As health care institutions have navigated a global pandemic, priorities for staff support and onboarding have changed
By Kaitie Marolf
Article 2 of the “Closing the Experience Gap” series. For more background on the experience gap and tangible adjustments organizations can make to combat it, read article 1, “Closing the Experience-Complexity Gap for Novice Nurses”
In July, Carol Boston-Fleischhauer, JD, MS, BSN, Managing Director and Chief Nursing Officer of Research at The Advisory Board Company, presented a webinar providing suggestions for navigating the increase in novice nurses within the workforce. She also explained how the decrease in staff experience was heightened by an increase in the complexity of needs for hospitalized patients, as well as the impact of the pandemic and supplied strategies for helping staff cope.
“This is a challenge that was stressing the approach to successfully transition new grads into the practice setting pre-COVID. Of course, today it is further complicated by the pandemic,” Boston-Fleischhauer said.
The Pandemic's Influence
COVID-19 has led to a decrease in the level of training and experience available to young nurses as it led to, in some cases, the loss of fourth quarter education in nursing school, and healthcare institutions having to pause classes, licensure exams, hiring, and onboarding to deal with current or potential surges.
As communities have reopened and institutions have adjusted the process of bringing new staff on board with COVID protocols in place and altered organizational and patient situations, Boston-Fleischhauer said one of the most important aspects to be considered is the handling of moral distress for new and existing staff.
She suggested looking at nurses in at least two groups: those who were hit by a surge and may be experiencing symptoms of PTSD and other mental health challenges, and those who were not hit by a surge and are nervous about their employment status if hours have been cut due to a lack of elective surgeries, fewer ER visits, and other factors.
“This is something you have to consider as you think about bringing novice nurses into a work environment with tenured nurses who are struggling themselves. In keeping with the learnings of Maslow's hierarchy of needs: at this point, all nurses, including your novice staff, have to have their foundational needs met, including an assurance of safety before you can ever expect nurses at any level to learn, achieve, or regain their potential.”
Guarding Clinicians’ Mental Health
Children’s Health Dallas implemented a frontline moral distress consult program, which allows staff to ask for help whenever they need it and at the end of any shift during which a triggering event occurred. While this example encourages all staff to request a consult whenever they feel moral distress, it can be particularly helpful in allowing novice nurses to learn that it is okay to ask for help.
Johns Hopkins created weekly moral rounds for all clinicians, including nurses and physicians, in response to the pandemic. Boston-Fleischhauer suggested building on that by creating cohorts specifically for novice nurses to discuss their experiences and present coping mechanisms.
“Pre-COVID at The Advisory Board, we presented support for moral distress as a strategy to combat workforce burnout,” Boston-Fleischhauer said. ”Post-COVID, for all nurses, in particular your novice nurses, we recommend viewing moral distress support as a priority organizational strategy to support that novice learner’s transition in. This is no longer a nice to have but rather a need to have.”