Improving New Graduate Nurse Retention With a Transition to Emergency Nursing Practice Program.

INTRODUCTION: Emergency department turnover rates increased at Sentara Northern Virginia Medical Center. Most applicants were new graduate registered nurses. A strength, weakness, opportunity, threat analysis revealed 3 weaknesses regarding new graduate registered nurses in emergency departments. Transition to practice program was necessary, new graduate registered nurse competency needed to progress rapidly, and retention rates needed improvement. METHODS: The emergency department registered nurse transition to practice pathway was created to address these challenges. Retention statistics were garnered through new graduate registered nurses length of employment. Improving retention rates at Sentara Northern Virginia Medical Center led to expansion of the program to the other 11 hospitals in the system. Self-report surveys were created later to evaluate the new graduate registered nursess' satisfaction with the program and perception of clinical confidence. RESULTS: Using the emergency department registered nurse transition to practice pathway, turnover rates at Sentara Northern Virginia Medical Center dropped from 46% to 5.1%. Post expansion, the overall program retention rates were 96% at 6 months, and 86% at 1 year. The 2-year retention rate prior to COVID-19 was 82%, afterward, it dropped to 65%. Most surveyed new graduate registered nurses had a confidence level of 25% or less on the first day. After their 17-week orientation, 54% reported confidence levels had risen to 75%. Within 6 months, 81% reported 75% confidence, at 1 year, 87% reported levels between 75% and 100%, and at 2 years, 100% reported a confidence level between 75% and 100%. DISCUSSION: This development of the emergency department registered nurse transition to practice pathway resulted in improved emergency department registered nurse retention and confidence. Savings from reduced turnover and reduced temporary labor staffing were achieved with this program. Implementation takes careful resource management, ongoing analysis, and research to validate return on investment.

The Impact of Burnout on Emergency Nurses' Intent to Leave: A Cross-Sectional Survey.

INTRODUCTION: Emergency nurses work in one of the busiest and most stressful departments in a hospital and, as such, may experience burnout more often than nurses working in other nursing units. This study examined the relationship among orientation, burnout (emotional exhaustion, depersonalization, and low sense of personal accomplishment), and intent to leave. METHODS: A cross-sectional survey design was used. Emergency nurses who were members of the Emergency Nurses Association were invited to participate in an anonymous survey. The Maslach Burnout Inventory tool was used to explore emotional exhaustion, depersonalization, and sense of personal accomplishment. Emergency nurses' intent to leave was assessed with the Turnover Intention Scale. A logistic regression analysis was used to investigate the odds of intent to leave for those who scored at or above versus below the median on each burnout subscale. RESULTS: The findings revealed that a formal orientation enhanced emergency nurses' sense of personal accomplishment and was associated with lower intent to leave. The odds of intent to leave were almost 9 times greater for participants with 5 or more years of experience, approximately 13 times greater for those with above-median emotional exhaustion, and more than 6 times lower for those with above-median sense of personal accomplishment. DISCUSSION: Emotional exhaustion and low sense of personal accomplishment were key factors influencing emergency nurses' intent to leave. Emergency nurse leaders may find that a formal orientation program enhances sense of personal accomplishment and decreases intent to leave. Creating work environments to help emergency nurses find joy in their work may be critical to work-life balance and staff retention.

An RNA interference model of RPS19 deficiency in Diamond-Blackfan anemia recapitulates defective hematopoiesis and rescue by dexamethasone: identification of dexamethasone-responsive genes by microarray.

Diamond-Blackfan anemia (DBA), a congenital erythroblastopenia, is a model disease for the study of erythroid differentiation but is poorly understood. RPS19 is the only gene yet to have been associated with DBA, but its relevance to erythroid differentiation is unclear. The molecular basis for the stimulation of erythropoiesis by glucocorticoids in patients with DBA has not been identified. We demonstrate that targeted degradation of the RPS19 transcript, through retroviral expression of short hairpin RNAs (shRNAs), blocks the proliferation and differentiation of erythroid progenitor cells in cultured human CD34(+) cells. Treatment of RPS19-deficient cells with dexamethasone restores erythroid differentiation to normal levels. We investigated the molecular basis of pharmacologic therapies for DBA using oligonucleotide microarrays to survey gene expression in CD34(+) cells treated with combinations of dexamethasone, erythropoietin, stem cell factor, and interleukin-3. Dexamethasone did not alter expression of RPS19 but activated a genetic program that includes a set of key hematopoietic regulatory genes. Genes specific to erythroid progenitor cells were up-regulated by dexamethasone, while genes specific to nonerythroid lineages were down-regulated. Deficiency of RPS19 therefore blocks proliferation of immature erythroid progenitor cells, and dexamethasone activates proliferation of the same cell population through mechanisms independent of RPS19.