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Enhancing a Professional Work Environment:
By the Nurses for the Nurses
Orthopaedic Service Line Work Environment Redesign Increases Job Satisfaction and Enjoyment
The first-time ambulatory nurses were invited to participate in the NDNQI survey was in 2021. The Orthopaedic Service Line (50%) scored 20.7% over the academic mean (29.26%) for the NDNQI survey statement: “Percentage to change your current position and/or work setting due to dissatisfaction within work environment within 3 years” (2021 NDNQI Results, 2022). For this statement, a lower percentage score is ideal.
The RN Coordinators (RNC) in the outpatient Orthopaedics Department analyzed the results and created a goal to provide an optimal work environment for all RNC within Orthopaedics and reduce work environment dissatisfaction by 5% by the following NDNQI survey in October 2022.
To reduce work environment dissatisfaction, the Orthopaedic RNCs collaborated with nursing management and implemented the four interventions to align with Stanford Health Care’s strategic priorities of “Our People. Our Customer. Our Care.” (Stanford Health Care, n.d.). In 2022, the four interventions we implemented were: hybrid remote work 3 days per week, RN Professional Development time, RNC monthly meetings, and coordinated events outside of work.
Hybrid remote work
RN RNC monthly meetings
Professional Development Time
Events Outside of Work
The hybrid model allowed RNCs to provide efficient and effective care to all patients regardless of location. RNCs were allotted four hours per month for professional development. Monthly RNC meetings and coordinating events outside of work were done to enhance the culture within the Orthopaedic RNCs. These changes focused on the “Our People” priorities, but the other two priorities were not forgotten. RNCs continued to provide compassion and care optimization for patients (“Our Customer”) and efficient care to all patients and families (“Our Care”). Based on the 2022 NDNQI survey results, our work environment dissatisfaction reduced by 100% and were deemed a success (2022 NDNQI Results, 2023).
Congratulations to the Orthopedic Service Line for your continued dedication to an optimal work environment for
Our People, Our Customer and Our Care.
Tania Golo-Atkin, BSN, RN, RN Coordinator, Orthopaedic Trauma Surgery and Fracture Liaison Service (FLS)
E3 Unit Improves RN-to-RN Interaction through CARE Values
E3 a Hematology/Oncology nursing unit has always remained steadfast in following their values that make up the acronym “CARE”, Compassion, Advocacy, Respect, and Empathy. E3 continually strives to apply these values to their interactions with patients, families, healthcare professionals, and their teammates.
When E3 received their 2021 NDNQI results, there was an opportunity to improve their RN-to-RN interaction and further promote their CARE values.
The COVID-19 pandemic caused increased stress and burnout among oncology nurses and due to infection prevention guidelines, RNs had less opportunity to interact with their coworkers. The E3 SLC and management team worked together to implement changes that eventually lead to E3 surpassing all their scores in the RN-to-RN interaction for the 2022 NDNQI results.
To improve the RN-RN interaction score, E3 SLC and Leadership addressed three key drivers: 1) nurses prioritize teamwork, 2) nurses will be able to utilize tools to combat stress, and 3) nurses will feel connected to team and develop trust with one another.
Prioritize Teamwork
Every call light is our call light
Every patient is our patient
Mid day huddle
Creation of E3 mission, vision and value statement
Stress Reduction
Mid day huddle: wellness check-in and activities
Meditaion, gratitude practices or stretching
Wellness Binder & Wellness Email reminders
Connection
& Trust
Staff Recognition
Monthly staff spotlight
Prioritize Teamwork: The team put signs on every unit phone that says “every call light is our call light; every patient is our patient” to promote a unified patient care mentality. A mid-day huddle was organized. The E3 team collaborated together and formed their own unit vision statement. E3’s mission, vision, and values was added to the daily huddle sheet for greater visualization and awareness.
Stress Reduction: Reduced stress, the team organized mid-day huddle to create a space to check in on how the staff members were feeling and conduct a wellness activity such as meditation, gratitude practice, or stretching. A wellness binder was created, and unit emails were sent out that provided information on the Employee Assistance Program, MERU health, and other wellness information.
Connection & Trust: To promote staff recognition, SLC organized a monthly staff spotlight to highlight fun information about an RN on the unit or other members of the interdisciplinary team.
From these interventions, E3 successfully improved their NDNQI survey results in all domains under “RN-RN Interaction”. E3 continues to grow their RN to RN interaction and foster greater teamwork among staff.
Improvements in 2022
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RN-RN Interactions
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RNs I work with count on each other to pitch in and help when things get busy.
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There is a good deal of teamwork among RNs I work with.
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RNs I work with support each other.
Congratulations to E3!
Submitted by: Casey Schade, BSN, RN, OCN, PCCN
Assistant Patient Care Manager E3: Inpatient Oncology
J4 CCU/CVICU Improves Interprofessional Relationships and RN Autonomy Through Transformational Leadership
In 2022, the J4 CCU/CVICU Shared Leadership Council focused on improving RN autonomy and interprofessional relationships based on the 2021 NDNQI scores.
For RN autonomy, they recognized that there was a lack of communication, opportunities for decision making, and unawareness of different roles as an RN.
For interprofessional relationships, the J4 SLC noticed a gap in RN communication with providers and in interest from staff to participate in bedside rounding.
The J4 SLC team brainstormed ways they could increase RN autonomy as well as guide staff to become more involved with contributing to their nursing care and clinical practice. The interventions implemented included identifying nurse leadership roles and responsibilities on J4 such as the Cardiac Surgery Liaison and the Float Nurse role, which opened opportunities for staff to participate in new hire interviews, become a preceptor, and provide education on nurse driven protocols.
They also involved the J4 Engagement Council to initiate social events outside of work and fun unit activities at work such as a monthly competition of counting steps every shift. The J4 SLC also encouraged the submission of Action Request Forms to SLC or anonymous suggestions and/or concerns to the J4 SLC Suggestion Box.
Throughout the year, they received multiple suggestions from staff and worked hard to address their concerns and implement new workflow changes and practice on the unit. The 2023 NDNQI showed an improvement in increase of that implementing these interventions made a difference with RN autonomy and increased RN satisfaction on J4.
Identifying RN Leadership Roles
J4 Engagement Council
Action Request Forms & Suggestion Box
Standardize RN to Provider Bedside Rounding
For interprofessional relationships, the gap in RN communication with providers and the expressed interest to participate in bedside rounding showed opportunities to develop process improvements in this area. A workflow structure was created to standardize RN to Provider bedside rounds with the CCU team to encourage strong communication and teamwork in creating a plan of care for each patient. A dedicated "Bat Phone" was created for the CCU Resident and updates were made on the Voalte application for easy identification of who to call. A rounding sheet was also created, and bedside nurses were encouraged to use it to guide them for their presentation during bedside rounds.
These interventions and workflow improvements are ongoing projects, but it has already improved the outcomes in autonomy, communication and teamwork between the RN and MD as reflected in the 2023 NDNQI scores. J4 CCU/CVICU met or exceeded the 2023 NDNQI score national average benchmark for Autonomy, RN-to-RN Interactions, and Interprofessional rollup.
Submitted by: Rey Marvin Avelino MSN, MBA, RN, FNP-BC, CCRN-K
J4 Interim Patient Care Manager