The Impact of Silos in Healthcare
Does departmental division compound nurse shortages and contribute to the skills gap?
In the organizational structure of a traditional hospital, the department leading educational and professional development and the department leading the hiring and staffing of nurses have existed in separate realms, with separate goals and responsibilities. Given the growing need for Registered Nurses (RNs), it's time to consider whether these historical silos in nursing could be compounding the shortages of nurses and thwarting our efforts to close the skills gap.
That was then...
How could these silos be contributing to the skills gap? It's not unusual for different departments in large organizations to maintain different goals and priorities. But when it comes to educating students and onboarding new grad nurses into the field, these silos create a disconnect. This misalignment can negatively impact the effective and efficient transition of these newly minted nurses into competent, practice-ready colleagues.
Education and professional development verticals within hospitals have traditionally been responsible for establishing and maintaining relationships with local colleges and universities. As part of their long list of responsibilities, they have been obligated to "take" some nursing students every year for clinical rotations. Under their oversight, nurses interested in climbing the clinical ladder were often encouraged, or even required, to precept a nursing student to reach the next rung—the motivation: fulfilling an obligation to support the next generation of nurses and satisfying a professional duty.
The obligatory nature of this work has given it a tendency to exist as a "nice to have" rather than a priority. As a result, clinical placement rotations became a challenge for the colleges and universities working to educate the next generation of nurses – so much so that 81% of university respondents in a Fall 2022 American Association of Colleges of Nursing (AACN) survey1 cited a lack of sufficient availability of clinical placement sites as their top reason for turning away qualified applicants to entry-level Bachelor of Science in Nursing (BSN) programs.
Often across the hospital campus, in many cases separated physically as much as logistically, the operational leadership team has been responsible for staffing and hiring nurses and collaborating with HR on recruitment. Their goals traditionally focused on attracting talented, experienced nurses, maintaining a well-balanced experience ratio within their departments, and then doing the hard work of retaining their talent. The idea of peppering in a few new graduates showed their openness to supporting the "next generation" of nurses, but the new grad nurse was not the preferred source of new staff – and therefore not the priority.
The well-balanced experience ratio has long leaned heavily on the knowledge and capabilities of veteran nurses, with good reason. Due to the complexity and hands-on nature of the profession, bridging the gap between the academic preparation new graduate nurses have received and the practice-ready skillset they need to thrive in a clinical setting has been a notoriously long, resource-heavy process.
This is now...
The new reality is that the "new" new grad is not the next generation but the much-needed "now generation" of nurses. The existing shortages, the exodus of experienced staff, and the retirement of highly accomplished staff have created new requirements, and the "nice to have" is now a "need to have."
With this turnover of experience, the new graduate workforce becomes crucial. This dependence amplifies the practice-readiness expectations for today's recent grads. Historically, the practice of blending a sprinkling of new graduates into a mature and experienced workforce was generally well-tolerated because the thumb of experience was on the scales and allowed for a considerable buffer in the need for the new grad to be genuinely practice-ready. The ramp was long, so to speak -- there was time for teaching, mentoring, and coaching well beyond orientation. The present reality has tipped the scales in favor of inexperience, thus shortening the on-ramp and necessitating the "new" new grads to be practice-ready and competent with the shortest orientation time possible. There is no time for training wheels; EVERYONE must pedal.
How does removing silos help?
"Un-siloing" the work of those supporting nursing students and those hiring nursing staff is essential to begin a shift in mindset from obligation to opportunity. As an aligned group, we must begin to view clinical experiences as a path to orientation, reduce duplicative efforts between the university and the hospital, and find a way to establish students as future employees of the organization.
Suppose we could embrace change: increasing the number of student nurses in a facility, creating adequate numbers of clinical education sites with robust and supported experiences, and genuinely nurturing student nurses. Doing so would unlock the opportunity to influence and curate the next generation of nurses. Linking the professional practice and education silo to the operational leadership silo has the potential to streamline the identification of talent, hasten the acquisition of nursing talent, and improve early enculturation and, ultimately, retention. The "new" new grad is the present and the future of nursing, and only our collective effort can ensure we maximize their potential in building a stronger nursing workforce.
- 2022-2023 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing. Washington, DC: American Association of Colleges of Nursing.