Respect Rx Remedy: Dosage of Decency – Decreasing Bullying & Incivility

Providence St. Vincent Medical Center, Portland, Oregon

Nov 20, 2024

CSI Summary

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CSI Presentation

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Project Topic:

Decreasing bulling and incivility

Hospital, City and State:

Providence St. Vincent Medical Center, Portland, Oregon

Unit:

Cardiac Intensive Care Unit (CICU)

CSI Participants:

  • Sophia Corso, BSN, RN
  • Olivia Edwards, BSN, RN, CCRN
  • Elise Kimball, BSN, RN
  • Lillie Le, BSN, RN, CCRN
  • Hannah Sauer, BSN, RN, CCRN

Project Goals/Objectives:

  1. Increase American Association of Critical-Care Nurses (AACN) Healthy Work Environment Assessment Tool (HWEAT) true collaboration score from 3.42 to 4
  2. 25% improvement in the Short Negative Acts Questionnaire (SNAQ) and Self-Awareness survey aggregate scores
  3. 10% reduction in overall turnover rate
  4. 10% reduction in first-year turnover (FYTO) rate
  5. 25% reduction in unplanned absence occurrences

Project Outcomes:

  1. HWEAT True Collaboration scores stayed relatively the same (3.42 to 3.41)
  2. 7% improvement in the SNAQ (never rating) and 3% improvement in the Self-Awareness survey (never rating)
  3. 14% reduction in overall turnover rate
  4. 50% reduction in FYTO rate
  5. 0.5% reduction in unplanned absence occurrences

Project Overview:

This nurse-led project occurred in a 28-bed cardiac intensive care unit (CICU) to address nurse bullying and incivility in the workplace. According to The Joint Commission (2021), 44% of registered nurses (RNs) have been bullied, with critical care units being one of the most common settings where bullying occurs. This project aims to promote a healthy work environment (HWE) by decreasing bullying and incivility within the CICU through the promotion of education on prevention and reporting of negative behaviors, while highlighting the fiscal impact bullying and incivility has on health systems. Additionally, while the team did not achieve their goal of increasing the HWEAT true collaboration score from 3.42 to 4.0, our post-intervention score of 3.41 indicates that we maintained a consistent level of collaboration, showing stability in our efforts.

In April 2024, the team created a mandatory evidence-based educational program for the CICU that included hands-on activities, role playing, videos, and open discussion for all existing and new staff.

The team utilized the AACN HWE Assessment Tool (HWEAT) (AACN, 2020), Short Negative Acts Questionnaire (SNAQ) (Anusiewicz, et al., 2021) and the Self-Awareness tool (Thompson, 2019 to evaluate pre- and post-intervention efforts.

The pre-intervention survey results highlighted that bullying and incivility were adversely affecting the CICU. Comparison of the pre- and post-intervention survey results showed a 36.4% overall improvement in the workplace environment with a reduction in the frequency of negative acts experienced by CICU staff during the post-intervention phase. In addition, there was a 2.1% overall improvement in the Self-Awareness survey, which suggests that individuals are becoming more self-aware and potentially altering their behaviors to create a more positive work environment. In summary, the interventions resulted in a positive shift in staff behavior and perception, leading to a better workplace environment and interactions.

The team assessed the financial impact of bullying and incivility on nursing overall turnover, FYTO and unplanned absences. The project resulted in $404,608 in annualized cost savings. Additionally, the team successfully reduced the overall turnover rate by 45.5% and FYTO by 45%. Unplanned absences also decreased by 0.5% during the post-intervention period.

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Disclaimer
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.