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Transforming Nursing Orientation:
Implementing the Tiered Skill Acquisition Model to Enhance Retention and Quality
Voiceover
Presenter(s)
Heather Reardon
Abstract or Description
Abstract
Nursing leaders are critical in driving organizational change within healthcare settings, essential for initiatives that improve patient care, enhance staff satisfaction, and achieve organizational goals. This case study explores Hospital XYZ's journey to improve retention, quality, and standardized orientation materials by adopting the Tiered Skill Acquisition Model (TSAM) for nursing orientation.
Situation
Faced with budget cuts and high nursing staff turnover, the director of nursing education identified the confusing orientation maps as a significant issue.
Background
Poor nursing retention rates has strained resources and jeopardized continuity of patient care and staff morale. The Director of Nursing Education working with the manager of nursing education to develop a more practical orientation process. The leadership's insight into current practices facilitated the TSAM implementation, which was designed to streamline and enhance the onboarding process for new nurses, thereby improving retention rates.
Assessment
Hospital XYZ’s culture emphasizes continuous improvement, patient-centered care, quality, safety, and technological innovation, aligning well with the TSAM implementation. The clinical nursing education team is committed to excellence, innovation, flexibility, and lifelong education, making them ideal champions for this change.
Critical stakeholders in the orientation process included nursing leadership, the clinical education department, experienced staff nurses, and new hires. Supporters of the change included senior nursing educators. At the same time, resistance came from some long-tenured nurses, two educators preferring the old orientation maps, and a unit manager concerned about increased paperwork.
The change plan aimed to increase nursing retention rates one year after hire, as measured by pre-and post-implementation data on retention, orientation length, and nurse satisfaction. The structured TSAM approach was expected to create a more efficient and effective orientation process, contributing to organizational goals.
Recommendations
Recommendations for the change process include improved communication, increased stakeholder involvement, and enhanced support for critics. Clear, consistent, and transparent communication fosters trust and engagement. Involving feedback from nurse exit interviews can provide insights and identify orientation aspects affecting retention. Additional training or partnerships with change champions can support those resistant to change.
Leadership Theories
Leadership theories applied in this case study include both classical and contemporary approaches. Nursing education leadership demonstrated essential traits such as intelligence, self-confidence, and determination, which are characteristics of the classical trait leadership theory.
The contemporary theory of transformational leadership, which involves inspiring and motivating team members by creating a compelling vision for the future, was apparent. The director effectively communicated the long-term benefits of the new orientation process, fostering an environment of enthusiasm and commitment among the clinical nursing education team.
In addition to transformational leadership, elements of situational leadership were evident within the case study. Both the director and manager adapted its style based on the readiness and needs of their team members. They provided additional support and training to those who were resistant to change and leveraged the strengths of champions who were enthusiastic about the new process. This flexibility in leadership style ensured that the team remained cohesive and effective throughout the implementation of TSAM.
The case study features the importance of effective leadership, strategic planning, and stakeholder engagement in driving successful organizational change within healthcare settings. By applying a blend of classical and contemporary leadership theories, nursing education leadership at Hospital XYZ successfully navigated the complexities of implementing a new orientation model, ultimately enhancing nurse retention and patient care outcomes.
Keywords: organizational change, leadership, nursing orientation, TSAM
Comments
Kevin Springer8 months ago
Hi Heather,
I am quite impressed with how you have created the format of your poster, which flows well. Your plan and timeline section draws attention quickly, causing the reader to grasp the essence of your project more quickly. Poor nursing retention rates have been a chronic issue facing the nursing profession for several years. In my experience as a staff nurse, a key element to a successful nursing orientation program is to have built-in flexibility within the construct to allow for the orientees to progress through the orientation process at whatever speed suits everyone the best. I fully support the chosen leadership theories as well. The theory of transformational leadership provides the necessary inspiration and motivation required for the program to be successful. The situational leadership theory provides the potential to be flexible, as I noted previously. Great job Heather.
I am quite impressed with how you have created the format of your poster, which flows well. Your plan and timeline section draws attention quickly, causing the reader to grasp the essence of your project more quickly. Poor nursing retention rates have been a chronic issue facing the nursing profession for several years. In my experience as a staff nurse, a key element to a successful nursing orientation program is to have built-in flexibility within the construct to allow for the orientees to progress through the orientation process at whatever speed suits everyone the best. I fully support the chosen leadership theories as well. The theory of transformational leadership provides the necessary inspiration and motivation required for the program to be successful. The situational leadership theory provides the potential to be flexible, as I noted previously. Great job Heather.
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Haley Paterson8 months ago
Heather,
Workforce challenges for nursing are, no doubt, a growing issue for the profession. Efforts for recruitment are challenging enough, but just hiring nurses is not enough. Retention is an important endeavor. On boarding new employees is extremely costly, and the orientation time can absolutely make or break the commitment of a newly hired nurse. I agree that it is vitally important for institutions to implement best practices in their efforts to support and retain their nursing staff. If I were a new hire at your hospital with this onboarding process, I could see this project communicating that the institution cared about my success and was there to support and invest in me which would be highly valuable as a new employee and affect my desire to remain at that hospital.
