Implementation and Case-Study Results of Potentially Better Practices for Staffing in Neonatal Intensive Care Units

Abstract

OBJECTIVE. Five NICUs that participate in the Vermont Oxford Network Quality Improvement Collaborative have implemented several potentially better practices in an attempt to decrease nurse turnover by 50%. These potentially better practices focus on orientation, rewards and recognition, healthy work environment, nurse-physician collaboration, and nursing autonomy.METHODS. Each unit implemented some or all of the potentially better practices. An Excel spreadsheet tool for tracking turnover rates was developed and used to measure the impact of the potentially better practices on retention. Rates were measured quarterly.RESULTS. After implementation of the potentially better practices, turnover rates fell at all of the NICUs ranging from 13% to 64%.CONCLUSIONS. Nurse retention is multifactorial. Implementation of the potentially better practices had a positive influence on nurse satisfaction but a varied impact on nurse retention. The impact of larger issues such as pay and staffing levels is significant and may not be influenced at the unit level. Implementation of 5 PBPs is described. These address orientation, rewards and recognition, developing a healthy work environment, nurse-physician collaboration, and nursing autonomy. Case studies from several different centers are highlighted. Lessons learned and suggestions for application of the PBPs in other centers are included. METHODS Development of the Nurse Turnover ToolThe percentage of nurse turnover on a quarterly and annual basis was selected to measure retention. Interventions and strategies that resulted in decreased nurse turnover likely would have an impact on and improve other areas in the work environment. Use of Plan-Do-Study-Act and the Rapid-Cycle Model for Improvement Each center prioritized PBPs that were developed by the group and worked to implement these via the model for improvement (Table 1). 1 This process requires the team to set a local aim, identify a measure to track progress, and break down the PBP into a series of smaller changes. Each of these smaller changes then is tested in plan-dostudy-act cycles. On the basis of analysis of what happens when the change is tried on a small scale, the local team takes action to embed further, modify, or abandon the plan for implementing the PBP. The implementation of a given PBP typically requires multiple plan-do-studyact cycles. The following case studies demonstrate application of this method. CASE STUDIES PBP 1: Facilitate Professional Development and Expertise Through Orientation (DeVos Children's Hospital)A successful orientation program that leads to the retention of staff is one that facilitates the new employee's welcome and integration to unit culture and can improve retention. 2,3 Careful evaluation of the program, including feedback from recent orientees and preceptors, is the first step in determining whether changes are needed. The NICU at DeVos Children's Hospital performed such an evaluation and implemented the following changes to the orientation program.Hiring practices at ...

Evaluation and Development of Potentially Better Practices for Staffing in Neonatal Intensive Care Units

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“…In contrast, 73% of physicians rated collaboration and communication with nurses as high or very high. A companion article 28 describes a tool that was developed by the STARS group to expose these differences in mental models. By gaining an understanding of these discrepant attitudes, concrete interventions can be used.…”

Use of Evidence‐Based Practice in School Nursing: Prevalence, Associated Variables, and Perceived Needs

“…A similar strategy was used for identifying stakeholders who might facilitate or inhibit adoption. Although nurse–physician collaboration influences EBP adoption in hospital settings (Schmalenberg et al 2005; Rikli et al 2006), this relationship typically does not apply to school nurses in the US. Various stakeholder groups (e.g., school administrators) that are present in the school setting, and may exert a similar influence, were substituted.…”

The relationship between healthy work environments and retention of nurses in a hospital setting

“…(2008) found that after participating in the creation of changes and implementing them, nurses reported increased perceptions of their work and their work environment. When staff created and implemented potentially better practices (PBPs) in five Neonatal Intensive Care Units because of high turnover, the turnover rates decreased anywhere from 13 to 64% (Rikli et al. 2006).…”