The first year as a nurse graduate is wrought with challenges of acquiring new knowledge and skills, and night-shift work adds another layer of stress to a beginning professional practice. Due to the high number of new nurse graduates who work night shift for the first time at Centra, Inc., the nurse retention coordinator (NRC) and nursing leadership designed a creative sleep program. This includes sleep education, sleep strategies, and discussion of the effects of shift work on nurses in a didactic and focus/support group format.
The NRC recognized that disruptive sleep wasn't only a quality-of-life issue for the new nurse, but potentially a quality-of-care issue for the patient as well. Research supports that lack of restorative sleep affects the new nurses' mental and cognitive abilities and also impacts physiologic risk, as evidenced by increased incidence of cardiovascular disease, diabetes, hypertension, and decreased immune response. Staff members who work night shift are at greater risk for falling asleep at the wheel and are also more prone to make errors than staff who work day shifts. Currently, the American Nurses Association is collaborating with the National Institute of Occupational Safety and Health in a research project that includes developing a curriculum to assist nursing staff adjusting to shift work.
At Centra, new nurse graduates are now educated on sleep importance, sleep strategies, and items to assist in restorative sleep, including a sleep kit.
Methods and approaches
Starting in the summer of 2008, the NRC met with new nurse graduates within Centra Lynchburg General Hospital and Centra Virginia Baptist Hospital in cohort groups to initiate a new nurse graduate focus/support group. During the first week of nursing orientation, the NRC told new graduates about the importance of sleep and strategies to improve their sleep environment. This was based on how sleep impacts the body. Strategies to improve sleep included modification of temperature, sight, and sound—all of which can impact the quality of restorative sleep. The new graduates were told where to purchase eye masks and earplugs if needed after attempting to use darkening curtains to decrease light or fans to decrease noise.
Questions pertaining to the new nurse graduates' perception of sleep were incorporated into the Nurse Graduate Pulse Check survey. Measurements through an online survey platform were then taken at intervals to ascertain the new graduates' perceptions of whether they were "getting enough sleep to perform well at work." The data were tracked over several cohort groups of new graduates throughout the year. Staff members also contacted the NRC to express their satisfaction with learned sleep strategies, such as trying the sleep mask or earplugs after not feeling as if they were getting adequate sleep.
Measurement and evaluation
The overall impact of this new program is seen in the fact that 93.4% of the new nurse graduates report they feel as if they're getting enough sleep to perform well at work. New nurse graduates are also at high risk for leaving not only their organization within the first year, but also the profession itself. Organizational data reveal a decrease in annual new graduate turnover from 28.8% in 2007 to 6.9% in 2009. Reducing any identified level of stress for the first-year nurse positively impacts the quality of care for patients and the quality of life for our newest professional colleagues.
Threshold for success is measured at 90% or above (internal benchmark). Initial data for the first two cohorts revealed that an average of 89% of participants were present for the informal education in 2008. This was partly due to an alteration in the nursing orientation, which left inadequate time to present to the entire class during allotted time. Changes were made in the structure and process for the third cohort (Cohort I 2009 for all new nurse graduates from May 2009 through December 2009). These changes were implemented to improve the number of staff members educated through a more formal approach. This increased the percentage of new graduates in attendance for sleep education through a formal didactic slide presentation on the importance of sleep as a quality-of-care issue and sleep hygiene strategies. In addition, all new nurse graduates are now provided with a sleep mask and earplugs in a small sleep kit. Staff members are instructed to call the NRC if they're having any specific challenges with their sleep and to also communicate any positive changes. Measurements will continue to be obtained with the newest 2010 cohort during their first year.
Another change in the formal program instituted in the beginning of 2010 is a pre- and posttest coinciding with the class. Two months of data were collected in late 2009 with regard to pre- and posttest scores and suggestions for clarification of test stems. After adjustments to the test and input from the new graduates themselves, pretest scores averaged 70 and posttest scores averaged 100. The NRC worked collaboratively with the new graduates to gain their feedback and suggestions for the class design and testing.
Figure 1 depicts the percentage of new nurse graduates who received education among four cohorts from 2008 through 2010 year to date. Internal benchmarking of 90% revealed Cohort I 2008 didn't meet threshold. The New Nurse Graduate Pulse Check asked, "If scheduled for Night Shift, did the NRC talk to you about sleep hygiene?" In 2009, the summer graduates (Cohort I 2009) had their schedules adjusted to meet with the NRC on the third day of their nursing orientation to ensure higher numbers of staff receiving sleep education. Cohort I 2010 year to date is at 100%.
Figure 2 depicts data from the New Nurse Graduate Pulse Check survey that asked, "Do you feel you are getting adequate sleep to perform well at work?" All cohorts revealed that they met internal benchmarking of more than 90%. The NRC will continue to monitor the cohorts on their perception of performance.
Figure 3 depicts the tracking of new nurse graduates. Data reveal a decrease in turnover from 28.8% for 2007 to 6.9% for 2009.
Quality ZZZs equal quality care
A beginning nursing practice is filled with excitement, anxiety, and an extremely high learning curve. A strategic focus on sleep education is a way to model that sleep is a quality-of-life issue for our newest professional colleagues and that the organization cares about each new graduate as a person.
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