For many of us, fall brings back memories of the start of a new school year, whether as a student, teacher, or nursing professional development (NPD) practitioner. It is a time for establishing new goals and meeting new challenges!
A recent research report published by the Advisory Board Company, Nursing Executive Center (2019), a best practices firm that works to improve the performance of healthcare organizations around the world, reported that hospitals are facing a new challenge termed the "experience-complexity gap" (Advisory Board Company, Nursing Executive Center 2019, p. 4). As experienced nurses retire in large numbers, hospitals are losing years of experience and replacing the workforce with novice nurses. Occurring at the same time, the complexity of patient care is rapidly rising. In order to meet the needs of the increasing complex patient care, the transition of the novice nurse to the competent nurse needs to occur more quickly and the knowledge, skills, and attitudes of the current experienced nurses needs to be better leveraged (Advisory Board Company, Nursing Executive Center, 2019).
This challenge has significant implications for the NPD practitioner. Little change has occurred in nursing orientation programs since the 1940s (Kennedy, Nichols, Halamek, and Arafeh (2012). A study conducted by Harper, Aucoin, and Warren (2016), commissioned by the Board of Directors of the Association for Nurses in Professional Development on the organizational value of nursing professional development, reported that orientation activities "consume the highest percentage (33%) of NPD department times" (p. 245). Nursing professional development practitioners and their departments are spending a significant amount of time in orientation activities. However, are the current orientation strategies effective in meeting the needs of nurses in this increasing complex healthcare environment? Where is the evidence that these activities are addressing the changing nursing workforce?
The Advisory Board report recommends three approaches to help meet the experience-complexity gap. First, new-to-practice nurses need to be "taught more effectively by scoping the first 12 weeks of orientation and standardizing preceptor work." Second, levels of experience should be "redistributed across the organization," and finally, practice should be "differentiated for experienced nurses" (Advisory Board Company, Nursing Executive Center, 2019, p. 5).
I am encouraged by the work that has been published in The Journal for Nurses in Professional Development (JNPD) on improving orientation and developing preceptors. Since January of this year, JNPD has published more than 17 articles addressing these concerns. In this issue of JNPD, several authors share keys finding on how to improve orientation. Woolwine, Romp, and Jackson, in their article on "Game On: Evaluating the Impact of Gamification in Nursing Orientation on Motivation and Knowledge Retention," describe the use of gamification teaching methodologies and its positive impact on and motivation knowledge of the new nurse. A study conducted by Boyer, Mann-Salinas, Valdez-Delgado, and VanFosson, "Using the Delphi Technique to Determine Core Competencies of a Nurse Competency Program" identified essential elements within a competency or transition program, and Wendler, Wendler, and Wendler, in their article "Innovation During Orientation: How Does Rhetoric Drive New Graduate Nurse Performance?" describe the innovative use of technical writers in the development of orientation forms for experienced and new to practice nurses. I am inspired by the work of these authors and, others but there remains much more to be done! As the healthcare environment continues to increase in complexity and the experience of our workforce changes, NPD practitioners must continue to push the boundaries of innovation and develop evidence-based approaches to meet this challenge. I encourage you to submit manuscripts and ideas that address this challenge as we strive for in excellence in patient care.
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