EP10EO

 

Staffing, Scheduling, and Budgeting Processes EP10EO

 

1. Provide one example, with supporting evidence, of an improvement in the organization’s nurse turnover rate associated with clinical nurses' participation in nursing retention activities. 
   • Turnover rate data must be in the form of a graph and a data table
   • Data presented must be at the organization level.

 

AND

2. Provide one example, with supporting evidence, of improvement of a clinical unit’s nurse turnover rate associated with clinical nurses’ participation in nursing retention activities.
   • Turnover rate data must be in the form of a graph and a data table
   • Data presented must be at the unit level.

 

 

Example a: Greenwich Hospital Livingwell CARES Program and the Diversity and Inclusion Council Decrease the Nurse Turnover Rate

Problem
On the April 2018 Greenwich Hospital (GH) Press Ganey Employee Engagement Survey, nurses identified resiliency as an area with opportunity for improvement. The survey was administered to all nurses at all levels and settings. In April 2018, the organization’s nurse turnover rate was 6.0. This includes all nurses at all levels and settings.

 

GH nursing leadership recognized the importance of addressing this need, as they know that nurses’ wellness and level of engagement directly impacts the quality of patient care. In addition, providing outlets to decrease stress and increase employee engagement would help decrease nurse turnover. Nursing leadership sought strategies to decrease stress, increase resilience, promote diversity and inclusion, increase engagement and, ultimately, retain talent.

 

GH provides an on-site health coach with the Livingwell CARES program, which provides nurses with clinical support and various programs to participate in self-care activities and well-being and to reduce nurse turnover. The Livingwell CARES program offers support and care coordination to nurses and their families. The program offers education and counseling to nurses with chronic health conditions such as diabetes, asthma, heart disease and high blood pressure, and health coaching and support for those who want to live a healthy lifestyle with healthy behaviors and to reduce health risk factors.

 

In April 2018, Laura Flahive, BSN, RN, CWPC, CHC, ADS was hired as the Nurse Care Coordinator and Health Coach for Livingwell CARES at Greenwich Hospital. Flahive has a wide background in health and wellness. She is certified as an Oncology Chemotherapy and Biotherapy Provider, is a Nationally Certified Health Coach, a CWPC-Certified Corporate Wellness Coordinator, an ADS-Acupuncture Detox Specialist, a Reiki Master, an M Technique Practitioner and a Freedom From Smoking Tobacco Cessation Educator. 

 

Goal
Decrease the Greenwich Hospital organizational nurse turnover rate.

 

Participants

 

Greenwich Hospital Livingwell CARES Team and Healing Environment Council Members
Name/Credentials	Discipline	Title/Role	Department
Laura Flahive, BSN, RN, CWPC, CHC, ADS	Occupational Health, Wellness	Director, Healing Environment Council	Livingwell Cares Greenwich Hospital
Roberta Brown, BSN, RN, BC	Nursing	Coordinator Integrative Medicine, Clinical Nurse, Healing Environment Council	Integrative Medicine
Marie Dalton, MSN, RN, BC	Nursing	Clinical Nurse, Clinical Resource Nurse, Healing Environment Council	Emergency Department
Cathleen Scanlon, BSN, RN	Nursing	Clinical Nurse, Clinical Resource Nurse, Healing Environment Council Chair	Maternity
Noeme Gaynor, BSN, RN, CAPA	Nursing	Clinical Nurse, Clinical Resource Nurse, Healing Environment Council	Ambulatory Surgery
Barbara Leafe, MSN, RN, NE-BC	Nursing	Director	Medicine, GI
Terri Nicoladse, MSN, RN, EFM-BC	Nursing	Clinical Nurse, Clinical Resource Nurse, Healing Environment Council	Labor & Delivery
Kathy Barto, RN, NNICU	Nursing	Clinical Nurse, Clinical Resource Nurse, Healing Environment Council	NICU
Susan Draper, RN	Nursing	Clinical Nurse, Healing Environment Council	Surgery
Kathy Bzroska, BSN, RN, CCRN	Nursing	Clinical Nurse, Clinical Resource Nurse, Healing Environment Council	MSICU
Karen Stern, RN	Nursing	Clinical Nurse, Healing Environment Council	Intermediate Care

 

Diversity and Inclusion Council
Name/Credentials	Discipline	Title/Role	Department
Jerry Laureano	Transportation	Coordinator	Transport
Annie Nardi, DPT	Physical Therapist	Coordinator	Surgery
Angela Melwani, BA	Human Resources	Human Resource Specialist	Human Resources
Ellen Stacom, BSN, RN, WOCN	Nursing	Clinical nurse	Hyperbaric Wound Care
Thalia Soriano, BSN, RN	Nursing	Clinical Nurse	Surgery
Debbie Romaniello, BSN, RN, IBCLC	Nursing	Clinical Nurse	Maternity

 

Description of the Intervention
Retention Activities: Livingwell CARES Provides Resiliency Programs

 

May-September 2018
Based on the 2018 Employee Engagement Survey results, Flahive sought to work with nurses, including clinical nurses, to implement programs to support nurses’ physical and emotional health.

