The Neurotrauma SICU (NTSICU) implemented the healthy work environment initiative to improve staff communication skills and techniques for conflict resolution; establish true collaborative relationships with physicians and team members; engage staff in decision making; and develop clinical nurse leaders.
NTSICU was faced with new nursing and medical leadership, and an increase in direct care hours necessitating hiring many new to practice RNs and requests from staff to address morale and turnover. Nursing leadership worked collaboratively with medical leadership, nurse practitioners and clinical nurses to ensure the development and sustainability of the work environment. A common vision maintained consistency with our efforts as we confronted numerous challenges and effected several changes.
Specific strategies included teambuilding workshops, conflict resolution techniques, clarifying practice expectations, structuring interdisciplinary rounds, developing collaborative practice teams to address clinical guidelines and incorporating the healthy work environment initiative into staff performance appraisals.
After the first year, based on the NDNQI Database, NTSICU had increased RN satisfaction in all areas and achieved Top Quartile Cut Point for Adult Critical Care in decision making, autonomy and communication. There was increased RN satisfaction attributed to our healthy work environment initiative in RN-RN communication, RN-MD communication and teamwork between co-workers. Since the start of the initiative, nurse turnover has decreased to below 10%. Several evidence-based practice guidelines have been implemented to address the clinical needs of our patients; nosocomial VAP and BSI rates decreased to below the 50th percentile nationally.
A healthy work environment contributes to successful implementation of evidence-based strategies with measurable outcomes in RN satisfaction, safety and patient care. Presenting an organized, committed effort from a multidisciplinary team in order to improve teamwork, communication and engage staff in this process promotes clinical excellence.
