to practice plan. 

This individualized approach of monthly meetings that focused on the progression of each new nurse led us to implement weekly check-ins. The check-ins were led by the NPD assigned to that clinical unit. Every week the NPD would meet the new nurse for 5-10 minutes in a variety of settings. The discussion was focused on the nurse as a human first and nurse second. Questions around well-being, including management of stress, how they are feeling overall, and any personal concerns that are affecting them physically and/or emotionally. The NPD would partner in real time with the unit leadership to provide needed assistance and resources that could be provided by organization. This approach was successful, and relationships were being built, therefore the decision was made to extend the check-ins monthly throughout all new nurses first year of onboarding. Utilizing the scope of practice outlined in the Nursing Professional Development Scope & Standards of Practice (4th ed.), our department was able to evaluate education and training, play a vital role in orientation and onboarding, facilitate the transition to practice period, contribute to improving quality outcomes, and demonstrate our leadership and change management expertise. 

The triad meetings identified that communication from preceptor to educator and manager was lacking; however, it was difficult to schedule time to accomplish this communication, given the increase in the total number of nurses on orientation and the variation of shifts worked. This revealed the importance of moving from a paper orientation documentation process to an electronic orientation documentation process. The NPDs collaborated with a UPMC Health System engineer to create an electronic application that housed the needed skills and initial competency checklist, along with several sections for the preceptor, preceptee, educator, and unit leadership to communicate electronically with real time availability to all parties. The resulting electronic application engaged preceptors and preceptees , as this technology  was more efficient, easier to access, and familiar to those utilizing it then the previous pen and paper process. The orientation books and associated checklist were often lost, not completed in real time, and not utilized to propel or individualize the orientation and onboarding process.  Following the implementation of the electronic process, orientation documentation and skills checklist completion improved, with a majority of nurses completing their orientation documentation in its entirety by the end of orientation. The improved documentation on the new hires’ progress and skill development in real time, enabled the leadership team, including the educator, to quickly intervene to improve clinical skill deficiencies. 

By strengthening and creating a space for NPDPs in our organization, the department was successful in reducing the turnover rate for nurses new to practice from 49.8% at the end of calendar year 2021, to 19.63% at the end of 2022, to 12.95% at the end of 2023. Overall nursing engagement scores improved from 71% in 2022 to 72% in 2023. 

References

Harper, M. G., & Maloney, P. (Eds.). (2022). Nursing professional development: Scope & standards of practice. (4th ed.). Association for Nursing Professional Development