Turn Over Patients Not Staff

Overlake Medical Center and Clinics (Bellevue, Washington)

CSI Summary

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CSI Presentation

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CSI Toolkit

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Added to Collection

Project Topic

Turnover in the Emergency Department

Hospital Unit

Emergency Department

CSI Participants

Kristen Rosenberger, BSN, RN, CEN
Debbie Rossie, RN, CEN
Leah Shepperd, BSN, RN
Marlaina Snavely, BSN, RN, CEN
Loretta Vasicek, BSN, RN, CEN

Project Goals/Objectives

  1. To decrease emergency department (ED) staff turnover 50% during the first year of employment
  2. To create a healthy work environment by refining the onboarding process
  3. To help new hires feel more supported as they transition into the department

Project Outcomes

  1. Reduced first-year turnover 58%
  2. Improved the work environment in the areas of feeling valued, supported and respected
  3. Increased satisfaction at work with more staff reporting that they would still be working in the department in the next year
  4. These outcomes resulted in an estimated annual fiscal impact of $188,500.

Project Overview

The turnover rate for RNs and patient care technicians (PCTs) employed less than 12 months was 53% during the 2019 fiscal year. High turnover is not only costly to the hospital but it also increases stress and workload for the nurses and PCTs who continually have to precept and train new people.

To begin addressing the problem, our CSI team sent out a work environment survey to pinpoint why so many staff members were dissatisfied. We learned that many of the staff did not feel supported. We directed our improvement efforts toward the onboarding process. We implemented an interview committee, offered a preceptor class, held a preceptor meeting, updated preceptor resources, debuted a buddy system and created a portal to increase communication between orientees, preceptors and leadership.

Nine months after our kickoff, we were elated to find that we had surpassed our goal of decreasing turnover by 50%. We achieved a 58% reduction, down to just 22% turnover within the first year of hire. Our post-project results showed positive changes in all categories of the five-item AACN Healthy Work Environment Survey, indicating staff felt much more supported on the unit.

Our ultimate goal is to keep turnover down on our unit by continuing to address areas that need improvement and being active members in the onboarding process. Aside from improving the work environment on our unit, we have saved the hospital a significant amount of money.

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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.

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.