Retaining Lost Knowledge: A Challenge and Opportunity for Nurse Leaders

Health care is one of the fastest growing job sectors in the US (BLS, 2018). While millennials are gravitating to nursing in unprecedented numbers, concern about a shortage of experienced registered nurses (RNs) is growing. With the profession’s most experienced RNs retiring, the nursing workforce is poised to lose one million experienced RNs by 2030, resulting in a huge loss of expert nursing knowledge (Buerhaus, Skinner, Auerbach, & Steinger, 2017). Meanwhile, a Deloitte (2018) survey of millennials indicated that 43% of millennials envision leaving their jobs within two years with only 28 % planning to stay beyond five years. Nursing is facing is a transitioning workforce that will be more transient resulting in a critical loss of knowledge at a time when health care is becoming more complex and cost sensitive. Addressing lost knowledge presents both challenges and opportunities for nurse leaders.

Starks (2013) defines knowledge as a mix of experiences, values, contextual information, and expert insight that provides a framework for evaluating and incorporating new experiences and information. Nurse experts use knowledge to improve decision-making abilities (Rogers, Mubako, & Hall, 2017). With advanced reasoning skills and their ability to link concepts in meaningful ways, nurse experts are particularly adept at solving problems. This skill set is critical to preventing adverse, even catastrophic, patient care events.

Tacit knowledge is the accumulated expertise or “know-how” about a subject that people develop through personal experience (Johnson, Baker, Fletcher, & Charles, 2018). This type of knowledge contains subjective insights, intuitions, and hunches and often resides only in individual’s heads (Bleich et al., 2015). Knowledge transfer is the conveyance of knowledge from one person to another (Rogers, Mubako, & Hall, 2017). Tacit knowledge can only be transferred to other individuals by interactive participation such as shadowing, coaching, or mentoring (Starks, 2013).

When expert nurses resign or retire, the tacit knowledge they possess departs with them. The cost of their departures has likely gone unrecognized, uncalculated, and underestimated. Wong and Noe (2010) estimated that a failure to share knowledge costs Fortune 500 companies $31.5 billion annually. Health care organizations lack a means of capturing and transferring the knowledge of expert nurses to ensure that what they know will be available for future use (Sherman, 2008).

DeLong (2004) recognized four types of tacit knowledge that should be transferred. These types of knowledge are 1) human, 2) social, 3) cultural, and 4) structural knowledge. An examination of manufacturing, engineering, business, and technology industries offers practical, proven techniques for transferring critical knowledge from experts to others before it is lost to retirements and resignations. Over the past two decades, health care has adopted effective safety practices from these industries. While the notion of knowledge transfer within the nursing workforce is in its infancy, there is much that can be learned from these global industries regarding capturing lost knowledge.

This presentation will heighten nurse leader’s awareness of the impact of lost knowledge and provide recommendations and time-tested practices for capturing and transferring expert knowledge in health care organizations. While nursing shortages are not a new problem in health care, this shortage calls for new thinking and innovative solutions.