The millennial engagement, resiliency and retention study: What does your millennial advanced practice registered nurse workforce really want?

BACKGROUND: Increasing the use of advanced practice nurses may be one of the most viable options to meeting the burgeoning health care demands of older Americans and impending provider shortage over the next two decades. However, keeping the millennial workforce engaged and retained continues to be a significant challenge for health care administrators. PURPOSE: The purpose of this study was to understand the intergenerational advanced practice registered nurse (APRN) workforce and assess what job satisfaction factors impact APRN intention to stay, and explore how variables such as resiliency style and age affect retention in these young careerists. METHODS: This was a single-center, cross-sectional descriptive study using survey methodology. A total of 405 APRNs from all specialties and practice sites from a large Midwestern Academic Medical Center were eligible to participate. A total of 165 APRNs completed the survey, which was a 41% response rate. RESULTS: There were no significant differences in mean resiliency scores by age cohort (p > .05) or a higher intention to leave in millennial-aged APRNs versus older APRNs (p > .05); however, there were significant mean differences in job satisfaction responses that warrant consideration in millennial versus older "baby boomer" APRNs on items such as professional growth, compensation, monetary bonuses, and expanding procedures and skills within scope of practice. IMPLICATIONS FOR PRACTICE: Understanding generational differences in APRN job satisfaction assists hospital leaders to develop strategies to support, engage, and retain younger careerists, which may help mitigate turnover.

Shared Medical Appointments: Impact on Clinical and Quality Outcomes in Veterans With Diabetes.

Managing diabetes poses substantial challenges to the over 29.1 million Americans afflicted, and is financially overwhelming to the US health care system. One potential strategy is utilizing a group approach to care delivery or shared medical appointment (SMA). The purpose of this 3-year retrospective VA study was to investigate differences in clinical and quality outcome measures in veterans with type 2 diabetes who used SMAs and those who received only usual care (UC) one-on-one with their doctor. This observational, 2-group cohort study used abstracted medical records from a large Midwestern Veterans Administration hospital. Clinical outcome metrics included hemoglobin A1c (hbA1c), systolic blood pressure, low-density lipoprotein cholesterol, and emergency department (ED) visits. Quality outcomes included Veterans' Administration (VA) Department of Defense clinical practice guidelines for the management of diabetes. A total of 988 total VA cases were examined retrospectively over 3 years: 371 cases had used SMAs and 617 were in the UC cohort, and had never attended a diabetes SMA. The study period used abstracted VA medical records from 2008 to 2010. There were no statistically significant differences in HbA1c, systolic blood pressure, and ED visits between groups; however, hbA1c for individuals who attended SMAs was 8.55 (standard deviation [SD] = 1.72) and UC was 7.49 (SD = 1.28) (P < .001). All clinical outcomes were worse at baseline for the SMA cohort. UC had mean ED visits/3 years (mean = 18.62, SD = 13.53, P < .001) versus SMA participants (mean = 27.97, SD = 14.00, P <. 001), revealing a propensity for high health care utilization. SMA providers had statistically significant differences over UC cases on quality measures, including ordering annual ophthalmology and podiatry examinations (P < .001) and prescribing aspirin and angiotension-converting enzyme inhibitors (ACE-I). SMAs may provide a venue for assessing and delivering quality care for patients with type 2 diabetes. More research is needed to ascertain effective strategies for diabetes disease management in high-risk patients.

Shared medical appointments after cardiac surgery-the process of implementing a novel pilot paradigm to enhance comprehensive postdischarge care.

To facilitate the physical and emotional needs of patients undergoing cardiac surgery and their families, our Cardiac Surgery Outpatient Clinic at Cleveland Clinic, a nonprofit multispecialty academic medical center in Cleveland, Ohio, decided to implement a trial of a novel care delivery paradigm called Shared Medical Appointments (SMAs). The purpose of this venture was to facilitate timely access to care 3 to 5 days after hospital discharge, include family members in the education process and the care of the patient, and provide a forum for support and shared learning among patients who have been through like surgical experiences. The clinic system, which performed 3,597 open heart surgeries and 213 robotically assisted cardiac surgeries in 2008, already used family education classes to provide instruction to the patients and family prior to surgery. Because this medium was an effective way to disseminate knowledge, we theorized that using an SMA would be an effective strategy to provide timely medical care after discharge and garner support, education, and increased access to timely medical care after discharge. Although there were many physicians in subspecialties performing these types of clinic visits at our institution since 2002, by the spring of 2007, a group of cardiothoracic nurses decided to perform a trial on this model in this cohort of patients and be a fully nurse-led SMA to provide comprehensive care after discharge. Preliminary patient satisfaction surveys have revealed that 92% of post-cardiac surgery patients rated the experience as good or excellent, and 82% would prefer an SMA for their next clinic visit rather than an individual visit. These data are consistent with physician-led SMA satisfaction surveys in our organization to date. Although still in its relative infancy, an SMA for this cohort appears to have merit in enhancing the support and education as well as providing for the complex medical needs of these patients.