Hospitals and health systems around the world are facing a new kind of shortage among the nursing workforce: a shortage of experience. As mass retirements continue, there is an exodus of experience leaving organizations across the country. With the quickly growing nursing workforce, leaders will need to rely on the influx of novice nurses to backfill vacant positions.

At the same time, care complexity is rising. On average, patients are older and have more chronic comorbidities. Care processes—including electronic documentation and more standardized protocols—are becoming more complex, while length of stay is getting shorter.

As a result of this rising complexity, it’s more difficult for nurses to transition to practice, for at least three reasons. First, nurses have more to learn to be considered competent. They must have a richer understanding of pathophysiology, understand a wide range of treatment options, and be prepared to deliver highly complex care. Second, it’s harder for nurses today to learn on the job. There are no more “easy” patients to assign to new graduates as low-stakes learning opportunities. And because there is more to do in less time, nurses have less time to focus and reflect on their own development. Finally, the shortage of experience means there are fewer expert nurses to mentor and provide feedback.

As the collective experience of the workforce declines and care complexity rises, a new challenge is emerging, which the Nursing Executive Center has termed the “experience-complexity gap.” This gap is projected to grow as nurses continue to retire. If unaddressed, the experience-complexity gap has the potential to result in increased adverse care outcomes and negatively impact care quality.

The three paths this study presents to close the experience-complexity gap are:

1. Teach novice nurses more effectively by fiercely scoping weeks 1-12 and standardizing preceptor work.
2. Redistribute experience across the organization by creating career pathways to select units and care sites.
3. Differentiate practice for experienced nurses by positioning competent and proficient RNs “at-the-hip” and scaling the impact of expert RNs.

Use this report to learn how to close the experience-complexity gap.

Teach novice nurses more effectively

Fiercely scope weeks 1-12:

• Practice 1: Streamlined RN orientation (p. 20)
  Supporting Tool: Dartmouth Hitchcock’s new RN competencies
• Practice 2: Targeted skills intensive (p. 26)
  Supporting Tools: Additional resources from Indiana University Health
• Practice 3: Unit-based learning intervals (p. 34)

Standardize preceptor work:

• Practice 4: The preceptor’s ready-to-use teaching kit (p. 42)
• Practice 5: Standardized preceptor boot camp (p.47)
  Supporting Tool: The Nurse Preceptor Toolkit
  Supporting Tool: Additional resources from SickKids

Redistribute experience across the organization

Create career pathways to select units and care sites:

• Practice 6: Targeted role transitions (p. 58)
• Practice 7: Direct-to-ambulatory program (p. 63)
  Supporting Tools: Additional resources from Emory Healthcare

Differentiate practice for experienced nurses

Position competent and proficient RNs “at-the-hip”:

• Practice 8: RN partner rounds (p. 74)
• Practice 9: Role-based team nursing (p. 79)

Scale the impact of expert RNs:

• Practice 10: Tiered precepting model (p. 85)
  Supporting Tools: Additional resources from Legacy Health
• Practice 11: Expert-led care team (p. 89)

• Patricia Benner’s stages of clinical competence
• The Nurse Preceptor Toolkit
• Bridging the Preparation-Practice Gap, Volume I
• Bridging the Preparation-Practice Gap, Volume II