Getting Back on Track - A Case Study Describing Turnaround of a Patient Care Unit in a 6 Month Time Frame

Purpose:
Partner with the nursing staff to enhance clinical competency, improve work environment, decrease turnover and improve productivity.

Significance:
Nursing unit was without manager; falls with injury above NDNQI benchmark (1.04 per 1000 pt days vs benchmark 0.78); complaints pertaining to competency existed; turnover: RN-21%, unlicensed-54%; vacancy rate: RN-9%, unlicensed-23%; productivity-80-90%; NDNQI PES mean score=2.76 (25th percentile).

Strategy and Implementation:
A strong nurse leader from within the organization, who had no clinical expertise specific to that area, agreed to accept interim responsibilities. The first step was to do a comprehensive assessment including the following: feedback from the Vice President, 1:1 interviews with current staff, physical environment, observe care delivery model, input from physicians and other members of the multidisciplinary team, patient/family rounds. A fishbone diagram focusing on policies, people, place, provisions and procedures was created from the data gathered. From the fishbone diagram, issues and strategies to overcome were identified and prioritized. Multidisciplinary resources were pulled together to address immediate operational issues. Partnership with the Medical Director was established as well as trust and credibility with the staff. Staff were recruited and empowered to participate on action teams, expectations were articulated, time lines established and people held accountable.

Evaluation:
Within 90 days, productivity exceeded 97%. At 6 months, falls with injury decreased to 1/2000+ pt days; turnover: RN-20% (those we expected to leave, resigned), unlicensed-15%; vacancy rate: RN-2%, unlicensed-0%; NDNQI PES survey re-issued at 6 months - mean PES score=3.13 (75th percentile).

Implications for Practice:
Managers do not have to be the clinical expert to achieve positive outcomes. A healthy work environment contributes to engaged staff, decreased turnover, increased efficiency and cost effectiveness and positive patient outcomes.