 

Flahive engaged Roberta Brown, BSN, RN, BC, Coordinator Integrative Medicine, Clinical  Nurse; Marie Dalton, MSN, RN, BC, ED Call Back Nurse, Clinical Nurse; Cathleen Scanlon, BSN, RN, MNN, Clinical Resource Nurse, Clinical Nurse; Noeme Gaynor, BSN, RN, CAPA, Clinical Resource Nurse, Clinical Nurse; and Barbara Leafe, MSN, RN, NE-BC, Director of Medicine, GI; and the members of the Healing Environment Council to launch three new programs: the Maternity Program, Wellness Book Club and Wellness Retreat Days. The purpose of the professional governance Healing Environment Council, whose membership consists of clinical nurses, is to promote healing for patients, families, nurses and employees, and to create an optimal work environment for nurses.

• The Maternity Program provides nurses with education and coaching for a healthy pregnancy, newborn care and post-partum self-care. This program is designed to support employees during pregnancy and afterward during the transition to motherhood and preparing for return to work. The program is invaluable in assisting employees, including nurses, who are new mothers to remain employed.
• The Wellness Book Club provides nurses who are working to improve their well-being with support from colleagues. This program is a social activity to build a sense of community for nurses. Evidence demonstrates that building a sense of community improves nurse satisfaction and reduces nurse turnover.
• The Wellness Retreat Days are offered to all nurses in their department during work hours. The Wellness Day provides an opportunity for self-care and relief from the demands of the workday. Flahive offers the evidence-based therapies of Reiki, M-Technique, chair massage and meditation. These programs decrease nurses’ stress and directly address the feedback provided by nurses in the Employee Engagement Survey related to resiliency and stress management.
• Flahive developed a unique program for the nurse residents in the PTAP accredited with distinction (ANCC) Nurse Residency Program. Flahive focuses on new nurses, helping them build foundations for health and self-care. She personally offers the following classes to the nurse residents (new nurses with less than two years of acute care hospital experience), who are at greater risk of burnout leading to turnover: exercises in motivational interviewing, resiliency in nursing, mindfulness and meditation, mindful transitions and other rituals in the workplace, social and community well-being, and intellectual wellness and passion. This has increased the retention of new nurses.

 

Flahive also attends monthly nurse staff meetings to perform stress relief exercises. She and members of the Livingwell CARES Team and Healing Environment Council created mini retreats for units. By increasing access to internal resources to promote health and wellness, Greenwich Hospital nurses identify issues that cause stress and address them, develop stress management skills, build resiliency, promote wellness and increase engagement. Flahive’s work and the Livingwell CARES program have thereby helded reduce the nurse vacancy rate.

 

Diversity and Inclusion Council Increases Diversity and Inclusion for Nurses

 

July 2018-September 2019
In July 2018, Lizette Martinez, Chief Diversity Officer, Yale New Haven Health System (YNHH), launched the Diversity and Inclusion Council at Greenwich Hospital. The council is supported by the office of YNHHS Diversity and Inclusion (D&I), through training and education. Martinez collaborated with executive sponsor Norm Roth, President/Chief Executive Officer, who provides direct senior leadership support and solutions to barriers and is an advocate for diversity and inclusion. GH leadership recognizes that Diversity & Inclusion creates a healthy environment in which differences are celebrated and different cultures and beliefs are accepted. People who are different feel welcomed and are invited to participate in the workplace activities rather than being isolated.

 

Greenwich Hospital’s multidisciplinary D&I Council includes clinical nurses, leaders, Human Resources and a Transportation Service employee. Clinical nurses are key participants in the D&I Councils and serve as Inclusion Champions, who are awarded this title after completing three training courses: Ouch! That Stereotype Hurts!, Defeating Unconscious Bias, and Cultural Competency. The training provides tools to assist colleagues in dealing with any issues or concerns regarding bias, stereotyping and other cultural matters.

