Retaining institutional wisdom: Using an evidence-informed approach to transfer knowledge from experienced nurses to new nursing staff 

Number 21, March 2009

Many healthcare organizations are grappling with the consequences of high attrition rates. To address this, and as part of the process of becoming a learning organization, 

the Baie-des-Chaleurs Health and Social Services Centre in Quebec has developed an evidence-informed approach to capture the knowledge of experienced nurses and transfer it to new staff.

“It really started with our continuous improvement committee,” says Christine Arsenault, department head and learning organization project advisor. She explains that the committee had been developing procedures and best practices to help eliminate nursing errors, but encountered problems in implementing the procedures effectively. Committee members finally realized that something important was missing: the direct involvement of nurses in the process.

In 2005, a nurse committee was established to review existing literature on knowledge creation and transfer. The committee’s research revealed many key concepts, including the importance of formalizing tacit or implicit knowledge and the benefits of supporting professional skills development within an organization.

Armed with the evidence, the committee mapped out a new process to identify, formalize, and transfer knowledge at the Centre. However, Arsenault says, the committee quickly saw that it needed a specific project that would allow them to apply the key concepts “hands-on” and yield tangible outcomes. 

At the time, the Centre was facing high retirement rates among nurses. “We were concerned,” explains Jean-Luc Gendron, co-ordinator of quality and risk management and communications, “about the influx of new, inexperienced nurses, the loss of institutional knowledge from those retiring, and the impacts these could have on the quality of care.” The maternity department – which had a high number of new, inexperienced nurses – was selected for a pilot project.   

After a preliminary phase of knowledge capitalization and research on best practices, senior nursing staff, in collaboration with new nurses, identified the various skills and competencies required by nurses in the maternity unit. They then developed strategies to transfer this knowledge. Initiatives included clinical monitoring by an experienced nurse mentor, a “tricks of the trade and expert advice” summary from experienced nurses, and a tool to help new nurses reflect upon their clinical experiences and transfer the knowledge to other situations. 

However, says Arsenault, it was the video that really captured people’s attention. A video was produced that followed an experienced nurse as she provided care in the maternity unit, from admission to the delivery to the post-partum period, with a voiceover explaining the rationale for each action taken by the nurse. The committee knew from its research that video technology had been proven to be an effective way to capture and transfer tacit knowledge – knowledge that is difficult to transfer because it is acquired over years of experience. Videos are also especially helpful for nurses in remote areas, who often do not have experienced colleagues to consult.

The pilot project was effective on several levels. “All of our new maternity nurses in 2007-08 successfully completed their orientation,” reports Arsenault. (In 2005, only 40 per cent succeeded.) Moreover, the use of supplemental staff to compensate for less-experienced nurses is down, no adverse events have been reported since the project began, and the Centre hasn’t lost a single new maternity nurse in the past two years. As an added bonus, the project has built pride and cohesiveness throughout the organization: new nurses feel part of a team, and experienced nurses now recognize the value of the knowledge they possess and the value of sharing it.

The team won a 3M Innovation award for the pilot project in eastern Quebec and the model is currently being implemented elsewhere in the Centre. Another project, dubbed “Virtual Companion,” is now underway to create video clips of various procedures, which nurses can access with an MP3 player. Arsenault says that the number of projects under development is growing at an accelerated pace, and they affect all spheres of activity of the organization. “We hope,” she says, “that our experience will help and inspire others to undertake this type of initiative.” 

For more information contact Jean-Luc Gendron.