Ensuring Consistent Orientation & Training Amid Staffing Challenges

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Written By Robin Carter (consultant)
 

One of the biggest patient safety concerns in recent years has been staffing shortages. While this isn’t a new challenge, it is one that has been exacerbated by factors like the COVID-19 pandemic, an aging healthcare workforce, and the growing need to care for an aging population. To meet these increased needs, some facilities use temporary staff (who are sometimes referred to as “travel staff”). Temporary staff, like all facility staff, need orientation and training to provide safe care. However, training requires time from an already strained workforce. This can negatively impact morale and increase burnout among other members of the care team, which can contribute to increased turnover.*

What We’ve Seen in Oregon

In July 2024, we started asking healthcare facilities “What's one thing you would want other facilities to learn from your event analysis?” through our Patient Safety Reporting Program (PSRP). By December, we received several reports that identified the completeness of orientation and training for temporary staff in their shared learning. Some examples from PSRP reports that highlight the need for training include: 

  • Not documenting information in the right place

  • Not following policy or procedure (e.g., not doing a required assessment or an independent double-check)

  • Not knowing how to use equipment or computer systems, like smart pumps, electronic health records, or bed alarms

These reports noted a need to ensure that orientation and training for temporary care staff are complete. In order to get there, facilities will need strong, standardized organizational processes in place.

What You Can Do

While identifying this gap is an important first step, digging into why orientation or training isn’t happening consistently is essential to addressing underlying issues. For example, perhaps the organization didn’t have enough staff available to provide complete and timely orientation. Or maybe they didn’t have a standardized unit orientation to complement their standard new employee orientation.  

  • Strategy: Hone your skills as a learning organization. Use evidence-based approaches, like these tools from the Institute for Healthcare Improvement, to better understand why orientation or training isn’t happening consistently in your organization.

    • Root Cause Analysis and Action (RCA2) can provide a standardized approach to analyzing specific adverse events, including helpful triggering questions related to training and the Five Rules of Causation tool, which can help you dig deeper into an event’s underlying causes.

    • The Patient Safety Essentials Toolkit offers additional, practical support for your event analysis process. The Developing Reliable Processes tool can help you develop strong, long-term solutions that address the underlying causes identified in your event analysis. (It also includes a worksheet for a variation on the Five Rules of Causation called the 5 Whys.)

Temporary staffing is an important short-term solution to fill critical staffing gaps, but when used as a long-term solution, it may ultimately exacerbate the underlying problems that created the staffing shortage in the first place. Working to build a supportive organizational culture that prioritizes safety for patients—as well as for the healthcare workforce—can reduce feelings of burnout and increase job satisfaction, which can reduce staff turnover. 

  • Strategy: Measure staff turnover. Including measures of staff turnover in your patient safety reporting to senior leadership can help make the connection between turnover, organizational culture, and safety.   

  • Strategy: Understand your organizational culture. Routinely conducting a culture of safety survey using a validated instrument, like the AHRQ Surveys on Patient Safety Culture® (SOPS®), is a great way to assess your organizational culture. Share the survey results with leadership and staff, and use what you learn to help prioritize your patient safety initiatives.

  • Strategy: Invest in your organizational culture. A positive, responsive organizational culture and environment can help build morale and resilience, providing the kind of support that reduces turnover. Adopting AHRQ’s Communication and Optimal Resolution (CANDOR) can help! 

 
 

Hey, Hospitals!

Conducting a facility-wide culture of safety survey, and using evidence-based event analysis approaches like RCA2, can help you meet the CMS Patient Safety Structural Measure, Domain 3: Culture of Safety & Learning Health System.

*Muir, K. Jane, Joshua Porat-Dahlerbruch, Jacqueline Nikpour, Kathryn Leep-Lazar, and Karen B. Lasater. 2024. “Top Factors in Nurses Ending Health Care Employment Between 2018 and 2021.” JAMA Network Open 7 (4): e244121.

Additional Resource

Robin Carter (consultant)
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