How Allina Health is boosting nurse retention rates

Burnout is a growing problem among U.S. nurses, with over half reporting symptoms of poor physical and mental health, according to a 2018 study published in the Journal of Occupational and Environmental Medicine.

To help address burnout and increase retention rates among new graduate nurses, Minneapolis-based Allina Health has developed a unique solution via a partnership with the National Council of State Boards of Nursing: the Allina Health System Nurse Residency Program.

Program participants include all nurses hired by Allina who completed their degree less than a year ago. Since starting the program in 2017, Allina has seen a 4 percent decrease in nurse turnover rates. Nurses also report consistent improvements in work confidence and competencies as they near the end of the one-year program. 

Here, Susan Makela, RN, BSN, Allina's director of clinical education for talent and organizational development, and Kaitlin Codner, RN, BSN, a learning partner within Allina's talent and organizational development department, discuss the program's positive effects on new nurses' confidence and competence levels in the workplace.

Editor's note: Responses have been lightly edited for length and clarity.

Question: What was the motivation behind creating the program?

Susan Makela: One of the motivations behind the program was increasing retention rates. About 25 percent of nurses leave a position within their first year of practice, according to the National Council of State Boards of Nursing. Here at Allina, we had a turnover rate of 13 percent in 2017. We were able to reduce that to 9 percent within the first year of implementing the program.

Kaitlin Codner: We were also seeing an increase in new grad hires. We wanted to design a great program to support these new hires in their transition into practice. 

Q: What does the program entail for nursing residents? 

SM: New nurse grads from the entire Allina Health system go through the program. Each nurse takes five online modules that we purchase through the National Council of State Boards of Nursing. We then augment the modules with three instructor-led classes to enhance and support what the nurses have learned online. These cohorts of new nurse grads stay together, so they get to know each other really well. They're not new nurses all by themselves at a hospital, they're part of a group that comes together through the residency courses.

KC: The instructor-led classes also personalize the foundational concepts our new nurses learn online by providing the residents with the Allina perspective and giving them a strong sense of support. Residents meet with different speakers from our different departments, who put a face to Allina's resources. We also do a portion on self-care. One of our tag lines is, "We don't want our grad nurses to just survive, we want them to thrive at Allina Health."

Q: What is unique about this program compared to other nurse residency programs?

SM: Our approach is unique in that most programs do not have a blended, augmented approach; they either do the instructor-led courses or the online modules. The National Council of State Boards of Nursing has told us we were the first in the nation to have a blended approach that also included hospitals, home care services and clinics. In contrast, most other programs are solely hospital-based. We've got a good database for showing the positive outcomes of having a blended, interdisciplinary nurse residency program within the different areas of home care, clinics and hospitals. 

We're also unique in terms of the sheer number of residents who have come through the program. From August 2017 through December 2019, we will have put 1,022 nurses through our residency program. 

Q: What outcomes have you seen as a result of this program? How do you measure those outcomes?

KC: One way we measure the program's outcomes is through the Casey Fink Graduate Nurse Experience Survey, which measures new graduate nurses' experience upon entry to the workplace through their transition into their role as a professional nurse. The survey has 46 questions that cover demographic information; skills and procedure performance questions; comfort and confidence questions; job satisfaction dimensions; and some open-ended questions about transition difficulties and work environment.

The three instructor-led classes are spread six to eight weeks apart throughout the program. On the day before the nurses' first day of class, we have them fill out the Casey Fink survey. Then we wait until the third and final class to have the students fill out the same survey one more time. 

At the end of the year, we pull the data from these surveys and look at residents' responses to five key markers: communication and leadership, professional satisfaction, patient safety, support and stress. We present the findings to our nursing leaders to give them direct feedback on what our new grads are saying. Since the program began, we have seen significant increases in all those key markers at the end of the program compared to the beginning of the program. In the program's first year in 2017, for example, 71 percent of nurse residents felt they were confident communicating with physicians prior to the program, and 91 percent felt confident communicating with physicians after the program.

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