By Gini Beatty, MSN, RN, CNOR, NPD-BC
In the current health care climate, recruitment and retention are a continuous challenge for perioperative leaders and educators. Graduate nurses transitioning to practice and experienced nurses shifting into the perioperative arena are faced with increased patient acuity, more complex procedures, advanced technology adjunct procedures and growing case volumes. What edge can the perioperative service line offer to entice new team members to make this their career choice?
One of the things that has been key to our success in the CVOR at Inova Fairfax Medical Campus has been communication and the ability to demonstrate the structure that is a key component of our onboarding and orientation process. Candidates are very vocal about their desire and, frankly, need to have substantial support during their orientation process and beyond. Due to the nursing shortage across the country, jobseekers are implementing a careful and critical examination of organizations, based on how they feel their odds of success and safety will be.
A significant key to success is developing and maintaining a culture of psychological safety. This can start with engaging the staff in discussions to develop departmental norms for behavioral interactions and, subsequently, holding each other accountable. Some examples include items in positive categories like recognition (how do they recognize one another in real time) and professionalism (extending courtesies and grace, assuming positive intent). Departmental norms can also define unacceptable behaviors in categories such as: negativity (no aggressive language or behavior, gossip, incivility) and exclusion (no favoritism, agism, sexism, racism and making sure to include all team members). Another essential tool to developing a healthy workplace is to reframe legacy thinking. Replace the phrase, “This is how we’ve always done it” with “What if we tried this?” In addition, reward out-of-the-box innovative process improvement ideas. This will create an environment that is conducive to learning and team building, which bolsters retention.
After developing your learner-friendly culture, being able to offer a systematic, structured orientation demonstrates a secure choice that prospective employees find reassuring. At Inova Fairfax Medical Campus, we provide a 24-week perioperative fellowship with didactic and simulated labs in concert with live clinical experiences, with a primary preceptor, offering applicants an approachable alternative to the compressed orientation in other inpatient service lines.
Related to retention, it is important to stay fluid in your orientation and onboarding process so that it can be customized to your learner’s individualized needs. Several aspects that our team has incorporated that have worked well have been components that allow us to “pivot” quickly. We have experienced learner satisfaction when we can cohort new team members that can experience their orientations jointly. This establishes an immediate support system for one another to share experiences, build camaraderie, and disseminate lessons learned. This initial process of team building is essential to the new learner’s success and a key aspect of the perioperative department team member.
Also, in response to our team’s growth, we have had to be mindful of preceptor “burnout” and having newer nurses perform in the preceptor role. We introduced an ongoing preceptor development program that offers quarterly mini classes to touch on recurring preceptor challenges. Those include learning-style and teaching-style awareness, generational learner differences, and effective feedback and communication skills. And, to support new preceptors, we introduced our triad model. This model provides each preceptor/learner dyad with a senior team member mentor that becomes their clinical subject matter expert as well as clinical decision-making coach for the advanced beginner preceptor and novice learner.
Additional successes include our preceptor “matching” program. After we have identified the primary preceptors for each cohort, we allow each orientee to spend time with every preceptor. At the end of week two, we have individual conversations with all the preceptors and learners to determine their comfort level with each person they have interacted with and then, as a leadership and education team, we “match” the individuals into dyads and assign them a mentor. This allows all the stakeholders to have a sense of ownership of the learning process.
Finally, a crucial part of the process is the consistent communication of each triad with department leadership. Although the department educator is in communication with the preceptors and learners during every shift, we conduct bi-weekly formal check-ins that include the clinical director, nurse educator, preceptor and learner. These are structured and include standardized documentation of clinical progress, knowledge assessments and personal satisfaction for the learner. It allows an opportunity to identify any gaps in growth by or support for the learner that can be addressed earlier rather than later. If any adjustment to triads or teaching-styles needs to be made, we can do so to reduce the attrition rate amongst team members with less than one year of employment.
All of these components with the addition of the nurse residency program, foundational certification preparation courses, clinical ladder opportunities and shared governance participation entice perspective team members and engage them throughout their transition to practice within our organization to contribute to both recruitment and retention.
