Succession Planning Promotes Bedside Nursing Expertise

Nurse leaders worried about an exodus of seasoned bedside nurses should start preparing the next generation of RNs now to assume responsibilities. 

This article appears in the September/October 2018 edition of HealthLeaders magazine.

Succession planning is usually talked about in the context of leadership development. Nurse leaders are on the lookout for RNs with the potential to be the next great nurse manager, VP of nursing, or CNO.

Then they set about coaching, mentoring, and educating them so they're prepared to step into those roles when the need arises.

Succession planning geared toward direct care nurses is much less common says, Suni Elgar, MPH, BSN, RN, OCN, associate director, clinical operations, blood and marrow transplant and immunotherapy at Seattle Cancer Care Alliance, but is equally as important.

"I feel like we as a nursing community talk a lot about leadership succession planning, which is extremely important, but I also feel that we need to really focus on how we’re going to do succession planning for our bedside nurses," she says.

So, what does bedside succession planning look like? Similar to leadership succession planning, it enables nurses to build their skills and knowledge so they are ready to step into new clinical opportunities when they arise.

Here, Elgar talks about the benefits of bedside succession planning as well as ways to apply the practice.  

Retention
 

Data from the decade-long RN Work Project study found that about 17.5% of newly licensed RNs leave their first jobs after one year, and 33.5% leave within two years.

While this new generation of nurses is eager to jump at new opportunities, baby boomer nurses are starting to retire.  

In 2016 and 2017, SCCA's outpatient blood and marrow transplant clinic, which has 65 nurses, had five nurses retire. During that same time, four nurses left the clinic to either stay home with family or for other employment opportunities.

"Nurses transition to new roles throughout their careers, but there are ways we can do better [at keeping] them in their careers and keeping that wealth of knowledge," Elgar says. "With succession planning the idea is you’re retaining your nurses longer, so you’re keeping that value of experienced nurses."

Knowledge Transfer
 

Losing decades of knowledge and experience as seasoned nurses leave the workforce is a legitimate concern for nurse leaders.

Succession planning tackles this issue head on by making the transfer of knowledge from expert nurses to more novice nurses a priority.

It recognizes that, while retirement is inevitable, if an organization constantly prepares its next generation of nurses to step in where needed, it's effects can be mitigated.

"It’s really focused on [asking], 'Who are those amazingly well seasoned nurses with a wealth of knowledge, and how can they impart that to the next generation of nurses?'" Elgar says. "And, helping those nurses understand why it’s so important to pass on that information."

When experienced nurses understand their value, they become enthusiastic about sharing their knowledge with others.

"When we have students from our local universities come here, [the experienced nurses] are really excited to see them. They enjoy the process of learning from them as well as helping them further their education," she says. "They’re engaged in being mentors for our new nurses coming to the clinic."

An example of preparing for smooth transitions happened recently in the BMT clinic.

Elgar knew one of her seasoned nurses was going to be retiring and another one of her staff members would be filling his position. She was able to have both nurses work side-by-side for a few months until he retired.

"The nurse that replaced him has been here for five or six years, but for her to be able to spend real quality time with him before he left, was so important," Elgar says. "They have certainly had interactions and discussed patients before, but to spend that dedicated time together before he left was huge."

Hire one nurse ahead
 

Elgar was able to give her staff that time to share knowledge because of the organization's commitment to hire "one nurse ahead."

"By creating an internal float pool, when a nurse retires, or they leave and move somewhere else, we are able to quickly fill with one of our nurses who’s already trained, who’s already skilled, who can take on the work and make sure that patient safety is first and foremost," she explains.

Educate in place
 

In addition to peer-to-peer knowledge transfer, successful succession planning also includes an organizational commitment to continued education for nurses of all experience levels.

"We make sure that all of our nurses have dedicated time for education," Elgar says. "For our group, we have four 8-hour education days per year and all of the nurses go to those. Then we have additional funds and time where they can pursue education outside of our institution."

There is also a course for nurses who are mentors and preceptors.

Additionally, the organization started a nurse residency program in 2012. About twenty nurse residents have gone through the program and the organization has retained all but one of those nurses.

Staff engagement
 

Elgar says succession planning contributes to the BMT clinic's above-average NDNQI scores,

"We ranked in the 75^th– 90^th percentile in most professional practice environment subscales, consistently outperforming the NDNQI mean on all nine subscales," she says.

Here's how the BMT clinic compares in some areas to other academic medical centers:

• Staffing and resource adequacy: 3.11 to 2.76
   
• RN-to-RN interaction: 5.60 to 5.15
   
• Professional development opportunity: 4.69 to 4.36
   
• Professional development access: 5.11 to 4.40

"If we have nurses that are well ingrained and who are engaged in the work that they do, we know that they are going to be better performers than those who are not. If we have that ability to have someone mentor the next group of nurses, we’ve just created such a better experience for our patients and our staff," Elgar says.