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Creating a culture of lifelong learning

A strategy for organizational success

Pabico, Christine, MSN, RN, NE-BC; Perkins, Charles K., MBA; Graebe, Jennifer, MSN, RN, NEA-BC; Cosme, Sheri, DNP, RN-BC

doi: 10.1097/01.NUMA.0000552736.33707.7b
Department: Pathway to Excellence®
Free

At the American Nurses Credentialing Center in Silver Spring, Md., Christine Pabico is the director of the Pathway to Excellence® Program, Jennifer Graebe is the director of primary and joint accreditation, and Sheri Cosme is the director of the Practice Transition Accreditation Program and the Nursing Skills Competency Program. Charles K. Perkins is the senior manager of business operations at the Providence St. Joseph Health Nursing Institute Clinical Academy in Renton, Wash.

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A competent workforce supported by continuing professional development (CPD) is the foundation of successful healthcare organizations. Those who invest in CPD recognize the impact it has on optimizing performance and ensuring the delivery of safe, quality care. The 2016 follow-up report to the 2011 Future of Nursing report recommended that healthcare organizations prioritize interprofessional and lifelong learning so “nurses are prepared to work in evolving healthcare environments.”1,2 CPD enables nurses and all members of the healthcare team to improve their knowledge, skills, and practice to ensure they're confident and competent to provide evidence-based care that positively impacts patient outcomes.3

CPD should be implemented within a strategic context to support nurses' professional practice.3 The American Nurses Credentialing Center (ANCC)'s Pathway to Excellence® Program has a dedicated standard focused on the onboarding and CPD of the nursing workforce. Pathway-designated organizations recognize CPD and lifelong learning as essential elements in creating a positive work environment and make them an organizational priority.

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Transitional support

Engagement in CPD must begin when a nurse transitions from student to RN. For newly hired nurses, the Pathway standard requires comprehensive onboarding plans that include assessment of the orientee's learning needs and individualization of clinical experiences. Onboarding also involves an ongoing series of events that engages nurses not only from the receipt of their position offer to join the organization, but also continuing through the time they become established in their new role.

Transitioning from nursing student to RN is an overwhelming phase for many. In fact, new graduate nurse attrition rates are estimated to be as high as 30% in the first year of practice and potentially 57% in the second year.4 The fact that new graduate nurse attrition is costly financially and professionally—with an estimated cost of $82,000 or more per nurse, as well as negative implications for care quality—further emphasizes the need for structured onboarding practices.4 Support and guidance from leaders, mentors, and preceptors allow for a smooth transition into practice.

The Future of Nursing report recommended that organizations implement RN residency programs designed to support the transition from school to practice or practice in one care setting to another.2 Participation in orientation and an RN residency program are both components of the onboarding process. RN residency programs provide new nurses with the time and support to transition professionally by offering opportunities for socialization and acculturation. RN residency programs also provide comprehensive preceptor-led competency assessments, immediate involvement in CPD, and, most important, a well-structured onboarding experience—all essential elements of creating a supportive environment that are promoted in Pathway organizations.

Due to the emergence of RN residency programs and an inconsistent use of terminology, the American Academy of Nursing recommends that all RN residency programs gain accreditation, which allows for purposeful alignment of organizational and health or public health goals to be achieved through standards of content design and integrity.5,6 The ANCC's Primary Accreditation Program accredits organizations that provide nursing CPD and the Practice Transition Accreditation Program (PTAP) accredits all transition-to-practice programs within nursing. Organizations that have earned Primary and PTAP accreditation for their residency and CPD programs embrace the importance of standardization and CPD.

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An exemplar organization

Providence St. Joseph Health (PSJH) offers a prime example. As the third-largest health system in the country, with over 110,000 employees and 51 hospitals in Alaska, Washington, Montana, Oregon, California, Texas, and New Mexico, PSJH has made employee retention a priority across the system with specific efforts focused on its 45,000 RN workforce. These retention efforts, which are woven into the PSJH 2015-2020 nursing strategic plan, fall into three large categories: having all acute ministries hospitals begin the Magnet® or Pathway to Excellence journey, supporting professional development and education through the University of Providence, and launching the PSJH Nursing Institute Clinical Academy.

The Clinical Academy is responsible for developing, implementing, and evaluating systemwide nursing residency and fellowship programs specifically targeted to improve the onboarding experience of new RNs and those transitioning from one specialty to another. Groups of subject matter experts were brought together from across PSJH to compare onboarding systems, structures, and materials. These groups continued to work together until standardized curricula were developed and launched across the health system in mid-2016. A systemwide approach ensures that every nurse joining PSJH receives the same evidence-based program regardless of the location in which they're hired. Since it began in April 2016, over 4,000 RNs have participated in one of the Clinical Academy's 24 RN specialty residency or fellowship programs.

To evaluate the success of the Clinical Academy, the PSJH executive team selected three outcome indicators to monitor: reducing first-year RN turnover, decreasing short-term contract (agency) RNs, and achieving program accreditation within the first 3 years. In 2015, first-year RN turnover was relatively stable, averaging 19%. Since the Clinical Academy launch, the turnover for RNs graduating from PSJH's residency and fellowship programs dropped to 8.51%. This represents a 53% reduction that saved an estimated $20 million in reduced turnover in just 24 months. Similarly, agency spending has steadily dropped every year since the Clinical Academy was established. Compared with the $115 million all-time high that PSJH hit in 2015, agency utilization decreased 12% in 2016, 111% in 2017, and 117% in 2018 (annualized using the first 9 months of data).

Achieving the final goal in July 2018, the PSJH Clinical Academy residency programs at 10 of the Magnet hospitals and 3 of the Pathway to Excellence hospitals were accredited with distinction by the ANCC PTAP. PSJH leaders strongly believe that their organization is a great place to work but were surprised to see the organization listed ninth on Forbes' list of America's Best Employers for New Graduates in 2018.7 The ranking was a validation that their organizational strategies were effecting real change in their culture and drawing the highest caliber RNs to their workforce.

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Committed to development

Organizations with strong onboarding processes and a continuum of CPD opportunities have been linked to job satisfaction and retention.8-12 It's important to note that onboarding strategies should apply to nurses transitioning from one specialty to another, as well as new-to-practice nurses. Focusing only on annual or mandatory education fails to recognize that CPD can be about anything a nurse needs to know to do the job.

In addition, the Pathway standard for professional development specifies that nurses have input into the selection of educational offerings provided by their organizations. The success of CPD activities can be attributed to the inclusion of nurses' input.13 The Pathway professional development standard also requires organizations to modify schedules to allow nurses to attend CPD activities and ensure that support is provided for nurses to attend conferences, become certified, or join a professional organization. Lastly, the standard encourages organizations to develop their own internal career ladder and other programs that foster lifelong learning.

Pathway organizations recognize that creating a culture of lifelong learning is a valuable strategy for organizational success. By investing in onboarding, transition support, and ongoing developmental opportunities for nurses, Pathway organizations demonstrate a commitment to their patients and the success of their employees.

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REFERENCES

1. Institute of Medicine. Assessing Progress on the Institute of Medicine Report The Future of Nursing. Washington, DC: The National Academies Press; 2016.
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