Decreasing Callouts In A NICU

Project Topic:

Meaningful Recognition

Hospital, City and State:

Atrium Health Wake Forest Baptist Hospital, Winston-Salem, NC

Unit:

• Neonatal Intensive Care

CSI Participants:

• Sheena Patterson, BSN, RNC-NIC
• Megan Underwood, BSN, RN

Project Goals/Objectives:

1. Decrease staff call-outs 10% within 12 months
2. Increase champion/committee involvement 10% within 12 months
3. Increase Healthy Work Environment Assessment Tool (HWEAT) survey results to >4 in Meaningful Recognition standard
4. Increase overall number of HWEAT scores returned

Project Outcomes:

1. 11.2% reduction in staff call-outs; 48 fewer RN call-outs in 2026 vs 2025
2. 40% increase in champion/committee involvement
3. Increase in HWEAT Meaningful Recognition results from 2.93 to 3.22
4. Increase in HWEAT survey participation from 47 to 83 responses
5. These outcomes resulted in a positive estimated annual fiscal impact of $52,224 and a return on investment of 163%

Project Overview:

The Dale & Karen Sisel Level IV NICU at Atrium Health Wake Forest Baptist implemented a nursing workforce project, Boots, Babies, and Best Care, in efforts to address concerns related to staff morale, workplace culture, meaningful recognition, staff disengagement, and RN call-outs. Pre-implementation HWEAT results demonstrated an aggregate score of 2.87, categorized as Needs Improvement, with Meaningful Recognition scoring 2.93. Only 47 of 197 eligible staff (24%) completed the initial assessment.

The project focused on strengthening staff connection, recognition, and engagement through intentional recognition activities, team-building initiatives, staff appreciation events, and opportunities for peer-to-peer engagement. Interventions were designed to be accessible across shifts and to promote a more positive and supportive work environment within a large, high-acuity NICU.

Postimplementation results demonstrated improvement in workplace perceptions. The aggregate HWEAT score increased from 2.87 to 3.22, moving from Needs Improvement to Somewhat Healthy. Meaningful Recognition increased from 2.93 to 3.22, and survey participation increased from 47 to 83 respondents, reflecting greater staff engagement with the assessment process.

Workforce outcomes also improved. RN call-outs decreased from 427 during January–June 2025 to 379 during January–June 2026, a reduction of 48 call-outs and 11.2%. January 2026 was affected by a state-of-emergency winter storm and had higher call-outs than January 2025; however, call-outs were lower in every subsequent month from February through June.

The reduction in call-outs resulted in an estimated six-month savings of $26,464, exceeding the projected savings goal of $23,248 by $3,216 (13.8%). Based on the first six months of results, estimated annualized savings are approximately $52,928.

Overall, the project demonstrated that focused efforts to improve recognition, staff engagement, and workplace culture were associated with measurable improvement in healthy work environment scores, staff participation, RN attendance, and workforce-related costs.