Rhythm Beyond the Beat: Shout Out Success, Shut Out Distress

Project Topic:

Debriefing process to improve true collaboration and meaningful recognition

Hospital, City and State:

Providence Sacred Heart Medical Center, Spokane, WA

Unit:

Cardiac Intensive Care Unit

CSI Participants:

• Michele Torres, BSN, RN, CCRN
• Courtney Cowley, BSN, RN, CCRN
• Caden Rogers, ADN, RN, CCRN-CMC-CSC
• Jennifer Murray (left the project in month 3)

Project Goals/Objectives:

1. Increase AACN Healthy Work Environment Assessment Tool (HWEAT) True Collaboration score from 3.29 to 3.5
2. Increase HWEAT Meaningful Recognition score from 3.36 to 3.85
3. Decrease turnover 4 RNs
4. Decrease OT from $39,200 to $20,000 per pay period

Project Outcomes:

1. Decreased HWEAT True Collaboration score to 3.21
2. Increased HWEAT Meaningful Recognition score to 3.42
3. Turnover was unchanged; 9 nurses left in 2024, however, none were related to burnout or unhappiness on the unit when discussed in exit interviews
4. Increased OT overall (doubled though the same number of staff left each year)
5. Potential annualized fiscal impact -$63,490

Project Overview:

Throughout the duration of the year, our project took several turns from the original plan. Our unit and HWEAT numbers created a challenge to determine a project worth implementing due to lack of extreme HWEAT scores in any category. Eventually, we opted to focus on meaningful recognition and true collaboration. Originally, the idea was to begin a debrief process with a journal so people could write entries and be debriefed individually; this came with a concern of HIPPA and access to the journal from a sustainability perspective. We then discussed the possibility of creating a dedicated email for people to submit their debriefs; this felt impersonal which was not the goal of improving morale and creating togetherness. Therefore, the final project settled became monthly debrief meetings.

The first meetings were held at the bridge of shift change at the hospital with a virtual option to provide an opportunity for day and night shift to attend. After two poorly attended meetings (7 people total), we chose a meeting place away from the hospital in a central location and got approval from management for the meeting to be paid. At this point we also began inviting nurses from the ICU. We also changed the wording of these meetings away from “debrief meetings”, that can sometimes be associated with a negative connotation and focused towards “caffeine connection club”. To help sustainability, we chose to hold meetings on the third Monday of each month at the same time and location. This ultimately increased our average attendance.

We also focused on turnover numbers related to the number of nurses leaving between July-November 2023 and 2024, OT hours, and OT cost during this time frame. The number of nurses that left in 2023 was 9, and the amount for 2024 was also 9; however, our OT hours and numbers about doubled. In 2023 the hours of OT totaled 6,619.25 hours and in 2024 this number increased to 12,873.18 hours. Given the same number of nurses left between the two time periods, and across the year in total it is reassuring that given the drastic OT increase not more nurses left. When broken down, 2 nurses left for spouse related military reassignment, 3 left to go to school, 1 retired, 4 relocated, 1 passed away, 6 left for other employment opportunities unrelated to burnout of unhappiness within the unit, 4 prioritized their health instead of night shift and long commutes, and 2 were found to not be a good fit in the position unrelated to burnout. In total, these numbers show that none of these nurses leaving were related to burnout. Limitations are seen within this data when discussed with management. In terms of the drastic increase in staff OT hours, major factors include increased patient volume including device related patients, and family medical leave of absence (FMLA) when compared to the prior year. Consequently, increased OT hours also led to increase in cost which was also higher due to increased pay to nursing staff during the new year per the union contract.

When observing the True Collaboration score the decrease of 0.7 could be that there were more survey responses on the post HWEAT when compared to pre-implementation. It is also assumed a True Collaboration score has decreased due to several physician changes within the unit causing less collaboration between interdisciplinary teams and roles, leading nurses to feel less supported in their role at bedside, and thus less collaboration; this has been highly discussed at debrief meetings to provide nursing support. The Meaningful Recognition score is presumed to have increased due to project implementation.

In addition to the HWEAT, the CSI team created a separate survey targeted to the unit. This was released pre and post project; however minimal responses were collected. Unit morale was most focused on, and this number went from 3.6 to 3.8 out of five stars. Throughout the project the most consistent barrier to data collection has been unit participation, and the unit staff being comfortable to change. Though the project shows no return on investment with cost, the overall improvement of meaningful recognition being our main goal was met and is definitely noticed on the unit with the debrief meeting feedback. These meetings will continue to occur due to the implemented sustainability factors in place, including paid, regularly scheduled monthly debrief led by project champions, management and unit staff buy-in, and chaplain participation in monthly meetings to assist with debrief.