High nurse turnover in the Emergency Department is a significant problem in many hospitals. As the overall experience of the nursing staff decreases, trauma programs are challenged to maintain care quality.
ED and trauma program leaders at Erlanger Health System, a Level I trauma center in Chattanooga, Tennessee, addressed this complex problem with a unique job share arrangement. According to Stephanie Spain, RN, CCRN, TCRN, adult trauma program manager, the new staffing model improves staff retention and supports staff education.
Challenge: Fewer experienced nurses in trauma bay
“Ever since COVID, we have felt the effects of staff turnover in our Emergency Department. High turnover resulted in steadily decreasing nursing experience in the ED as a whole, but it was especially felt within the trauma bay. In particular, we noted issues related to protocol adherence, quality trauma care and documentation. Missing pieces of vital documentation ranged from no patient temps to entirely missing secondary assessments. Even with mentorship provided by our highly specialized Critical Care Nurse Clinicians in real time, we were still feeling the effects of not having experienced nurses consistently assigned to the trauma bay.”
Innovation: Trauma ICU/ED job share initiative
“In our hospital, nursing retention was higher in critical care areas than in the ED. And for numerous reasons some really great young (nursing years) nurses in the ED were thinking of transferring to the ICUs. After brainstorming several ideas, ED nursing leadership responded to this challenge by developing a Trauma ICU/ED job share initiative. Nurses from both areas can apply for a job share position, and an equal number of ICU nurses to ED nurses are selected. Each position is shared in a partnership (one ICU nurse to one ED nurse). When the ICU nurse is doing his or her 2-week rotation in the trauma bay, the ED nurse is working 2 weeks in the ICU. Due to the trauma-focused nature of the position, job share personnel are assigned to the trauma bay when they are on shift in the ED. The job share initiative was launched in 2021, and it initially included two positions. Due to immediate popularity, the program was expanded in early 2022 to include three more positions, involving a total of 10 nurses (five from the ICU and five from the ED).”
Results: Lower turnover, better quality
“Thanks to the job share initiative, we are better able to staff the trauma bay with experienced nurses and nurses who are growing into trauma leaders and content experts. We have seen steady improvement in quality of care as well as documentation compliance, and we have also noted greater collaboration between the two departments. In addition, the job share initiative has had a major impact on nurse retention. During 2022, our system as a whole had a nurse turnover rate of 20.4%. During the same period, the TICU and ED turnover rates were 32.3% and 42.3%, respectively. In comparison, there was zero turnover among TICU/ED job share nurses in 2022.”