Seeking methods to improve nurse retention, decrease patient harm and enhance nursing clinical practice, a clinical advisor team model was designed and implemented in a regional Magnet hospital to empower clinical nurses.
Significance
The 2018 national vacancy rate for registered nurses is currently 8.2 percent (NSI Nursing Solutions, 2018). This health care organization currently experiences a system registered nurse vacancy rate of 9.1%. Additionally, the average cost for registered nurse turnover is approximately $39,500 per team member. To support closing the vacancy gap for this organization and decreasing the financial burden of nurse turnover, this model was implemented with the intention of creating a team of clinical coaches.
Literature Review
Clinical coaches focus on the combination of personal and professional development of clinical teams (Faithfull-Byrne et al., 2017). Personal connections with novice team members create venues for informal dialogue of routine struggles and clinical practice challenges (Walker-Reed, 2015). Several effective elements in the coaching relationship strengthens the connection between advisors and nurses: open communication, passion and inspiration, caring relationships, mutual trust, exchange of knowledge and role modeling (Eller, Lev, & Feurer, 2014). This relationship provides framework for mentoring to the nurse’s current role and practice, thus guiding the transition to clinical practice (McNamara, 2014)
Working in partnership with professional staff development specialists, coaches offer real time education to clinical nurses (Faithfull-Byrne et al., 2017). The alignment of personal and professional development influences healthy work environments, workforce retention and patient safety outcomes. Press Gainey (2015) proposes comprehensive analyses of the relationships between structure, process and outcome measures that improve patient safety, care delivery and healthcare value.
Strategy and Implementation
The Professional Staff Development team on boarded 12 Clinical Advisors in January 2018. The Clinical Advisors support critical care, cardiovascular, progressive care, medical-surgical, perioperative services and emergency medicine clinical environments. After orientation to the foundations of professional staff development, the clinical advisors assessed individual clinical environments for gaps in achieving nurse retention, patient safety and enhanced clinical practice. Working in partnerships with Professional Staff Development Specialists and operational leaders, Clinical Advisors developed patient safety rounding workflow, orientation coaching and joy in work foundations for their clinical teams. The Advisors address clinical outcomes with their environments with aligning current clinical practice with organization policy and best practices. The role is an advocate for novice nurses, coaching and guiding new colleagues during the transformational first year of clinical practice.
Outcomes
The clinical advisor team model was implemented to improve nurse retention, decrease patient harm and enhance nursing clinical practice. First year nurse retention rates improved from 72 to 79 percent one year after implementation. Additionally, organizational CLABSI events decreased by 35 percent and patient falls decreased by 17 percent one year after implementation.
Implications for Practice and Summary
Clinical advising is an effective process for professional transition to clinical practice. The role provides a foundation for nurse retention and patient safety. Organizations seeking methods to achieve increased nurse retention and excellent patient safety outcomes will benefit from this model.