The Older Nurse in the Workplace Retention or Retirement

<p>The nursing workforce, as with other health professionals, is aging with 50% aged over 47 years. In combination with predictions of continuing nursing workforce shortages, an aging population and increasingly complex health environment, this presents a unique set of challenges to the healthcare sector as both the population and nursing workforce continue to age. A review of the international literature suggests that the majority of older nurses in the workplace (50 years and over), are highly experienced and have extensive knowledge and practice wisdom from their years of nursing. What is also clear is that the current environment does not always support this cohort of nurses and that they often feel less valued. As a consequence, in a time of unprecedented shortages, we are at risk of losing this valuable experience from the workplace prematurely. Some suggested strategies to support this group of nurses include consideration of health and safety issues, flexibility with rosters and shift pattern, options for part time work, continuing professional development and ensuring their experience and knowledge continues to be valued in the work place. This research was carried out to explore the understanding of the issues facing the older nurse in a New Zealand context. There is a significant gap in literature as to the experience in the workplace of older nurses in New Zealand. In relation to health workforce retention, strategies are described from a general workforce perspective. Specific strategies in relation to the retention of the older nurse are not addressed or described. The international literature describes both the older nurses' experiences and strategies that can be used to retain them in the workforce, which have relevance to the local healthcare environment. Using a descriptive survey design two groups of Clinical/Charge Nurse Managers in two separate District Health Boards were asked about their awareness of the issues facing older nurses and what strategies they were using to address them. It was the assumption that as a group they were very aware of the issues facing older nurses and were often using informal strategies in an attempt to retain this group of nurses. The aim of this research was to raise awareness of the needs of the older nurse in the workplace and to capture and describe the strategies being used. Results indicated that indeed the Clinical/Charge Nurse Managers were very aware of the issues facing older nurses in the workplace and were innovative in their attempts to retain them in the workplace, and these retention strategies were similar to those discussed in the international literature. The need for national direction and organisational policy in place to support the Clinical/Charge Nurse Managers' retention efforts was also raised in the literature and I believe also needs consideration in the New Zealand context.</p>

The Older Nurse in the Workplace Retention or Retirement

<p>The nursing workforce, as with other health professionals, is aging with 50% aged over 47 years. In combination with predictions of continuing nursing workforce shortages, an aging population and increasingly complex health environment, this presents a unique set of challenges to the healthcare sector as both the population and nursing workforce continue to age. A review of the international literature suggests that the majority of older nurses in the workplace (50 years and over), are highly experienced and have extensive knowledge and practice wisdom from their years of nursing. What is also clear is that the current environment does not always support this cohort of nurses and that they often feel less valued. As a consequence, in a time of unprecedented shortages, we are at risk of losing this valuable experience from the workplace prematurely. Some suggested strategies to support this group of nurses include consideration of health and safety issues, flexibility with rosters and shift pattern, options for part time work, continuing professional development and ensuring their experience and knowledge continues to be valued in the work place. This research was carried out to explore the understanding of the issues facing the older nurse in a New Zealand context. There is a significant gap in literature as to the experience in the workplace of older nurses in New Zealand. In relation to health workforce retention, strategies are described from a general workforce perspective. Specific strategies in relation to the retention of the older nurse are not addressed or described. The international literature describes both the older nurses' experiences and strategies that can be used to retain them in the workforce, which have relevance to the local healthcare environment. Using a descriptive survey design two groups of Clinical/Charge Nurse Managers in two separate District Health Boards were asked about their awareness of the issues facing older nurses and what strategies they were using to address them. It was the assumption that as a group they were very aware of the issues facing older nurses and were often using informal strategies in an attempt to retain this group of nurses. The aim of this research was to raise awareness of the needs of the older nurse in the workplace and to capture and describe the strategies being used. Results indicated that indeed the Clinical/Charge Nurse Managers were very aware of the issues facing older nurses in the workplace and were innovative in their attempts to retain them in the workplace, and these retention strategies were similar to those discussed in the international literature. The need for national direction and organisational policy in place to support the Clinical/Charge Nurse Managers' retention efforts was also raised in the literature and I believe also needs consideration in the New Zealand context.</p>

Reducing falls in the outpatient oncology clinics.