 

Activities to increase inclusion included:

• Martinez and Maria Alicea, from the office of YNHHS Diversity and Inclusion, came to Greenwich Hospital to provide information about the Diversity and Inclusion Council and share ways that employees can get involved with the organization’s diversity and inclusion efforts. At this open house information session, Martinez focused on clinical staff participation to increase engagement in system-wide objectives.
• Jerry Laureano, Transportation Coordinator and D&I Chair; Annie Nardi, DPT, Coordinator Joint and Spine Program, Surgery; Angela Melwani, Talent Acquisition, Human Resources, D&I Co-chair; Ellen Stacom, RN, WOCN, Clinical Nurse, Hyperbaric and Wound Care Center; Thalia Soriano, BSN, RN, Clinical Nurse, Surgery; Debbie Romaniello, BSN, RN, Clinical Nurse, Maternity; and Norman Roth, President/CEO, D&I Council Executive Sponsor, met to finalize the council’s strategic objectives for FY19. Based on feedback from the 2018 Employee Engagement Survey, the council developed action plans with strategies to focus on talent management, which included developing ways to better attract, develop and retain nurses and other candidates with diverse backgrounds.
• The D&I Council held the Amazing Race contest, a call-to-action contest to heighten cultural awareness. The participants in the contest competed for prizes while racing to complete activities that involve visiting places and interacting with people who may be different. Nurses had an opportunity to meet other nurses throughout the organization and make connections. This networking activity contributed to building a sense of community and collegiality among nurses to help increase nurse retention.
• Greenwich Hospital participated in YNHHS’ first annual Diversity and Inclusion Summit. The Summit included expert speakers on topics such as celebrating differences in people and accepting all cultures at the workplace, awards for D&I Councils that accomplished goals, and Amazing Race contest winners. The purpose of the summit was to bring together employees from all delivery networks to meet and embrace differences while educating them on ways to embrace differences in the workplace. At this event, the Greenwich Hospital Diversity and Inclusion Council was named Council of the Year for YNHHS, and Roth was named D&I Council executive sponsor of the year, for their work to increase diversity and inclusion at GH.

 

Outcomes
Clinical nurses' participation in nursing retention activities led to a decrease in the Greenwich Hospital organizational nurse turnover rate. 

 

Nurse retention was increased as a result of the implementation of programs to promote health and wellness, provide tools to manage work-related stress and provide an environment that promotes diversity and inclusion. The organizational nurse turnover rate decreased from 6.0 in April 2018 to 3.0 in October 2019, 1.5 November 2019 and 0.5 in December 2019.

 

 

Evidence EP10EOa-1, Greenwich Hospital Organizational Nurse Turnover Rate

 

 

Example b: Medical Oncology Reduces Turnover by Implementing Nurse Retention Activities

Problem
The Medical Oncology unit is a 14 bed inpatient unit that provides specialized cancer care to adult patients. The unit experienced an increase in nurse turnover in 2016. Six nurses resigned from their positions resulting in high utilization of travel nurses. In September 2016, Kristina Capretti, MSN, RN, OCN, ANP-BC, Oncology Program Director and Irene Piazza, DNP, RN, AOCNS, Oncology OP Nurse Manager/Clinical Nurse Specialist reviewed nurse staffing and nurse turnover rates for the Medical Oncology unit. Opportunities to improve nurse retention rates were identified.

 

In Q3 2016, the Medical Oncology nurse turnover was 4%. This is measured as the number of Medical Oncology nurses who resigned, retired, expired or were terminated divided by the number employed during the same period.

 

Goal statement
Decrease the Medical Oncology unit’s percent nurse turnover.

 

Participants

 

Medical Oncology Nurse Retention Taskforce
Name/Credentials	Discipline	Title/Role	Department
Kristina Capretti, MSN, RN, OCN, ANP-BC	Nursing	Oncology Program Director	Oncology
Irene Piazza, DNP, RN, AOCNS	Nursing	Out Patient Nurse Manager/Clinical Nurse Specialist	Oncology
Lynn Carbino, BSN, RN, OCN	Nursing	Oncology Nurse Navigator	Bendheim Cancer Center
Nancy Scofield, RN, OCN	Nursing	Clinical Resource Nurse (clinical nurse)	Bendheim Cancer Center
Andrea McPherson, BSN, RN, OCN	Nursing	Clinical Nurse	Bendheim Cancer Center
Danielle Piacente, BSN, RN, OCN, CHPN	Nursing	Clinical Resource Nurse (clinical nurse)	Medical Oncology
Jane Curto, BSN, RN, OCN, CHPN	Nursing	Clinical Resource Nurse (clinical nurse)	Medical Oncology
Jocelyn Walls, LCSW	Social Work	Oncology Social Worker	Oncology

