Retention Through Education: Improving the Nurse Training Journey

By Matt Phillion

More and more, the industry is seeing healthcare education institutions shift toward competency-based learning, offering students and trainees hands-on clinical experiences in addition to their traditional theoretical training and exams. There remains opportunity, however, to improve how these advancements in training are tracked and reported to avoid gaps and inefficiencies.

How do we determine the best way to provide more access to hands-on learning, and then track that training to ensure the next generation is ready to provide quality care for an ever-growing patient population?

“Education is always a journey,” says Patty Knecht, chief nursing officer with Ascend Learning. “For a technical education, such as construction or HVAC, they’ve always been very competency-based. Historically, it’s been less likely to see that as a strategic approach in healthcare, at least on the professional level.”

But at the same time, Knecht notes, there are clear indications that competency-based education works.

“The closer we get to aligning competency to practice, the shorter the time to productivity—and as important if not more important, it builds confidence in that student,” says Knecht. “I don’t think anyone would dispute that there has always been a gap between education and practice because of how complex healthcare is. You are immersed in it in an independent role in unique ways, and you’re not eased in as you might be in other situations.”

That is, very quickly, healthcare professionals find themselves in time-sensitive non-clinical-related job roles where decisions need to be made quickly where it would be best to consult with an expert. Ideally, Knecht says, new grads come on board with a level of competency that they don’t have a level of shock or worry.

“We don’t want them to start with, ‘Oh my gosh, I am now responsible for this patient’s care, who is very sick and whose situation is very complex,’” says Knecht. “When they start feeling that they’ve learned about something like this situation but they’re not sure they’re totally confident in themselves, that’s when burnout and stress gets higher.”

Improving retention through learning

Retention needs to be a focus right from the beginning, Knecht says.

“I’m really passionate about this. How do we clearly assess and treat retention along the whole lifespan of the learner?” she says.

The industry is focused on assessing academic readiness and ensuring the student has the early academic prep to enter a nursing program and be successful.

“We then need as they enter the program to build up what is at least an early level of confidence, if not competence, so they don’t feel immediately like they’re in over their heads,” says Knecht.

Knecht believes strongly in immediate, personalized learning, and that both human instructors and technology need to do constant remediation to help foster that.

“It’s not about taking a test and see what you got wrong, go study more and then come back, take another test, and move on,” she says. “They might read a bit, jump into a case study that has a clinical judgment base to it, process that and learn from it, and then be tested on that knowledge. But at the end of the road, competence isn’t just a check box but about the hard skills that person has, how that individual is going to be part of a cohesive team and how they’ll respond to medical emergencies.”

Using a combination of real-life clinical site experience and simulation-based technology can help both the student and the faculty analyze the results of the teaching to identify gaps for further training.

“Speaking specifically of nursing, a new grad will see 46% of their tasks in the first year involve clinical judgment,” says Knecht. “If they don’t come in with the competence and confidence they will quickly burn out.”

New grads can struggle with normal, expected tasks, but then add on any number of more unexpected events and that burnout gets even more intense, be it an unusual case, an unexpected patient demise, a high-stress situation like cardiac arrest, or even situations where the patient’s family is not coping well and causing distress on the unit.

“All of that level of anxiety contributes to burnout, and they may start to feel like they don’t have those core strengths to draw upon, and it becomes a vicious cycle,” says Knecht. “Retention goes beyond just the nursing program. When they’re in the employee environment, there needs to be technology and tools that allow managers and directors of nursing to look at the entire spectrum of team members and say, ‘Do I have the right skills I need with the right balance, and if I don’t how can I get there efficiently?’”

We can’t talk about burnout without talking about staffing, Knecht notes.

“If we don’t have quality outcomes, we’re either getting penalized, or we have less income from payers,” she says. “And of course, safe care is always the core focus.”

Slowing the current shortage

While burnout and attrition is being felt across the entire industry, nursing faces unique challenges, Knecht says.

“We have an exodus of our seasoned nurses who have been long-term experts. They are a lifeline to our students,” says Knecht. “We say find your lifeline early, know who you reach out to when you only have a minute or 30 seconds to find them in a moment of decision.”

Those moments will become fewer and fewer as the nurse becomes more experienced, guided by what their lifelines share. What we’ve seen, however, is that much of the brainpower provided by those veteran nurses has left the industry.

“The technology of AI can be instrumental here,” says Knecht. “Our AI mentor has protective guardrails that pulls knowledge exclusively from evidence-based sources. Our goal is to have tools available that will be able to be more specific in answering questions, and we’re working tirelessly with technical and subject matter experts to make this a reality that is helpful both in practice and in education.”

Beyond education and training, there is also a need to make sure nurses have the ability to be heard.

“How do we empower our students, our new grads, and our seasoned staff to continue to feel like they have the power to be heard, and that they have a voice?” says Knecht. “That voice becomes stronger when we have the evidence we need to tell our stories in a quick and efficient way. The burnout phenomenon worsens when people feel like they have no control over their roles.”

There are huge opportunities to address retention and burnout right now, Knecht says.

“The journey is still in front of us, and right now, particularly post-COVID, we’ve seen a rise in awareness of the needs of healthcare teams,” says Knecht. “I hope that we continue to evolve and that we see leaps in efficiency because technology has virtually eliminated all non-nursing, non-healthcare tasks so that the humans can provide the personal level of connection that is needed for holistic healing.”

Flashier types of technological advances might be top of mind, but what Knecht points to are those advancements which continue to enable to put nurses at the forefront of patient care.

“I believe nurses will continue to be key members of the team and we need to make sure we don’t become an automated factory in healthcare,” she says. “Instead, we focus on intentional, data-driven technology to provide better service to our families and patients. Nurses are over 4 million strong—there’s a lot we can do together.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.