“Retaining experienced nurses in direct clinical care is essential for improving quality patient care,” Erin Beers, RN, BSN, OCN^®, said. “Clinical advancement systems must recognize these nurses and the expertise they bring to bedside nursing.”

Beers, an RN at Lehigh Valley Health Network (LVHN) in Allentown, PA, described how her organization’s cancer institute reduced nurse turnover by investing in professional development, certification, and a clinical advancement system.

A PRIME Example

Through LVHN’s program—“Program for Recognition of Individual Merit and Excellence,” or PRIME—nurses can earn points in eight categories:

1. Years of service
2. Profession (specialty certification, membership in a nursing organization)
3. Leadership (charge RN, chair or co-chair of a committee)
4. Recognition (award nomination)
5. Engagement (community service, hospital committee)
6. Education
7. Teaching
8. Research

Nurses apply online, and a committee determines PRIME status: level 1 (novice) through level 4 (expert). Nurses who achieve level 3 or 4 receive a one-time bonus. Those at level 1 or 2 are encouraged to continue to develop within the eight categories and reapply.

Outcomes of PRIME

In the first year, 55% of eligible nurses submitted for PRIME status in the cancer institute and 31% of those achieved level 3 or 4. The institution has linked the clinical ladder to increased staff satisfaction, more employee engagement, and less turnover. Since PRIME implementation, staff satisfaction has improved and nurse turnover has decreased by 37%. LVHN conducts ongoing evaluations of staff satisfaction and turnover, Beers said.

A Program to Boost Oncology Nursing Certification

Many accrediting organizations recognize the importance of oncology nursing certification to demonstrate competence and quality. For example, the Commission on Cancer offers commendation based on percentage of certified nurses.

To earn commendation, Sutter Medical Center Sacramento (SMCS) in California developed a program to increase nurse certification by 22%, said Clinical Nurse Educator Dulcy Wilson, MSN–Edu, RN, OCN^®.

Identifying Barriers

The institution conducted a survey to explore factors that may prevent nurses from becoming certified:

• A minimum of two years of experience required to take the examination
• The cost of certification
• Reimbursement limited to one certification annually
• Lack of recognition for certification

Seeking Solutions

SMCS determined that professional development should be part of ongoing discussions, from new hire orientation throughout nurses’ careers. The institution implemented an extensive hands-on orientation process and required nurses to complete ONS courses. A new hire contract sets expectations for professional development, and an annual education plan provides constant feedback and support.

To support and incentivize specialty certification, SMCS:

• Holds monthly certification review sessions
• Offers study resources
• Gives assignment priority to certified nurses
• Pays for testing and offers more reimbursement for dual certification

Recognizes certifications on a bulletin board, at staff meetings, via staff emails, on new identification badges, and during a certification recognition day

Awards certified nurses with certification pins and other “goodies”

The program has been successful thus far, Wilson said, evidenced by more nurses with the oncology certified nurse (OCN^®) and blood and marrow transplant certified nurse (BMTCN^®) credentials: in 2014, the institution had one OCN^® and one BMTCN^®; by 2019, it had nine of each. 

“It takes talented and educated nurses to ensure quality care for patients with cancer, and having certified nurses increases an organization’s ability to provide current, evidence-based treatment for patients in the ever-changing landscape of oncology,” Wilson said.