Page 10
Within REACH
Improving work environment and retention in a progressive care unit (Part 1 of 2) Suzanne Beels, MSN, RN, AGCNS-BC, CCRN; Susan Blankenship, MS, BSN, RN, PCCN - CVI Surgery & Educational and Organizational Development Methods and procedures In June 2020, concerns were brought to Cardiovascular Institute (CVI) leaders regarding high turnover rates amongst 7SPCU nurses, a Cardiovascular Progressive Care Unit (PCU). The 7MPCU and 9SPCU employees were combined in December 2019 to form a new CVI surgery PCU. Nurses were challenged with learning skills to care for cardiac, vascular, and thoracic surgery patients: creating a lengthy competency validation list of high-level skills. Purpose and aims The purpose of this quality improvement project was to appropriate a weekday floating charge nurse (FCN) to support RN staffing levels on the CVI Surgery PCU. Project aims were to increase RN retention rate and increase the overall ‘Appropriate Staffing’ Standard Score. Current state of knowledge The American Association of Critical Care Nurses (AACN) led the way in defining and measuring the impact of work environment on patient and nurse outcomes in acute and critical care units. The Healthy Work Environment (HWE) survey collected data and focused on six standards for creating an HWE: True collaboration, skilled communication, effective decision-making, meaningful recognition, appropriate staffing, and authentic leadership. Ulrich et al. identified five themes in their review of nurse work environment studies completed from 2005-2017, one of which was the positive correlation of HWEs with psychological health, job satisfaction, and retention (2019, p. 68). They also noted HWEs were negatively correlated with emotional strain and burnout (Lampo, 2019). Description of population and benefit 7SPCU is a 20-bed PCU. The benefits of establishing a weekday FCN were to develop and maintain frontline clinical expertise and improve the work environment. Methods and procedures The FCN role was developed to address employee feedback while meeting the project goals. The FCN did not carry a standard patient assignment but was available on the unit to fill any gaps in care. By utilizing the most experienced nurses in the FCN role, they were the most knowledgeable and versatile RNs to handle the responsibilities. Specifics of the role: •
Daily tracking of time allocation: Out of the 370-day pilot, the FCN was utilized 140 days
•
FCN hours were scheduled as 8-12-hour shifts during high churn as staffing permitted
•
Exclusions included nightshift, weekends, and holidays
•
The FCN was pulled back into staffing as a bedside RN with a patient assignment when 7SPCU or another PCU required support
FCN time was allocated into primary categories as identified on the graph below. Most of the shift was spent in direct patient care raather then managing throughput.
