C.O.N.N.E.C.T.E.D.: Catalyst for Enculturating New Graduates into Emergency Nursing

Abstract

Poster presentation Session G presented Friday, September 28,1:00-2:00 pm Purpose: The literature is replete with citations attesting to the negative influence of role overload among registered nurses working in emergency department (ED) settings. Increased patient acuity and volume, nurse dissatisfaction and shortages, and budgetary constraints contribute to high staff turnover, which invariably impacts patient care and outcomes. The purpose of this initiative was to create an innovative onboarding program for recent nurse graduates to assist them in adapting to the ED environment; improve staff morale and satisfaction; foster an evidence-based and patient-centered culture; and ideally reverse the high turnover rate. Design: Successful assimilation into the organization at hire is an essential element in retaining staff. An interprofessional team, comprised of nurses (direct care providers, educators and leaders), faculty from a local nursing school, and physicians partnered in implementing a quality improvement project entitled C.O.N.N.E.C.T.E.D. (acronym for Creative Onboarding of New Nurses to Eliminate Clinician Turnover in the Emergency Department). Setting: Participants were provided with 16 weeks of 1:1 preceptor experience in the 48-bed, level III trauma center (with approximately 80,000 annual visits), didactic classes, and cross-training in multiple specialties including: hemodialysis, labor & delivery, newborn nursery, respiratory therapy, and intensive care. Participants/Subjects: High turnover and nurse vacancy rates (32.7% and 11.3%, respectively) made it necessary to hire 41 new graduate nurses over a 17-month period just to maintain adequate ED staffing. However, new graduates are particularly susceptible to turnover. Nurse residency programs can offer structure and a nurturing environment that may significantly reduce turnover. All ED nurse residents participated in this project. Methods: Various educational pedagogies (problem-based learning, ED case studies, and simulation at the nursing school) were incorporated into the training. Didactic classes focused on additional skills (e.g., evidence-based practice, basic research methodology) to support the creation, translation and dissemination of evidence (both locally and nationally). Results/Outcomes: Since implementing the program, the retention rate among nurse residents has increased to 90%. These nurses function independently in all care areas, except triage, and report (both anecdotally and on nurse satisfaction scales) having a voice in planning, implementing, and evaluating patient-centered care. Implications: The C.O.N.N.E.C.T.E.D. program provides a roadmap that other EDs can use to assist novice nurses in acculturation into an often challenging environment.