I’ve worked in healthcare for more years than I care to admit – as nurse, manager, supervisor, researcher, panelist, educator, preceptor and mentor. When I first started practicing, patients on the medical and surgical floors of today would have been in the ICU.
The technology and capacity to extend life creates new levels of complexity in care. Yet reports indicate the number of experienced clinicians at the bedside is shrinking. About half of the registered nurses in the U.S. have diplomas or associate degrees and the other half are prepared at the baccalaureate level or higher. Less than one percent of our registered nurses are doctorally prepared. An estimated 33 percent of the registered nurses currently working in the hospital setting will retire within 12 years.
Hospitals increasingly rely on new graduates for staffing, and the bulk of these newcomers are graduating from associate degree programs. Newly licensed nurses are not fully prepared to deliver the degree of care necessary for today’s hospitalized patients. When new graduates do enter the workforce, it places additional burden on institutions and their experienced staff to strike a balance between providing the right amount of mentorship support and achieving safe staffing levels. Even the most supportive internship programs have turnover rates as high as 14 percent among new nurses.
In addition to the physical and emotional demands of bedside practice, nurses must integrate informatics, interdisciplinary teamwork, evidence-based practice, patient-centered care and quality improvement into their critical thinking and clinical practice. There are things we can do to better prepare and support clinicians as they enter the workforce:
- Increase the use of simulation in school, during internships and in continuing education – Close the experience gap by exposing new clinicians to real life scenarios and the complex challenges that they will actually face at the bedside. Simulation offers a safe and realistic approach to hands on learning, and it allows experienced clinicians to practice drills so that they are better prepared to respond to emergencies.
- Expand our advanced practitioner base – Increase the number of advanced practice nurses in the clinical and faculty space. The clinical, diagnostic and communication skills that come with advanced education are critical to providing the best care. Research shows there are 4.9 fewer deaths per 1,000 patients on intensive care units staffed with a higher percentage of nurses with bachelor’s degrees. In hospitals, a 10 percent increase in the proportion of nurses holding baccalaureate degrees decreased the risk of patient death and failure to rescue by five percent. We need more educated and experienced mentors to groom our new care professionals.
- Enable the virtual bedside – We’re only beginning to scratch the surface of what technology can do to provide the support new clinicians need to be successful. Both physicians and nurses coming into any health system today need to work in collaborative environments where teamwork is key. Leveraging technologies like mobile patient monitoring and other collaborative tools can provide a virtual support network for new clinicians and extend the reach of available mentors who can weigh in on concerning clinical situations in real time, even if they are not collocated with the less experienced clinician or the patient.
Everyone in healthcare should be committed in some way to limiting the shell shock that often occurs when newly minted clinicians come out of the classroom and enter a hospital or health system. The realities of the bedside can be overwhelming, but if we do a better job of preparing and supporting new clinicians, we can transform the experience for patients and for caregivers.