Engaging Bedside Nurses in Assessing and Improving the Work Environment

Purpose:
To create and evaluate a toolkit for bedside nurses to assist them in interpreting and analyzing their unique Practice Environment survey results, and to pilot a practice environment improvement strategy related to meal and non-meal breaks.

Significance:
A healthy practice environment is characterized by an engaged nursing staff, exercising control over nursing related issues. The NDNQI survey can help achieve these conditions when the data are used by that engaged nursing staff to improve both their practice and their practice environment.

Strategy and Implementation:
A toolkit was created to assist nurses in discussing their unit level data as a team. The "Discussion Guide” was developed to facilitate discussion and determine staff perceptions of unit practice environment strengths and weaknesses. The "Strategy Tool” was developed to assist staff nurses to prioritize opportunities to improve performance using Maslow's hierarchy of human need. The last tool consisted of brainstorming ideas as well as the actual questions asked in each section of the survey. The pilot group brainstorming process led to a unanimous decision to address the inability of staff members to take meal and non-meal breaks. The staff set a goal that nurses would be able to sit down, free of patient care responsibilities for their break. Guidelines were developed to address how breaks were going to be accomplished on all shifts. Rapid design methodology was used to implement the new guidelines.

Evaluation:
The number of nurses able to sit down free of patient care responsibility for meal breaks increased from 0% to 26%. The number of nurses who took a meal break lasting 30 minutes or longer increased from 29% to 39%. Qualitative feedback reveal that the staff felt empowered by their participation.

Implications for Practice:
The Practice Environment Survey is a powerful tool, but nurses need coaching and support to fully benefit from the data. It is imperative to engage nurses in data analysis and issue identification, as well as in the development, implmentation and evluation of an action plan in response to the data.