Fighting Our Way Back: When RN Satisfaction Gets Pounded by Fiscal Realities

Purpose:
Fiscal realities, resulting in decreases in RN hours and nurse-patient ratio increases, had a significant negative impact on RN Satisfaction. The Practice Environment Council (PEC) was chartered to increase RN participation in nursing-related administrative decisions.

Significance:
The NDNQI RN Practice Environment Survey clearly highlighted communication and engagement deficits, with scores below the Mean in Nurse Participation in Hospital Affairs.

Strategy and Implementation:
A Nursing Practice Environment Council (PEC) was added to our existing Magnet Councils. It was clear that recent administrative decisions regarding staffing left the direct care RNs feeling not only unheard, but helpless to impact their practice environment. The PEC membership was drawn from RN direct care staff leaders, with all nursing units represented. This council's mission, through direct communication with the CNO, COO, and CEO, is to receive current financial and administrative information, to serve as a direct link back to the units, and to return direct care RN feedback to administration. Receiving the financial information was an "eye-opening" experience for the PEC members and the direct care nursing staff. The PEC provided feedback to administration on decreasing overtime, eliminating specific entitlements, RN retention and benefits, development of a hospital-wide float pool, and revamping of unit based prn usage.

Evaluation:
All areas of the subsequent NDNQI RN Practice Environment Survey dramatically improved, exceeding the Mean.

Implications for Practice:
This example of pure shared governance highlights the value of direct care RN feedback into administrative decisions affecting the practice environment. We are reminded that everything we hope to accomplish relies on excellent communication.