Reducing RN Turnover on St.
Francis Clinical Units
Hayli Wagner, Katie Wyman, Ashley Crittenden, Julia Goode, Sarah Ellinghausen
Bon Secours Memorial College of Nursing
Abstract
Purpose: The aim is to decrease nurse
turnover rates in the first year on St. Francis’s
clinical unit. By decreasing turnover rates in
the first year, our goal is to decrease from
37.2% to 34.2% after one year of
implementation of a modified clinical ladder.
Background: Based on employee surveys
and leadership feedback, the clinical ladder is
too time consuming and not enough support is
offered when attempting to advance. Without
participation in the clinical ladder program,
nursing staff is more likely to leave the bedside
since they are not receiving adequate
monetary compensation.
Proposed Solution: Mentors will be assigned
when employees have completed residency in
order to assist with completion of the portfolio.
Workshops will be held at different times as
well to help those with portfolios and mentors
will get compensated for their time.
Implications for Practice: Clinical ladder
participation remains a challenge within the
hospital system. Modifying the clinical ladder
may lead to decreased first year nurse
turnover rates and make the process of
advancing on the clinical ladder easier for
employees.
Introduction and Description of the Issue
Macro Description: Lack of clinical ladder
advancement contributes to:
-Increased turnover rates
-Decreased job satisfaction
-Decreased likelihood to stay at bedside
(Ke & Chung, 2017).
Micro Description: Clinical units at St.
Francis reported an increased turnover rate
of 37.2% in 2021.
Data and Analysis of the Issue
-From February 2021 to January 2022, nurse
Lack of participation in the clinical ladder affects
turnover from first year nurses increased from
retention.
32% to 39%.
-As of January 2022, 5 nurses were at a Clin II
and 2 nurses were at a Cin III
-Nurses have voiced concerns about the
clinical ladder program being too time
consuming and overwhelming
Summary of Supporting Literature:
- A high turnover rate can result in low morale and unstable
organizational structure, which can lead to an unsupportive
environment and negative atmosphere (Ke & Chung, 2017).
-Research studies display that evaluation of clinical ladder
advancement programs result in higher retention rates and
increased nurse satisfaction (Wakim et al, 2019).
-Focused approaches designed to improve knowledge and reliable
CLP organization and operation can be successful in enhancing
satisfaction of CLP and improving hands-on nurse performances.
(Meucci et al., 2019)
-A study by Ke & Chung (2017), showed that nurses that were
higher on the clinical ladder had a greater sense of achievement,
job satisfaction, and opportunities for promotion due to the
development of teaching and management skills over time
-Research studies have show that a mentoring program for the
clinical ladder increased clinical ladder participation by 16.5%,
8.25% rise in certifications,and a 4.96% increase in those
advancing in their degrees (Merritt, 2019).
●● Implementation
● Evaluation
Proposed Solution
Root Cause AIM - Proposed Solution
The aim of our project is to decrease first year
nurse turnover rates on St. Francis’s clinical
unit from 37.2% to 34.2% within one year of
implementing a modified clinical ladder.
Proposed Solution: By assigning mentors at
completion of residency to assist with finalizing
of portfolio, hold one on one workshops
keeping in mind to accommodate night shift
and day shift workers, and compensation for
attending and participating in the workshops.
Conclusion
In conclusion, it is our belief that by assigning a
mentor to help with PNAP and the clinical ladder
Logistics advancement process, the first year nurse will
advance earlier in practice therefore increasing
● Education
retention and decreasing the turnover rate.
● Process
● Mentor pairing
Evidence has shown that nurses who are higher on
Stakeholders the clinical ladder are more likely to stay in their
current position.
● Nursing staff
● Nurse managers
Information sessions are currently being held
● Mentors about climbing the clinical ladder but we envision
Potential costs that incorporating interactive individual coaching
sessions will entice more nurses to participate in
● Individual coaching the sessions and in advancing on the clinical
● Applicant ladder. .
● Coaching space References
Timeline Ke, Y.-T., & Hung, C.-H. (2017). Predictors of Nurses' Intent To
Continue Working at Their Current Hospital. Nursing Economics,
35(5), 259-266.
https://link.gale.com/apps/doc/A514512727/AONE?u=googlescholar
&sid=bookmark-AONE&xid=081e83a6
Data Collection Merritt, K. (2019). Clinical Ladder Mentoring: The Impact on Nursing
Professional Development. East Carolina College of Nursing.
● Interviews http://hdl.handle.net/10342/7398
● Analysis: turnover, completed submission,
Meucci, J., Moore, A., & McGrath, J. M. (2019). Testing
successful submission
evidence-based strategies for clinical ladder program refinement.
● Process Measure JONA: The Journal of Nursing Administration, 49(11), 561–568.
Retrieved from https://doi.org/10.1097/nna.0000000000000812
Wakim, N., Sadule-Rios, N., Balbosa-Saunders, S., Butler, E., &
Montesino-King, B. (2019). Evaluation of the clinical competency
advancement program. Nursing & Health Sciences Research
Journal, 2(1),5–11.
https://scholarlycommons.baptisthealth.net/cgi/viewcontent.cgi?articl