 

Description of the intervention
Retention Activities

 

4th Quarter 2016

 

Educational Support for Newly Hired Nurses
Capretti and Piazza discussed interventions to support the large number newly hired oncology nurses. The majority of newly hired nurses had prior nursing experience however, most lacked oncology experience. Capretti and Piazza identified a need to provide educational support to new nurse staff members. Capretti and Piazza arranged for new oncology nurses to attend both the Essentials of Chemotherapy & Biotherapy class and the Oncology Fundamentals class at Smilow Cancer Hospital, Yale New Haven. These two classes provided new oncology nurses with a strong knowledge base about care of the oncology patient as well as chemotherapy administration.

 

Revised Medical Oncology Unit Orientation
Orientation for new oncology nurses was also re-evaluated. Capretti and Piazza worked with Nancy Scofield, RN, OCN, Clinical Resource Nurse, to develop a new opportunity for inpatient nurses to cross-train in the chemotherapy infusion suite at the Greenwich Hospital Bendheim Cancer Center. Spending time in chemotherapy infusion allowed newer oncology nurses time to observe chemotherapy administration and understand common treatment side effects. It also provided an opportunity for novice oncology nurses to learn port-a-cath and PICC-line care skills. Cross-training in the outpatient oncology care setting also gave inpatient oncology nurses a new perspective about the various roles of the oncology nurse and opportunities for growth in the future.

 

Certification Review Class
As a means to support more seasoned Medical Oncology nurses, Capretti and Piazza developed a curriculum for an oncology nursing certification review class. This review class was open to any oncology nurse with at least 1 year of experience in the field. The purpose of the review class was to provide educational support and encourage nurses to pursue certification. Nurses were paid for their participation in the class. Capretti and Piazza also partnered with Smilow Cancer Hospital to offer the ONCC Free-Take program giving nurses the opportunity to take an oncology nursing certification exam at no charge to the individual. Through this program, nurses are able to sit for the exam up to two times and if they pass, Greenwich Hospital is invoiced for the test fee. In addition, Greenwich Hospital provides a one-time certification bonus as well as reimbursement for certification renewal fees.

 

Partnering with Clinical Nurses for Team Building
Capretti recognized the importance of building a sense of esprit de corp as a strategy to improve nurse retention. Capretti, Piazza, Lynn Carbino, BSN, RN, OCN, Oncology Nurse Navigator, Andrea McPherson, BSN, RN, OCN, clinical nurse, Danielle Piacente, BSN, RN, OCN, CHPN, clinical nurse and Jane Curto, BSN, RN, OCN, CHPN, clinical nurse, worked together to schedule a team-building experience for oncology nurses.. After surveying the nurses, it was determined that the oncology nurses (both inpatient and outpatient) wanted to participate in a paint night at Pinot’s Palace in Stamford.

In December 2016, over 30 oncology nurses attended a fun and interactive painting experience. Nurses choose a beach-scene to paint because they felt this image depicted calmness and positive energy. Nurses from the outpatient and inpatient units bonded over laughs, painting and good food. Positive relationships were created resulting in improved communication and understanding between the inpatient and outpatient oncology areas. Feedback from all clinical nurses who attended the experience was extremely positive.

 

Clinical Nurses Implement Compassion Rounds
Curto and Piacente approached Capretti to request a forum for inpatient oncology nurses to speak freely and debrief about difficult patient cases. Capretti, Piacente and Curto recruited Jocelyn Walls, LCSW, Oncology Social Worker, to hold monthly compassion rounds with inpatient oncology nursing staff. The goal of the compassion rounds was to create a safe forum where nurses could speak openly about their emotions and share their personal experiences caring for end of life patients. Nurses value these meetings and look forward to each monthly session.

 

All interventions were fully implemented by the end of Q4 2016.

 

Outcomes

Clinical nurses’ participation in nursing retention activities improved nurse turnover on the Medical Oncology unit. Nurse turnover decreased from 4% in Q3 2016 to less than 1% for the subsequent three quarters.

 

 

Evidence EP10EOb-1, Medical Oncology Unit Percent Nurse Turnover