262 Background: Patients with cancer are at particularly high risk for falls and unfortunately may suffer worse outcomes with falls. Patients with cancer are at increased risk for fractures due to bony metastases, and worse subsequent bleeding due to thrombocytopenia from disease or from prophylaxis or treatment for deep vein thromboses. In 2020, there were 10 falls among patients with cancer in NewYork Presbyterian/Weill Cornell Medicine outpatient oncology clinics, with a fall rate of 0.31 falls per 1000 patient visit. In 2019, there were 14 falls (0.39 falls per 1000 patient visits).The aim of this project is to reduce the total number of falls and overall fall rate by 50% in NewYork Presbyterian/Weill Cornell Medicine outpatient oncology clinic areas by December 30, 2021. Methods: In Plan-Do-Study-Act (PDSA) cycle in February 2021, we identified key stakeholders (nurses, medical assistants, nurse navigators, and clinic managers) in NYP/Weill Cornell oncology outpatient areas. We engaged key stakeholders in a series of interactive conferences to introduce and implement quality improvement tools (root cause analysis and process mapping) with outpatient teams to identify risk factors for patients who fell in NYP/Weill Cornell oncology outpatient areas from 01/2020-12/2021. A standardized post-fall huddle process was implemented, and prior falls were reviewed using this process. Interventions were based on these identified risk factors to prevent falls in the outpatient clinic areas. In the second PDSA cycle which began April 1, 2021, a new handoff process was initiated in the outpatient clinic setting. Prior to the end of the shift, the charge nurse cross references the “G Drive list” with patient list for the following day and identifies patients with previous falls or those identified by nurses as being high risk for falls. This list is located in a commonly used, HIPAA compliant file location, which was already part of the normal scheduling workflow. These patients are then discussed in the daily huddle to create awareness by all staff and provide “handoff” between visits which by design cannot happen nurse to nurse with each visit. The team has been reviewing the list monthly to develop a sustainability plan. Results: Since the completion of the interactive QI conferences in PDSA cycle 1, there have zero additional falls in the oncology outpatient clinic areas. Continuing on into PDSA cycle 2 with the new handoff process, there have not been any additional falls. Conclusions: This project demonstrates an effective QI intervention to reduce falls in the outpatient oncology areas and prevent injuries in this vulnerable population. This multidisciplinary approach to identifying root causes for falls and reviewing our processes for monitoring patients in our infusion areas ultimately has led to significant reduction in falls. It has also empowered key stakeholders in our oncology clinics with QI tools to address other areas for improvement.

627 Strategies for Reducing Emergency Department Lengths of Stay for Admitted Pediatric Burn Patients

Introduction Various strategies to reduce emergency department (ED) lengths of stay (LOS) for admitted pediatric burn patients may be employed as a quality improvement project. Decreasing ED LOS may promote patient outcomes and reduce morbidity. Initial discussions were brought forth during trauma and burn multidisciplinary peer review rounds in March 2019 and have persisted to present day. Methods Several strategies, such as preparation of the burn unit staff within one hour of patient arrival in ED, notification to the burn unit by the burn attending of an incoming pediatric burn patient, allowing the PICU charge nurses or advisors to assist with room set up and admissions, and creating a checklist to assist PICU nurses and advisors in helping prepare for anticipating inpatient admissions. These strategies were designed and enforced in March/April 2019. In addition to these action plans, trauma activation alerts were added in December 2019 to the burn charge nurse phone for pediatric burn trauma one and trauma alerts for more expedient notifications. Finally, communication efforts between ED and burn leadership teams were conducted in June 2020 to help with additional mitigating of ED LOS, such as discussing the appropriateness of specialty consults while in the ED. Results Initial ED LOS was reduced from 209 minutes in March 1019 to 150 minutes in June 2019. Increased trends were noted in early 2020, with a peak at 244 minutes in July 2020. Additional interventions, such as trauma activation alerts and ED/Burn team communications, did not provide sustainable long-term reductions. Conclusions Recent strategies to reduce overall ED LOS trends have been beneficial, but not consistent, in sustaining downward trends. Action to perform a gap analysis to discover persistent barriers and to introduce additional structure, such as a burn trauma one algorithm, may provide stability to this metric.