Nurses Are the Star of Your Open Heart

Los Angeles General Medical Center, Los Angeles, California

CSI Summary

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CSI Presentation

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CSI Toolkit

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Project Topic:

Increasing nurse retention through meaningful recognition

Hospital Unit(s):

Cardiothoracic Intensive Care Unit

CSI Participants:

  • Kane Chau, BSN, RN, CCRN-CSC, TCRN
  • John Joaquin, BSN, PHN, RN, CCRN-CSC
  • Ethel Medina, OD, ADN, RN
  • Marie Valerio, BSN, RN
  • Whitney Witherspoon, BSN, RN, CCRN

Project Goals/Objectives:

  1. Decrease RN turnover rate from 27% to below 22%
  2. Improve RN Meaningful Recognition score on AACN’s Healthy Work Environment Assessment Tool (HWEAT) Score to above 3
  3. Improve HWEAT Aggregate Score to above 3.5
  4. Create and maintain a culture of gratitude
  5. Improve RN staff morale

Project Outcomes:

  1. Decreased RN turnover rate to 19% (30% reduction)
  2. Increased HWEAT Meaningful Recognition score for nurses from 2.75 to 3.59 (31% increase)
  3. Increased HWEAT Aggregate score from 3.07 to 3.54 (15% increase)
  4. Improved Nursing Quality Indicators (NQIs)
  5. These project outcomes resulted in an estimated annual fiscal impact of $212,000.

Project Overview:

In 2022, the full year RN turnover rate was 41%, more than double the national average of 20%. We set out to decrease the turnover rate in our unit. For six months in 2021-2022, our baseline data for RN turnover was 27%. When the CSI team sent the AACN Healthy Working Environment Assessment Tool (HWEAT) survey to all staff, the results showed a poor “Meaningful Recognition” HWEAT score.

Our project goal was to lower the RN turnover rate in six months by improving the HWEAT Meaningful Recognition score. We modified the University of California, Berkeley’s “Gratitude Strategies” to meet our project’s goals. These strategies included meaningful recognition from RN management to staff during bimonthly CTICU “Wheel of Recognition” events, RN to RN meaningful recognition using the “Gratitude Box” and “Hearts of Gratitude,” and the RN staff achievement recognition using the “Hollywood Wall of Fame.”

After six months, we repeated the HWEAT survey. Our data showed improvement of HWEAT Aggregate score from 3.07 to 3.54, a 15% increase. Our HWEAT Meaningful Recognition score improved 31% from 2.75 to 3.59, the largest percentage increase among the six standards. All six HWEAT standard scores also improved. Our six-month RN turnover rate decreased from 27% to 19% (a 30% reduction), with a noticeable improvement in RN staff morale and collaboration with the multidisciplinary team.

Our nursing quality indicators (NQIs) improved from three falls with injuries to zero. We were also able to maintain our central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) numbers at zero. Over 90% of staff participated in our “Wheel of Recognition'' bimonthly events.

Permission to Reuse Materials
The materials associated with this AACN Clinical Scene Investigator (CSI) Academy project are the property of the participating hospital noted above, not AACN. Requests to use content contained in the CSI team’s summary, presentation or toolkit should be directed to the hospital. We suggest reaching out to the hospital’s Communications, Marketing or Nursing Education department for assistance.

The AACN CSI Academy program supports change projects based on quality improvement methods. Although CSI teams seek to ensure linkage between their project and clinical/fiscal outcomes, data cannot be solely attributed to the project and are estimations of impact.