Decreasing nurse turnover has a positive impact on patient outcomes. Adequate nurse staffing leads to decreased adverse events related to patient care.7 Missed nursing care, which is substantially related to nurse staffing, correlates with an increased odds of patients dying after common surgical procedures. Nurse staffing and missed nursing care were significantly associated with a 30-day case-mix adjusted mortality. An increase in a nurse’s workload by one patient and a 10% increase in the percent of missed nursing care were associated with a 7% and 16% increase of the patient dying within 30 days of admission.8
Work environment is a principal element affecting RN turnover in nursing units. Understanding work conditions allows hospital administrators to increase job satisfaction and intent to stay.9 Evaluating workload, staffing levels, flexibility of scheduling, and relationships between staff nurses, physicians, and managers can cultivate a supportive environment. The purpose of this presentation is to discuss the benefits of academic-practice collaboration when identifying root causes of nurse turnover and developing sustainable solutions in a critical care unit.
The director of critical care at a local hospital sought counsel related to high turnover rates from a former nursing professor. Low morale, staff burnout, the financial impact of turnover, and the desire to provide high quality care consistent with the hospital’s mission were cited as reasons for the consultation. Three nursing professors at a state university met with the nurse manager and created a survey based on evidence-based literature and input from nurse administrators. The team obtained IRB approvals from the hospital and the university. The survey contained 35 Likert scale questions. The five categories included effective leadership, staffing and resource adequacy, professional practice, meaningful recognition, and communication and collaboration. Thirty-two registered nurses of 36 completed the surveys.
Survey results provided information confirming positives and challenges, creating opportunities for improvement. A few examples related to the five themes are discussed. Survey responses suggested some members of the nursing administration team were unresponsive and inattentive to employee concerns. Nurses also voiced concerns of inappropriate workloads and lack of adequate personnel. The critical care nurses perceived adequate opportunities to serve of hospital committees and attend continuing education programs. One hundred percent of the staff agreed that coworkers are willing to help when needed, however nurses disclosed a variety of unhealthy relationships with physicians.
The professors presented the report to the chief nursing officer, critical care manager, and unit manager, as an executive summary and included an overview, color-coded graphs with explanations, recommendations, and professional evidence-based literature. The report was delivered while displaying sensitivity to feedback that was potentially negative or volatile with the intent of helping the unit and organization. The nursing professors were not involved in executing recommendations as agreed upon at the beginning of the relationship.
The nursing team took immediate action to respond to the concerns revealed in the survey. Results, recommendations, and administrative response will be discussed. For example, the survey revealed concerns related to appropriate, safe staffing. As a result, nursing administration implemented a charge nurse training course utilizing case studies and active learning strategies. This course provided needed education regarding available resources and escalation plans associated with census and acuity-based staffing guidelines. Another response to nightshift staffing concerns was providing an expert ICU nurse who would not have a patient assignment in order to educate and assist the many novice ICU nurses.
Progressive organizations understand the value of "outside eyes" and collaborative relationships to broaden the potential for improvement. The nursing professors were able to utilize their unique position to communicate staff concerns without jeopardizing relationships and job security. The professors could relate to the intensive care nurses as well as nursing management. As a result, the professors were able to analyze conflict from all perspectives and help administration understand concerns.
The nursing shortage and high attrition rates motivate nursing administrators to establish and sustain a healthy work environment. Academic-practice collaboration enhances relationships, knowledge sharing, and the potential for improvement. Assessment of intensive care units or areas with high turnover can lead to valuable information to address necessary change. An accurate survey conducted and analyzed by a third party can identify critical problems that should be a priority for nursing administration. There is utility in surveying staff and not making assumptions. Sound leadership strengthens healthy work environments, promotes growth in nursing, enhances staff morale, enriches patient care, and reduces turnover rates.