By Katherine Kuren Black

Recruiting and retaining competent, engaged nurses is an ongoing challenge for health care facilities. With median RN retention in nursing facilities at 66.7 percent (AHCA, 2014) the costs associated with continually recruiting and onboarding new nurses can be staggering; perhaps as high as 75 to 125 percent of a nurse’s salary (Beecroft, Kunzman & Krozek, 2001). Pricewaterhouse Coopers’ Health Research Institute (2007) estimated that an increase in turnover of one percent can cost an average hospital $300,000 per year. Jones & Gates (2007) outline the considerable costs of nurse turnover, both economic and those related to decreased quality of care and lost organizational productivity and culture.

The difficulties faced by post-acute care settings are greater than ever in the current and rapidly changing landscape. PAC facilities are caring for medically complex patients, providing specialized nursing skills, and facing demanding new regulatory requirements. PAC staff must identify and implement best practices, assess patients astutely, use patient care technologies safely and work effectively with other health care disciplines. The negative economic effect of hospital readmissions alone requires a knowledgeable and skilled staff. Thomas, Mor, Tyler & Hyer (2012) in a study of 681 nursing homes, demonstrated a relationship between higher nurse retention and fewer re-hospitalizations. Additionally, PAC staff members are increasingly mandated to apply new skills in quality improvement methods to enhance clinical outcomes in an environment where informed and discerning consumers expect quality care.
Facing this multitude of challenges, PAC facilities often have fewer educational resources than their acute care counterparts. Nursing leaders enact multiple roles, which sometimes leaves staff education last in line for their time and attention. Concurrently, new nurses are expected to change jobs many more times than past generations. Each time a nurse leaves, the organization loses its investment in that nurse as well as knowledge, skill and productivity.

How can PAC providers attract and maintain a workforce of nurses in order to continue to meet patients’ needs for skilled, evidence-based, patient centered care? A nurse residency program is one way to help recruit, educate and retain new nurses; and in turn avoid the costs of nurse turnover. Between 2014 and 2017, the New Jersey Action Coalition developed, implemented and evaluated a statewide nurse residency program for PAC settings. The NJAC Nurse Residency Program reached over 100 nurses from over 50 PAC facilities throughout New Jersey, providing intensive, interactive education for both new nurses and their facility-based preceptors.

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