If you build it, they will stay: How a hospital network is using evidence to guide a professional development-based approach to nurse retention and patient care

Number 14, October 2007

Research has long shown that a better work environment can result in better healthcare. For nurses, a good approach is to invest in professional development in a big way. That is exactly what the University Health Network is doing.

University Health Network is an umbrella organization linking Toronto General Hospital, Toronto Western Hospital and Princess Margaret Hospital. In addition to providing patient care, it is a major research and teaching complex. Like other healthcare organizations, the network is faced with the critical issue of nurse retention.

Looking beyond short-term fixes, the network is using research evidence to help create a new employment philosophy in nursing that highlights professional development and patient-centred care. “Our approach is putting into practice studies showing that a successful nurse retention strategy is one that fosters ongoing professional development and makes it possible for nurses to rekindle their passion for their work,” says Mary Ferguson-Paré, vice-president of professional affairs and chief nurse executive.

Building research capacity among nurses and a research culture in the nursing organization have been key elements of the professional development agenda. “A survey showed that nursing staff were very interested in getting involved in research,” says Debra Bournes, director of new knowledge and innovation, “but it also confirmed the three main barriers that decades of literature have identified: a lack of time; a lack of resources; and a lack of knowledge about how to get started.”

The organization invested in creating the time, resources, structures and knowledge required for nurses to get involved in research. Two staff positions were created — a director of new knowledge and innovation and an innovation project manager — to guide the process. In addition, four nursing research chairs were established, two of which are completely funded, with fundraising in progress for the others. Resources were provided through the establishment of research awards, including a unique Nursing Research Challenge, which funds nurses who win a research proposal competition.

Individual and group mentoring has helped build nurses’ confidence and knowledge about performing research, and nurses have developed specific research skills through workshops on topics like research proposal writing, the critical appraisal of research, and writing for publication.

Since 2003, nurse researchers — 27 teams and 93 individuals — at University Health Network have applied for and received more than $20 million in funding. Ninety-five nursing research studies have been initiated and 119 publications have resulted. Dr. Bournes is also starting to see some wider impacts. “Our staff satisfaction scores are going up in several areas,” she notes, “and results from several research projects are being applied in care settings to improve patient care.”

Perhaps the most concrete impacts of the new focus on professional development can be seen in the “80/20 Human Becoming-Guided Patient-Centered Care Professional Development Model,” which was introduced in 2004 in an orthopedic surgery and rheumatology unit in the network. “This was one of the things we did to try to create the time that nurses said was lacking for research or other professional development,” says Dr. Bournes.

Nurses in this project spend 80 percent of their time in direct patient care and the other 20 percent on professional development — including some research, but also learning about a patient-centred care model called “human becoming,” which is about respecting the patient’s perspective on what matters most and tailoring nursing care to that perspective.

Results of a study on the project have shown a significant decrease in nurses’ overtime hours, significantly higher nurse satisfaction scores, no staff turnover, significantly higher education hours, significantly higher workload hours per patient day (indicating that the nurses spent more focused time with patients), and no significant increase in variable direct labour costs. The model has attracted international interest and is being replicated in a hospital in Regina, as well as in two other settings within the University Health Network.

“We are experiencing what the literature suggests,” says Dr. Ferguson-Paré, “that investing in professional development is an effective way to increase nurse satisfaction and retention, and improve patient care as well. It’s one of those virtuous circles that keeps on reinforcing itself in positive ways. And it’s more effective than using that same money to pay for the consequences of nurse burnout: sick leave and turnover.”

For more information contact Debra Bournes at Debra.Bournes@uhn.on.ca.