nurse satisfaction in the practice environment: a front ...€¦ · q1 q2 q3 q4 q5 q6 q7 q8 q9...
TRANSCRIPT
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Nurse Satisfaction in the
Practice Environment:
A "Front Line Winner"
Danielle H. Schloffman MSN, RN, NE-BC
ANA Nursing Quality Conference™
Friday, January 27, 2012
Session 211
11:00am – 12:30pm
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Session Objectives
1. Describe ways to engage clinical
nurses in improving their work
environment.
2. Identify structures and processes used
to support and guide staff for improved
practice environment outcomes.
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Hospital Demographics
• Academic medical center• Not-for-profit• 407 licensed beds• 1,200 clinical RNs
– Level II trauma center– 22,180 admissions– 65,895 ED visits– 679,602 clinic visits– 15,592 surgeries– 3,007 deliveries– 276 transplants
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Achievements
• Three-time ANCC Magnet-recognized®
• ANCC Magnet Prize® recipient
• ANCC Magnet Nurse of the Year® recipient
• CCNE accredited UHC/AACN Post-Baccalaureate Nurse
Residency Program
• University HealthSystems Consortium Quality and Safety
Leadership Award
• Ranked #1 hospital in Denver by U.S. News & World Report
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“Staff nurses have a voice.
There are opportunities
for a staff nurse with any
question or concern
to start a change
process.”
Jamie Nordhagen, RN, BSN, OCN
Level IV Permanent Charge RN
Oncology/Bone Marrow Transplant
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RN Satisfaction
• NDNQI Practice Environment Scale
results for 2009, 2010 and 2011
– >94% response rate
– Above Academic Medical Center median
for all categories
– At or above Magnet median for all
categories
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1
2
3
4
2009 3.03 3.17 3.10 2.95 3.16
2010 3.05 3.18 3.04 2.91 3.19
2011 3.04 3.16 3.07 2.87 3.17
Nurse Participation in
Hospital Affairs
Nursing Foundation for
Quality of Care
Nurse Manager Ability,
Leadership and Support of
Nurses
Staffing and Resource
Adequacy
Collegial Nurse-Physician
Relations
NDNQI Practice Environment Scale
All Units
Rating of the extent to which characteristic is present.
The higher the score, the more positive the rating on a scale of 1-4.
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Staff Engagement
• Professional Practice Model & Program
• Shared Leadership Model
• Evidence-Based Practice Model
• Culture of Transparency
• Interprofessional Collaboration
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Examples of Engagement
• Unit-based capacity nurses
• Short shifts
• Meal break buddies
• CNA shift times restructured
• New associate nurse manager role
All of the above were budget neutralAll of the above were budget neutral
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Donabedian's Model
• Structure: The elements or resources that must be in
place to deliver care
• Process: The interventions that must be performed
to deliver care
• Outcomes: The end product of quality care; reflects
the effectiveness of structure and process elements
Outcomes, by and large, remain the
ultimate validation of the effectiveness
and quality of medical care.
Outcomes, by and large, remain the
ultimate validation of the effectiveness
and quality of medical care.
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Structure + Process
• Pervasive culture of evidence-based
practice exists within organization
• Nurse leaders serve as mentors and
help facilitate change at the unit and
organizational level
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Outcomes
• 26 active RN led research/evidence-
based practice studies
• Clinical Example: Reduction in CA-UTI
rates with nurse-driven interventions on
General Surgery unit
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0
1
2
3
4
5
6
7
8
1st Q
tr 09
N=4
2nd Qtr
09 N
=2
3rd Qtr 09
N=1
4th Qtr 09
N=0
1st Q
tr 10
N=1
2nd Qtr
10 N
=2
3rd Qtr 10
N=1
4th Qtr 10
N=2
1st Q
tr 11
N=1
2nd Qtr
11 N
=0
3rd Qtr 11
N=0
QUARTER
RA
TE
/1,0
00
FO
LE
Y D
AY
S
RATE/1000 FOLEY DAYS NHSN BENCHMARK (1.8) Trendline CA-UTI Rate
Interventions
started
General Surgery CA-UTI Rate/1,000
Foley Days with NHSN Benchmark
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Structure + Process
• Nurses at all levels are expected to be
leaders
• Clinical nurse co-chairs for >60% of
interprofessional organizational
committees/councils
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Outcomes
• One of the highest overall mean scores
in Colorado for nursing participation in
hospital affairs and nursing satisfaction
• Clinical Example: Staff Nurse Council
clinical RN implemented TCAB project
on her unit to implement uninterrupted
meal breaks
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9
22
92
0
10
