A Pathway to Excellence shared governance council was created to help guide and support the organization along the journey and adhere to the guiding principles behind the healthy work environment. The council primarily consisted of direct care nurses, educators, and nurse leaders. An initial gap analysis was performed via online survey and the organization’s annual nurse engagement scores including the Practice Environment Scale. The results revealed a gap of knowledge in resources available.
Based on Donabedian’s Structure, Process, and Outcome Theory, the strategy to achieve a healthy work environment focused on educating staff on structures in place to help foster transition this knowledge into action and process implementation (Huddleston, 2014). A strategic monthly education and information exchange was chosen as the method of delivery. These sessions occur over the course of a year with each session focusing on an ANCC’s Pathway to Excellence practice standard. . Posters focused on how the organization achieved or had the resources to support each element.
To help drive engagement and participation a fun theme of baseball was selected. From the theme each session was referred to as a game day with an opening day and World Series. Each game day focused on one to two practice standards with poster presentations and game stations. Prizes were provided for participation and food that followed the theme was also provided. Participants received baseball cards at each event. At the end of the events, nurses could turn in the complete set for a chance to win a Fourth of July suite at the local minor baseball team game.
Both sites involved in the project showed statistically significant improvement in the Practice Environment Scale. The overall composite score of the PES was reviewed for each site for 2015 and 2016. Site one PES score was 3.11 in 2015 and 3.17 in 2016. At site two, the PES score was 3.16 in 2015 and 3.42 in 2016. An independent-samples t-test was conducted to compare the PES means from 2015 to 2016 for each site. There was a significant difference in scores for site one in 2015 (M = 3.11, SD = .26) and 2016 (M = 3.17, SD = .26); t (469) = -2.6. p = .01, (two-tailed). The magnitude of the differences in the means (mean difference = -.06, 95% CI: -.105 to -.015) was small (eta squared = .013). There was a significant difference in scores for site two in 2015 (M = 3.16, SD = .25) and 2016 (M = 3.42, SD = .28); t (63.18) = -4.017. p = .000, (two-tailed). The magnitude of the differences in the means (mean difference = -.26, 95% CI: -.387 to -.133) was large (eta squared = .2).
The organization subsequently passed their Pathway to Excellence designation. The methodology has also been adopted and further research has occurred in sister facilities which have also subsequently achieved Pathway to Excellence designation.