Taking the Burn OUT of Nursing

Project Topic

Improving quality of patient care by decreasing nurse burnout

Hospital Unit

2 South Intensive Care Unit

CSI Participants

Brooke Henriksen, BSN, RN CCRN
Amy Howell, BSN, RN, CCRN
Sonja Massie, BSN, RN, CCRN
Katie Troyer, BSN, RN, CCRN

Project Goals/Objectives

1. To reduce unanticipated sick calls 20%
2. To decrease late clock-outs 20%
3. To decrease number of urinary catheter days 20%
4. To decrease catheter associated urinary tract infections (CAUTIs) 50%
5. To decrease NASA-Task Load Index scores for two questions: (1) How hard did you have to work to accomplish your level of performance? (reduce 17%); and (2) How insecure, irritated, discouraged, stressed or annoyed were you? (decrease 30%)

Project Outcomes

1. Reduced unanticipated sick calls 14%
2. Decreased late clock-outs 14%
3. Decreased number of urinary catheter days 8.5%
4. Decreased CAUTIs 20%
5. Decreased NASA-Task Load Index scores (a) 6% and (b) 40%
6. These outcomes resulted in an estimated annual fiscal impact of $109,630 and a return on investment of 290%.

Project Overview

Our Intensive Care Unit had the highest catheter acquired urinary tract infection (CAUTI) rate in the hospital. Interventions were previously implemented to address our high CAUTI rate, but nurses were struggling with burnout. Lack of resource availability and feeling overwhelmed contributed to missed nursing care activity, which impacted care quality (for example, early catheter removal).

Our CSI team developed an acuity tool to identify heavy assignments and more efficiently allocate resources. Our team provided education about acuity tool use, the charge nurse collected scores once per shift and our unit assignment board was updated with an acuity level indicator ―green-low acuity, yellow-mid acuity, red-high acuity. We raised awareness among helper, charge and buddy nurses about ways to offer specific help to nurses that were “on fire” (red-high acuity), such as complete 0900 med pass (or other worklist tasks), turn patient, urinary catheter care, etc.

Use of assignment acuity colors has become part of our unit culture, but adoption of the acuity tool and fire prevention tool lagged. The project noticeably fostered increased awareness of teamwork. For example, we’ve seen an increased willingness by nurses to take their own “road trips” with patients (to CT, OR, interventional radiology, etc.) rather than rely on the trauma or helper nurse. We also decreased our incidence of CAUTI and the number of catheter days.

Sick calls and late clock-outs decreased 14%. We positively impacted our NASA-Task Load Index scores in two categories by 6% and 40%.. While our nurses’ perception about how hard they work didn’t change much, , those that responded to our survey did feel less insecure, irritated, discouraged, stressed and annoyed. We consider this a major victory in reducing burnout. The combined outcomes of our project resulted in an approximate annualized fiscal impact of $109, 744 and a return on investment of 290%.

We feel our efforts made a significant impact on the culture of our unit by daring to fight for improvement. We addressed the elephant in the room (burnout) and started a conversation about it. We watched our unit rise to the occasion to transform into a COVID-19 unit overnight. Bedside nurses on 2S continue to display innovative bedside leadership every shift as this pandemic unfolds. Although we currently have no plans to expand our project, we hope that the spirit of CSI on our unit will endure.