Roll Over Patients Not Nurses

Project Topic:

Inadequate nurse to nurse collaboration has led to an overutilization of the crisis/helper nurse, missed breaks and staying late; which all increase the risk of staff burnout and fatigue. Our project addressed this by creating a buddy system to enhance collaboration and supports.

Hospital, City and State:

Providence Sacred Heart Medical Center, Spokane, WA

Unit:

6S-6N (Cardiac Transplant/Cardiac Telemetry)

CSI Participants:

• Alicia Sedita, BSN, RN, PCCN
• Rasa Morris, BSN, RN
• Sophia Reed, BSN, RN
• Haleigh Edwards, BSN, RN
• Nickolas Watson, BSN, RN
• Jacob Allen, BSN, RN

Project Goals/Objectives:

1. Increase HWEAT True Collaboration score from 3.51 to >4
2. Decrease 1-year turnover rate of nurses 25%
3. Decrease overtime 25%
4. Reduce missed meal breaks 15%

Project Outcomes:

1. HWEAT True Collaboration score decreased to 3.32
2. Increased first year turnover rate 12 to 15 nurses
3. Decreased overtime 37%
4. Decreased missed breaks 63%
5. Increased HWEAT aggregate score 3.51 to 3.61; increased score for 4 standards (Effective Decision Making, Appropriate Staffing, Meaningful Recognition, and Authentic Leadership)

Project Overview:

The 6S and 6N cardiac units are advanced care environments that operate at maximum capacity, requiring highly skilled nurses to provide exceptional care in a fast-paced and mentally demanding atmosphere. Given the high turnover rates due to the physical and emotional demands of the unit, opportunities for improvement were identified to help reduce burnout and enhance team performance. In response, CSI launched the "Buddy System" initiative on June 28/29 and July 6/7, aimed at improving nurse collaboration, alleviating the burden on single crisis nurses, and reducing missed breaks and meals.

This initiative also aimed to improve communication, teamwork, and morale, thereby increasing nurse retention. Despite initial pushback and challenges with data collection, the project ultimately achieved its goals. The success of the project can be attributed to sustained effort, including repeated nudging, redosing, and occasional incentives to encourage participation. While the project has seen positive results, it also highlighted areas for continued growth and improvement in the future.

The implementation of strategies for the “Buddy System” was to further enhance nurse communication, foster collaboration, ensure appropriate staffing levels, provide meaningful recognition, promote effective decision-making, and cultivate authentic leadership within a healthcare unit, resulting in improved staff morale, reduced burnout, and enhanced patient care quality. Reducing nurse burnout, improving staff satisfaction, and enhancing patient safety by creating a more positive work environment.

The outcomes of our project were relatively anticlimactic. HWEAT participation improved by 36% (going from 42 to 96 caregivers) however the True Collaboration score remained in the “somewhat healthy” range” going from 3.37 to 3.32. First year turnover fiscal impact increased from 12 caregivers July-Dec 2023 to 15 caregivers July-Dec 2024. OT hours decreased 1,367 hours (37%). Lastly missed breaks decreased 63%. In total the sum of added cost from increased nurse turnover and the savings from decreasing OT and missed breaks there was an overall potential annualized fiscal impact $51,752.

Sustainability plan includes educating new RN orientees re. this buddy plan practice and have preceptors model the plan and to “be an example: treat others the way you want to be treated/implemented. We will work with our Unit Based Councils to discuss strategies to maintain and further develop a healthy work environment beyond the project duration, including ongoing leadership support and regular staff feedback mechanism. As evidence of 4 of our HWEAT standard scores increasing, we will continue to work together on our own unit work environments and improve outcomes.