Nearly half of registered nurses with more than 10 years’ experience plan to leave the profession in the next five years. New nursing graduates will fill many of their positions, but children’s hospitals are left to wrestle with ways to replace decades of bedside nursing experience.
“New nurses coming in have very little expertise on their side. When I began at the bedside 27 years ago, I used to look beside me and see experts who could answer my questions,” says Michele Lane, MSN, RN, nurse manager, neurosciences, St. Louis Children’s Hospital. “Now, it's a new grad asking another new grad.”
Leaning on experienced nurses
To help new nurses bridge the gap, St. Louis Children’s developed a new care delivery model based on Benner’s Novice-to-Expert Clinical Practice Framework, a structure used by hospitals for decades. However, it calls on the experience of seasoned nurses to help novices gain clinical competence and practical confidence.
The hospital piloted the program in its 46-bed neurosciences unit. Lane carefully selected expert-level nurses who wanted to serve as mentors and who had the nursing acumen required for the initiative.
Mentors’ roles were more nuanced than those of preceptors in nursing school. Instead of clinical instruction, mentors were charged with creating a supportive and intellectually curious learning environment. Through one-on-one meetings and bedside support with patient care, mentors focused on setting newer nurses up for success.
“The mentor was there to really drive them to think about things like time management and critical thinking—what are they going to do and why are they going to do it,” Lane says. “It was not to be a resource who does everything for them, but because they’re novice level, to help them build the foundation into nursing.”
Promising early results
The program launched just over a year ago, and St. Louis Children’s is already seeing improvements in performance and satisfaction ratings among nurses in its Neurosciences unit:
- The 12-month rolling RN-adjusted voluntary turnover rate decreased by more than half, from 39% to 17%.
- Among nurses with less than a year on the job, the 12-month rolling RN-adjusted voluntary turnover rate fell by 80%.
- Nurses with a year or less experience have demonstrated a 96% compliance rate with bar code medication administration (BCMA), besting the overall unit compliance rate of 94%.
- A conservative estimate cost savings of approximately $650,000 during the first year of this program.
- The unit’s Patient Experience Net Promoter Score (NPS) improved from 73.7 to 91.
- The employee satisfaction positivity rating rose from 50% to 64%.
‘A win all the way around’
While patients, families and early-career nurses benefit directly from the program, veteran nurses welcome the opportunity to serve as mentors.
“We’ve made a strong investment in the mentors themselves. They feel excited about this program, and it’s giving them an additional purpose and helping them develop professionally,” says Joan Smith, Ph.D., RN, NNP-BC, FAAN, director of Clinical Quality, Safety & Practice Excellence at St. Louis Children’s.
“It allows the mentors to grow as leaders and managers without leaving the bedside. We know people leave if they feel they are not developing professionally or have opportunities for advancement. If this can support that at the bedside, it's a win all the way around,” she said.
Plans for expansion
St. Louis Children’s expanded the program to a surgical floor earlier last year. Given the continued positive results on that unit, they have started expanding it to six acute care inpatient units, using four FTE’s. Additionally, the hospital is building a virtual platform to scale the number of mentees each mentor can advise and integrating student nurse techs into the model to develop a pipeline of future nursing candidates.
Lane's presentation was part of the session, "Approaches to Improve Employee Well-Being," at Children's Hospital Association's 2024 Transforming Quality Conference.
