Increasing Nursing Job Enjoyment and Patient Satisfaction on a High Acuity Adult Medicine Unit

Purpose:
Issues addressed: low staff morale and patient satisfaction on high volume, high acuity 28-bed progressive care medicine unit in urban, academic level 1 trauma center facility.

Significance:
Evidence that low staff morale and/or patient satisfaction are associated with inferior patient outcomes. Significant contributing factors to issues: medical coverage by 8 teams of MDs, semi-private rooms, 55% of RNs with < 2 years of experience, routinely high numbers of discharges and admissions.

Strategy and Implementation:
Innovation: Overhaul of unit leadership practices and culture. Strategies and Implementation: 1. Selective hiring practices including team interviews, candidate shadowing, setting clear expectations during interview process, hiring for attitude, interest and fit. 2. Enhanced orientation including matching preceptors to orientees based on Myers-Briggs assessments, consistent monitoring of progress, early identification of issues, immediately beginning to build conflict resolution skills with ongoing coaching. 3. Clearer and more equitable expectations of achievements necessary to advance on clinical ladder in addition to coaching and support to meet expectations. 4. Consistent and accountable leadership presence and visibility on unit 7 days a week. 5. Active leadership partnership with EVS, Nutrition Services, and Central Supply staff to decrease staff time and effort spent on environmental and supply logistics issues.

Evaluation:
2009 NDNQI RN Satisfaction T-Scores: Job Enjoyment increased from 61 to 70, Control of Work increased from 51 to 59. Unit has consistently ranked in 85th or higher percentile in Patient Satisfaction each month over past year (PRC surveys). Significant decrease in staff turnover over past 18 months.

Implications for Practice:
Consistent nursing leadership focus on hiring the right people, providing the right training, setting the right expectations, and providing the right support results in more satisfied nurses and patients.