20
30
40
50
60
70
80
90
100
2009 2010 2011
% of RNs
NDNQI RN Satisfaction Survey
Meal Breaks Free of Patient Responsibilities
Bone Marrow Transplant Unit
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Structure + Process
• Nurses are encouraged to be
innovative, creative thinkers and change
agents
• Administrative time for staff projects;
culture of quality and safety is
paramount
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Outcomes
• >200 nurse driven QI projects annually
• Clinical Example: Fall Champion clinical
RN completed statistical analysis of falls
on her unit to plan and implement
patient specific interventions
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0
1
2
3
4
5
6
7
8
9
10
3Q08 4Q08 1Q09 2Q09 3Q09 4Q09 1Q10 2Q10 3Q10 4Q10 1Q11 2Q11
Interventions
started
Total Falls per 1,000 Patient Days
Bone Marrow Transplant Unit
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Structure + Process
• Nationally accredited nurse residency
program, one year in length
• Extensive preceptorship assuring
successful clinical transition, specialty
courses, monthly support series,
reflective practice exercises to increase
critical thinking
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Outcomes
• 95% nurse resident retention rate first two years
• 72% of former nurse residents act as relief charge
nurses, permanent charge nurses, preceptors or
committee members
• 48% of inpatient nursing work force are graduates
of nurse residency program
• Clinical Example: Skin Champion clinical RNs
implemented nursing bedside rounds to increase
knowledge and accountability of PU on their unit
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0
5
10
15
20
25
30
Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Q12 Q13 Q14 Q15 Q162008 – 2011
Average Patient Census was 16
SICU Skin Rounds Initiated Linear (SICU)
Unit Pressure Ulcer Incident Report
Surgical Intensive Care Unit% of Patients Who Developed Unit-Acquired Pressure Ulcers per Surveyed Patients
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Structure + Process
• Organization supports professional
development and growth
• Robust professional practice model,
comprehensive tuition and CE
reimbursement programs
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Outcomes
• Clinical RNs
– >80% BSN
– 40% certified
• Managers/Directors
– 38% BSN; 53% masters; 6% doctoral
– 62% certified
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Consider thisL
• Are your staff nurses involved in
decision-making?
• What are your structures to support
research and evidence-based practice?
• Does your management team raise the
bar for nursing excellence?
• How creative are you with financial
resources?
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“I feel that if I have an issue I am listened to. I can
become part of the process to make my work
environment better.”Terry Rendler, RN, MSN, WHNP-BC
Level IV Staff RN Birth Center
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References & ResourcesColorado Hospital Association. Colorado Hospital Report Card. http://www.cha.com/
Donabedian A. (1966). Evaluating the quality of medical care. Milbank Memorial Fund Quarterly,44:166-206.
Donabedian, A. (1980). Explorations in quality assessment and monitoring: The definition of quality and approaches to its assessment. Ann Arbor, MI: Health Administration Press.
Donabedian, A. (1988). Quality assessment and assurance: Unity of purpose, diversity of means. Inquiry, 25:173-192.
Dunton, N., Gonnerman, D., Montalvo, I., & Schumann, M.J. (2010). Incorporating nursing quality indicators in public reporting and value-based purchasing initiatives. American Nurse Today, 6:14-17.
Goode, G., Fink, R., Krugman, M., Oman, K & Traditi, L. (2011). The Colorado patient-centered interprofessional evidence-based practice model: a framework for transformation. Worldviews on Evidence Base Nursing;8(2):96-105.
Kelleher, A., Moorer, A. & Makic M. B. (2012). A quality improvement project: Peer to peer nursing rounds and hospital acquired pressure ulcer prevalence in a surgical intensive care unit. Journal of Wound, Ostomy and Continence Nursing. (expected print March/April 2012).
Krugman M, Smith K, Goode C. (2000). A clinical advancement program: evaluating 10 years of progressive changes. Journal of Nursing Administration;30(5):215-225.
Magnet Recognition Program. American Nurses Credentialing Center. http://www.nursecredentialing.org/Magnet.aspx
National Database of Nursing Quality Indicators. https://www.nursingquality.org/
Oman, K., Makic, M.B., Fink, R., et al. (2011). Nurse-driven interventions to reduce catheter-associated urinary tract infections. American Journal of Infection Control; epub December 2011 http://www.ncbi.nlm.nih.gov/pubmed/22047997
Stefancyk, A. (2009). One-hour, off-unit, meal breaks. American Journal of Nursing, 109(1):64-66.