When I started as a leader in my hospital, I had to hire an entire unit's worth of nurses as we were predominantly reliant on travel staff. The onboarding process was not great, and I did not feel supported as a leader by our educator. It was very challenging starting a new position and hiring multiple new staff without a strong process for their orientation while also knowing how important it was for them to receive a solid orientation and its impact on retention. I wish so much that I had a team working on a change process like this that I and my department could have benefited from. I think this is important and great work. Feedback from nurses at exit interviews, especially from those in that window of one year of hire who could provide insight from their own experience, is an important perspective to learn from and wise to include in your recommendations. You identified important elements of situational leadership where leaders accounted for the readiness and needs of their team and dedicated extra time with those resisting the change. I think those efforts are important and are meaningful for positive change effects. I agree that effective education and orientation contribute to the organization goal of safe and quality care. I enjoyed your presentation. Thank you for sharing!
Haley
Workforce challenges for nursing are, no doubt, a growing issue for the profession. Efforts for recruitment are challenging enough, but just hiring nurses is not enough. Retention is an important endeavor. On boarding new employees is extremely costly, and the orientation time can absolutely make or break the commitment of a newly hired nurse. I agree that it is vitally important for institutions to implement best practices in their efforts to support and retain their nursing staff. If I were a new hire at your hospital with this onboarding process, I could see this project communicating that the institution cared about my success and was there to support and invest in me which would be highly valuable as a new employee and affect my desire to remain at that hospital.
When I started as a leader in my hospital, I had to hire an entire unit's worth of nurses as we were predominantly reliant on travel staff. The onboarding process was not great, and I did not feel supported as a leader by our educator. It was very challenging starting a new position and hiring multiple new staff without a strong process for their orientation while also knowing how important it was for them to receive a solid orientation and its impact on retention. I wish so much that I had a team working on a change process like this that I and my department could have benefited from. I think this is important and great work. Feedback from nurses at exit interviews, especially from those in that window of one year of hire who could provide insight from their own experience, is an important perspective to learn from and wise to include in your recommendations. You identified important elements of situational leadership where leaders accounted for the readiness and needs of their team and dedicated extra time with those resisting the change. I think those efforts are important and are meaningful for positive change effects. I agree that effective education and orientation contribute to the organization goal of safe and quality care. I enjoyed your presentation. Thank you for sharing!
Haley
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Erica Leal8 months ago
Hello Heather,
Great work on your presentation and poster. I liked how you emphasized the plan and timeline by having that section be the only section with a pop of color. That draws our eyes there immediately. I am familiar with this model as one of the hospitals in our system is trialing it. I hope the model becomes our system's standardized model as it will help with retention and build confidence to produce safe nurses who provide quality care. The selection of your nursing theories ties into the model very well. Thank you.
Erica
Great work on your presentation and poster. I liked how you emphasized the plan and timeline by having that section be the only section with a pop of color. That draws our eyes there immediately. I am familiar with this model as one of the hospitals in our system is trialing it. I hope the model becomes our system's standardized model as it will help with retention and build confidence to produce safe nurses who provide quality care. The selection of your nursing theories ties into the model very well. Thank you.
Erica
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Crystal Miles-Threatt8 months ago
Hi Heather,
I found your presentation on the TSAM model very informative and relevant, especially because my hospital has also implemented this model. It's clear that your director is dedicated to improving the orientation process for new hires to increase retention and quality. Although our reasons for adopting the TSAM were different, we faced similar issues with confusion in the orientation process and inconsistencies in practice across different units. We identified that some of these inconsistencies were due to variations in how preceptors trained new hires and assessed their competency. I'm particularly interested in understanding the training provided to your preceptors, as one of the challenges we encountered was the lack of investment in preceptor training. Our traditional method of gradually increasing the patient load during orientation was no longer effective. In the TSAM, nurses handle all 4 patients during orientation but are only responsible for specific skills, progressing through the tiers as they demonstrate competency. It's crucial for preceptors to be well-versed in the new model and effectively incorporate it into their training.
I found your presentation on the TSAM model very informative and relevant, especially because my hospital has also implemented this model. It's clear that your director is dedicated to improving the orientation process for new hires to increase retention and quality. Although our reasons for adopting the TSAM were different, we faced similar issues with confusion in the orientation process and inconsistencies in practice across different units. We identified that some of these inconsistencies were due to variations in how preceptors trained new hires and assessed their competency. I'm particularly interested in understanding the training provided to your preceptors, as one of the challenges we encountered was the lack of investment in preceptor training. Our traditional method of gradually increasing the patient load during orientation was no longer effective. In the TSAM, nurses handle all 4 patients during orientation but are only responsible for specific skills, progressing through the tiers as they demonstrate competency. It's crucial for preceptors to be well-versed in the new model and effectively incorporate it into their training.
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