A Strategy for Success: Expanding Skills, Growing the Clinical Workforce, and Improving Retention

Nurse leaders have forewarned impending nursing shortages for the past two decades due to an aging workforce and the decline in individuals choosing the nursing profession. The past two years of the COVID-19 pandemic have exacerbated the healthcare workforce challenges, including accelerating retirements and burnout. In a nursing workforce update, nursing turnover was at an average rate of 27.1% in 2021. Registered nurse vacancy rates are trending at 17%, increasing costs associated with temporary labor, nurse recruitment, and training. Not only is this common to nursing but also in roles that support nurses' work and patient care. Like other healthcare organizations, our organization has experienced an increased turnover of clinical positions and shirking recruitment pools. Therefore, clinical care will require support from other team members, such as medical assistants, to meet the demand.

Background: The ambulatory care clinics are part of an academic health system in the southeast region of the United States, with over 200 clinics providing primary care, specialty care, and outpatient procedures. The ambulatory care clinical operation offers under 2 million visits annually, responds to over 18 million patient-related messages, and refills more than 200,000 prescriptions. The system employs registered nurses, licensed practical nurses, and medical assistants to provide clinical care in collaboration with physicians and advanced practice clinicians. However, the role of the MA in the organization is limited to their qualified skill set.

Intervention: Nursing education sent a needs assessment survey to 375 MAs. The responses from the MAs were they felt they needed to integrate into the healthcare team, their voice needed to be heard by the leaders, and their job needed to be more significant. Based on the feedback, an MA council was developed to address job dissatisfaction and provide the MAs with peer collaboration and leadership presence. Additionally, nurse leaders, nursing education, and MAs developed a committee to explore retention strategies, evaluate current MA skills, and identify opportunities to expand practice. As part of the committee's work, the committee sent a survey to nurse leaders to determine additional skills needed for their clinical areas and ways to improve the MA orientation process.

Outcomes: As the MA-specific new hire orientation was developing, the organization needed to prepare the current MA staff by holding an MA expo and train the trainer event. The current MAs were incorporated into the expo as they will serve as preceptors and mentors to the new hires that attend the MA-specific orientation. The expo introduced new MA skills for training and a virtual professionalism course. The MA orientation consisted of a two-day training course based on identified gaps in knowledge and skills taught through didactic, large group discussion, hands-on skills, and simulation practices. The simulation portion allows the new hire to get comfortable with scenarios within the clinic environment. Investment in robust training for MAs will ensure safe clinical practice while partnering with the healthcare team to meet staffing demands.