MICU All-Star Surf Team: Riding the Waves Together

Project Topic:

• Address Moral Injury
• Prevent MICU RN’s from leaving the unit and/or professions
• Increase moral resilience among MICU RN’s
• Foster intentional communication between staff

Hospital, City and State:

Oregon Health and Science University, Portland Oregon

Unit:

Medical Intensive Care Unit (MICU)

CSI Participants:

• Erin Boni, BSN, RN, CCRN
• Sara Mohkami, BSN, RN, CCRN
• Monia Sayah, BSN, RN

Project Goals/Objectives:

1. Reduce intrahospital RN turnover and RN’s leaving ICU nursing 50%
2. Reduce sick calls 25%
3. Increase Rushton Moral Resilience Scale (RMRS-16) scores 5-10%
4. Improve Heathy Work Environment Assessment Tool (HWEAT) Authentic Leadership score to moderately healthy range (4.00-4.99) or higher

Project Outcomes:

1. Decreased RN turnover from 4 to 1 (75%)
2. Sick call hours were unchanged
3. Decreased RMRS-16 scores (2.94 to 2.5) with low response rate 28%
4. HWEAT Authentic Leadership score decreased from 3.83-3.49 with response rate 50%
5. Annualized potential fiscal impact (savings for RN turnover) is $337,662

Project Overview:

The work of critical care nurses exists at the edges of life and death, within complex scenarios. Moral injury occurs when nurses know what actions to perform but cannot execute them due to factors outside of their control. Repeated moral injury leads to moral distress and burnout. Nurses on a high acuity critical care unit in an academic medical center organized to combat the negative effects of moral injury. The baseline assessment of moral resilience identified nurses' greatest opportunities for building moral resilience reside in interventions targeted to improve moral efficacy and response to moral adversity. The unit’s Healthy Work Environment (HWE) assessment identified Authentic Leadership as the greatest opportunity for improvement. The group modified a script for a post-shift huddle designed to honor the challenging work nurses do, foster gratitude, promote nervous system regulation and create an intentional transition out of work. This script was shortened to fit with the busy environment and different opening exercises were developed to match the facilitators’ style. The team revised the existing pre-shift operational huddle to begin with a grounding exercise and set shift level intentions for community building. Staff feedback about both huddles was solicited online and reviewed monthly to refine the content to meet the unit’s needs. Moral resilience was measured at 6- and 12- months post-implementation, and HWEAT at 12 months, to determine the impact. Our main challenge was staff buy-in/participation and resistance from unit leadership in taking charge to complete the huddles daily. Our RMRS-16 scores decreased from 2.94 to 2.5 and our HWEAT Authentic Leadership score decreased from 3.83-3.49. Of note we had very low response rate for each. We were able to meet our goals of decreasing staff turnover 75% and our sick call hours were unchanged.