Hospitals Increase Training to Boost Nurse Retention

Realizing that California’s critical shortage of nurses is not likely to be over any time soon, local community hospitals are stepping up their orientation and education programs for new graduates, hoping to keep nurses happier in their work. Sharon Gerson, chief nursing officer at Providence St. Joseph Medical Center in Burbank, said the hospital has changed its program to make sure nurses going into more demanding hospital departments receive more training. “What we’re doing right now is evaluating the need of different levels of care, medical/surgery nurses require less training than critical care nurses,” Gerson said. Critical care nurses now take 16 weeks of training, where their counterparts in medical/surgery wards are through after 12 weeks. Neil Apeles, who teaches at a similar program at Valley Presbyterian Hospital, said that when he first went through the new graduate training two years ago, new nurses would all receive the same basic training, no matter what department they were working in. Since then, Valley Presbyterian has changed its program so that all nurses start off in the same classes, and those who will be treating more critical patients stay for extra training. Apeles teaches nurses going into telemetry units, the unit to which critical patients are transferred once they have stabilized. “Those nurses actually like the fact that they get a foundation in med/surg, and then they move on to more advanced knowledge,” Apeles said. “In the past, nurses often felt overwhelmed when they would go into telemetry, and they didn’t necessarily have that specialized training. They either had to go to an outside class, or had to take a separate class here at Valley Pres. It wasn’t offered to them as a new grad program, so it discouraged a lot of nurses from going into the specialties that they wanted to.” Lydia Wong, director of education at Valley Presbyterian, said she decided the hospital needed to extend its new graduate training program after she noticed an extremely high rate of attrition. After the first three months on the job, Wong said that as many as 30 to 40 percent of nurses were leaving. Most nurses say that salary is the main reason for leaving, but Wong suspects that many of them simply feel unprepared to do their jobs. Now, instead of a four week training period, nurses can have anywhere between 12 and 18 weeks of education and clinical training before they work independently. “I don’t’ think a new graduate can just jump into ICU and be able to function, you really need to build up your skills and knowledge,” Wong said. “A lot of (nurses) were very nervous working on their own after two or three weeks.” Gerson says that nurses often say they feel unprepared when they start working at a hospital. “When we go to schools, job fairs and recruitment fairs, we’ve found that other hospitals don’t offer that length of training, and it often sets up the nurses for not feeling comfortable when they’re out independently after the program is over,” Gerson said. “Some (nurses) say their orientation programs are much shorter, but we are finding that with any hospital, the level of care required by patients is constantly getting higher.” “Hospital nursing care has become more specialized, there is more technology involved,” said Liz Jacobs, spokesperson for the California Nurses Association. “Even working in general, medical/surgery units, those areas are getting more specialized, so that you may have an orthopedics unit or a unit that’s more med/surg oncology.” Programs more common Jacobs said that new graduate training programs started to become less common in the 80s in 90s, when the state was enjoying a surplus in nurses. But that surplus started turning into a shortage and last year California passed a nurse to patient ratio law that requires hospitals to increase its staff. Jacobs said that in the last couple of years, new graduate programs have become more common, and that’s good news for nurses. “If you look at medical professions, certainly the intern and resident programs go on for years,” said Jacobs. “In nursing, you graduate, go out into the real world and you sink or swim. A lot of nurses have sunk.” At Valley Presbyterian, changes in the new nurse training program’s classes were deemed necessary when it became clear that larger, university hospitals were doing a better job of getting nurses into specialized training programs. “At larger teaching institutions, they would invite people (into specialized programs) because they have the resources to be running these types of programs,” said Apeles. “For a community hospital, I think this is great, I think we’re ahead of the game because we have that type of structure. Even if we do have a small class we’re still able to run that type of program, or at least provide individual training.” Mentoring nurses Valley Presbyterian and Providence St. Joseph also make mentors available to their new nurses to give professional and emotional support. “We have mentoring set up so that they have a point person they can go to, a lot of people might not feel comfortable going to a supervisor,” said Gerson. Gerson said that she makes sure to schedule her own one-on-one talk with every new registered nurse the hospital hires, as well. Nurses who complete the training program together are also likely to feel more comfortable relying on each other, Gerson said. “I think they develop relationships within the program that continue once they get out,” said Gerson. “They use each other as a sounding board, as an option where they would turn if they had an issue.” Rizagul Chakerhaan, an intensive care nurse at Valley Presbyterian, said the job is so demanding that if she couldn’t rely on her co-workers, she’d be overwhelmed. Chakerhaan, who went through training and now works side by side with Katherine Dizon, said working with nurses she’s already bonded with helps a lot. “Working in the ICU, if you didn’t have support from doctors and nurses, I don’t think you’d be able to do it. It’s so scary here,” Chakerhaan said. Bonds between workers Apeles and Gerson both say community hospitals are successful in recruiting because of the family-like atmosphere that employees enjoy. The bond that smaller hospitals build between co-workers can be just as important as a high salary. Providence St. Joseph relies on temporary and traveling nurses to fulfill its state-mandated staffing requirements, Gerson said. Although temporary and traveling nurses can often make more money working for staffing agencies than for hospitals, Gerson says she’s been able to recruit a number of them as full-time nurses once they’ve worked at Providence St. Joseph. Lauren Teichner, a nursing student at Mount St. Mary’s working at Valley Presbyterian now, said she plans to apply for a full time job when she graduates. “A big teaching hospital, especially like UCLA where you have medical students, residents, even though you have a long training period you don’t get as much exposure because you have all these other people who are trying to learn too,” said Teichner. “I’ve been exposed to the management, and really gotten to know who’s running the hospital.”