Staff Engagement Improves Nurse Retention and Patient Outcomes

Purpose:
The goal of this initiative was to improve retention of RNs and patient outcomes. Since the greatest RN turnover occurred in the first year of employment, orientation of new nurses was augmented to increase retention. To improve patient care outcomes, four nursing units become Magnet Pilot Units.

Significance:
A stable, vibrant nursing workforce is critical to high quality patient care outcomes. Improvement of retention rates was essential to enhancing nursing care excellence in the journey towards Magnet status, improving patient outcomes, and reducing institutional costs of turnover.

Strategy and Implementation:
Three innovative strategies to support retention were New Nurse Fellows, Clinical Coaches, and Nurse Manager Academy. New Nurse Fellows and Clinical Coaches were trained in paired cohorts over a 6-month period to build teamwork and support networks for newly hired nurses. The Nurse Manager Academy offered training of current and emerging nurse managers to advance leadership skills and sustain staff growth and enculturation of support systems beyond the critical first year. Staff exchanges with a Magnet facility were implemented to address four patient outcomes (patient satisfaction; RN Satisfaction-autonomy; RN Satisfaction-decision making; and hospital acquired decubitus ulcers). Performance Improvement projects focusing on the four outcomes were implemented on the Magnet Pilot Units to enhance patient care and improve RN retention via increased engagement of staff in quality initiatives. These strategies were implemented over three years with funding from a federal training grant.

Evaluation:
From 2006-2009, all outcomes improved: RN retention from 55.97% to 62.5%; Patient Satisfaction (from 84.6 to 87.4); RN Satisfaction- autonomy (from 44 to 48); RN Satisfaction-decision making (from 41 to 45); and decubitus ulcer rate (from 15.3 to 13.8). Focus group findings were very positive.

Implications for Practice:
Patient and nurse outcomes can be improved when staff are given tools to make a difference; facilitated peer engagement had a synergistic effect beyond initial expectations; sustained guidance and support resulted in continuous improvements; staff-initiated solutions worked best on each unit.