Structural Empowerment

Reducing RN Turnover by Increasing Personal Connections

A variety of initiatives helped reduce turnover rates among RNs recently, but one of the most successful and effective has been a formal mentorship program created and led by clinical nurses after graduating from the RN residency.

The program began with an evidence-based practice project focusing on 25 new graduate nurses who worked in a float pool known as the Clinical Resource Team (CRT). CRT nurses are trained to provide care in multiple high-acuity units, maintaining competency in more than 10 specialties. These training expectations and increased dynamic work environments contributed to lower-than-normal retention rates in 2020.

Evidence-based practice (EBP) shows that standardized mentorship programs offer valuable, confidential peer support. At Children’s Health, the IOWA model of EBP is used to guide RN residents through the EBP process as they take projects from problem identification to best practice solution. Over two years, this cohort of CRT RN residents built an evidence-based mentorship program to include clear guidelines, compatibility questionnaires for mentor matching, formal relationship contracts and a post RN satisfaction survey.

Post surveys identified areas for improvement, assessed RN job satisfaction and highlighted low mentor participation, a problem also found in the literature. The RN residents used this feedback to recruit more mentors, incentivize participation through the Clinical Nurse Achievement Program, collaborate with unit educators and garner support from the CRT Shared Governance Unit Council.

By 2022, retention improved dramatically among the original 25 CRT RN residents. Mentees reported higher job satisfaction with no intention to leave CRT, and 50% became mentors themselves. Surveys showed that mentor-mentee communication nurtured a sense of belonging and camaraderie.

Due to overwhelming success, one of the CRT nurses is now attending the Texas Christian University Evidence-Based Practice fellowship program with a goal of further developing the mentorship program. The CRT nurses are also presenting a professional poster at the Society of Pediatric Nurses national conference and presenting the program at Nursing Grand Rounds in 2023.

Nursing Grand Rounds: Showcasing In-House Expertise

Nursing Grand Rounds were re-imagined beginning Nurses Week 2022, providing a joyous occasion to return to post-pandemic, in-person learning and networking. Great effort went into building a live program that staff could attend in person or virtually. Recording each session means nurses who are interested in a topic but unable to attend can listen later as their schedule allows. These recordings have proven invaluable in strengthening professional practice awareness across multiple shifts and campuses, as well as among other care partners.

Nursing Grand Rounds are held quarterly and provide attendees with continuing nursing education units (CNEs). Featured topics include:

• Adopting evidence-based practices
• Reducing patient monitor alarm fatigue

“Nursing Grand Rounds showcase the exceptional work our nurses are producing to improve patient outcomes, and advance research and scholarship independent of our physician colleagues and in collaboration with them.”

Attendance has been robust, with 130 to 150 attendees at each live session (in person and virtual) with many more viewing the recording later. Surveys show almost all attendees say a session changed their clinical practice for the better. Nursing Grand Rounds also help nurses build confidence in their presentation skills in front of a friendly audience with their colleagues before presenting at national conferences.

Building Nursing Careers from Day One

In 2022, Children’s Health successfully renewed its RN Residency program accreditation by the Commission on Collegiate Nursing Education (CCNE). Since 2017, all new nurse graduates enter our one-year residency program to help them successfully transition from nursing school to the realities of working bedside. The program includes classroom learning, implementation of an evidence-based project and high-fidelity simulations.

The residency program’s goals include:

• Creating a supportive culture of clinical inquiry
• Helping new nurses discover the type of nurse they want to be
• Instilling a questioning attitude and speaking up for safety
• Teaching them they have a valuable voice and input into patient care
• Outlining possible career paths for their future

Reaccreditation was an 18-month process of documenting the program, its processes and its outcomes. After a three-day on-site visit, CCNE awarded Children’s Health with accreditation for another five years.

Currently, about 120 nurse graduates go through the program per year. In 2023, the plan is to increase recruitment so that a diverse pool of 300 RNs a year are trained to support system growth and prepare the future nursing workforce. The residency program also serves as an important recruiting and retention tool for the hospital due to the rigor of the training and the supportive environment created for new nurses.

“I really enjoyed having reflection and being able to talk about how we were feeling. Knowing that I was not alone, and that my stress and anxiety was norma, made it so much easier to transition from a student to a nurse.”

Clinical Nurses Disseminating Knowledge

A team of six Children’s Health nurses attended and presented at the Society of Pediatric Nurses (SPN) Conference in April 2022. One podium presentation and three professional posters focused on Children’s Health nursing efforts on:

• Supporting a culture of clinical inquiry through shared governance
• Improving patient safety by predicting early deterioration in the pediatric pulmonary population
• Precepting, in the pandemic era of reduced clinical preparation, for the new graduate nurses
• Implementing an innovative protection program for high-risk suicidal patients

Some of the key takeaways for the nurses who gathered at the conference inspired them to meet monthly over the following year to take action. This team then turned the knowledge they compiled into podcasts, posters, presentations and performance improvement opportunities to educate the nursing staff about:

• Human trafficking importance for nurse recognition and safe response
• Best practices to manage patient monitor alarms and reduce alarm fatigue
• Orienting using tiered nursing skill acquisition
• Evidence-based techniques for managing hospitalized children with autism spectrum disorder

This group worked from May to September 2022 to plan and facilitate the “Human Trafficking and Your Role: Recognize, Respond and Report Victims of Human Trafficking for the Health care Professional” Conference held Oct. 7 at the Dallas campus. They worked with Reclaim 611, a nonprofit organization that empowers front-line professionals to help end human trafficking. This powerful presentation was well-attended and made a tremendous impact on clinical staff.

Due to increased mentoring of clinical nurses by this SPN group, Children’s Health is sending an even larger group of nurses to the 2023 SPN to present three podium presentations and 10 professional posters.

“The knowledge we gained and the connections we made during the SPN conference ignited our desire to expand upon and share the great knowledge Children’s Health nurses are contributing to their profession every day.”