Safety in Numbers

University Hospitals St. John Medical Center, Westlake, Ohio

Nov 06, 2024

CSI Summary

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CSI Presentation

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CSI Toolkit

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Project Topic:

Implementing a Healthy Work Environment to Decrease Turnover

Hospital, City and State:

University Hospitals St. John Medical Center, Westlake, Ohio

Unit:

Medical Intensive Care Unit (MICU)

CSI Participants:

  • Candice Cadle, BSN, RN
  • Michael Seaton, RN

Project Goals/Objectives:

  1. Decrease nursing turnover rate 10%
  2. Increase the percentage of nurses who agree on the survey of nursing assignment acuity to 50%
  3. Increase the AACN Healthy Work Environment Assessment Tool (HWEAT) Appropriate Staffing score to ≥ 4

Project Outcomes:

  1. Decreased rolling RN turnover rate 18% compared to the same period one year ago (2023)
  2. Increased percentage of nurses agreeing on the survey of nursing assignment acuity from 30% to 53%
  3. Increased HWEAT Appropriate Staffing score from 3.57 to 4.21
  4. Increased all HWEAT standard scores
  5. Outcomes resulted in a potential annual fiscal impact of $179,485

Project Overview:

Based on anecdotal evidence, there was a sense among our project team that low staffing was an issue in our unit. Permanent staff was frequently supplemented by temporary travel nurses or nurses floated from other units, which raised concerns about workload distribution and fairness of assignments as well as the ability to properly match patient acuity to skills and experience of available nurses. The initial HWEAT assessment results reflected this, as Appropriate Staffing was the lowest scoring component on the survey, with a score of 3.57—a “somewhat healthy” grade. These results made it a natural choice to focus our interventions on improving staffing and decreasing turnover.

We planned to achieve this by improving the workplace culture on the unit in two ways: (1) to promote a sense of fairness, and (2) to facilitate a sense of belonging or inclusiveness among staff members. In pursuance of the first, we developed a nursing assignment acuity guidelines tool that categorizes patients by workload acuity and assigns a value of 1-3 so that everyone knows who the more difficult (and easier) patients are when making RN patient assignments for a shift. We made adjustments to the tool based on feedback from nursing staff and surveyed nurses at the beginning and conclusion of the project to gauge agreeance to the items on the acuity tool. Agreeance to the tools’ effectiveness increased 23%. To improve a sense of belonging and inclusiveness in the unit, we implemented a “float buddy” program where the Charge Nurse (or other designated person) checks in with unit personnel floated to other units. Also, we developed an employee recognition form to express appreciation for co-workers on the unit; these forms and other team-building information are displayed on new communication boards in the employee break room.

The intended outcome of these interventions is to make the unit a more welcoming place to work, where all staff feel a part of the team and are treated fairly. We would measure these outcomes in two separate ways. The first was to look for improvement in HWEAT and supplemental survey results from the beginning of the project compared to those at the end of the project. Secondly, we obtained rolling monthly 12-month average RN turnover data from Human Resources that we would compare and look for improvement year over year.

We rolled out our project interventions a couple of weeks prior to formally promoting them via a kick-off during a monthly staff meeting and then repeated our message for the next week or so during daily shift huddles. We promoted the program via distributed T-shirts with our slogan, “Stop the Drain, Let’s Retain,” a bulletin board, and at one point our project was featured in an article throughout the hospital system on the internal employee digital workplace. At the conclusion of our project time, we were pleased to see our goals had been met. Survey responses indicated an improved perception of a healthy work environment, as the HWEAT Appropriate Staffing score increased from 3.57 to 4.21 and aggregate scores across all categories increased from 4.06 to 4.50. Our supplemental survey questions regarding nursing patient assignments aligned with these results, indicating increased agreement from a rate of 30% to 53% by the end of the project. Further, RN turnover had decreased 18% compared to a year ago (nine positions in 2024 vs. 11 in 2023). Evaluated in terms of cost to the hospital to train a new RN ($52,350 per one external 2023 staffing report), these resulted in a potential annual fiscal impact to the hospital of $179,485 with a 1904% return on investment.

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.

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.