The Florida Center for Nursing

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Retention & Recruitment Funded Projects
Projects Awarded in the Inaugural Year - 2009
Funding Total = $ 74,030.25
Total return-on-investment (ROI) of $13.92:$1.00

The Center recognizes and thanks Blue Cross / Blue Shield of Florida Incorporated for its contribution matching FCN's dedicated funding level thus allowing more projects to be selected.

Shands at the University of Florida (Gainesville, FL)
Project Title: Enhancing Staff Nurse Satisfaction by Improving the Efficiency of Nursing Care

Brief Description: The literature shows that documentation, medication administration, and care coordination are the three main targets for improving the efficiency of nursing care. The objectives of this project are: (1) to identify the most problematic area causing inefficiency on adult and pediatric medical/surgical units at Shands at the University of Florida; (2) to design and implement interventions by examining systems and the work environment to improve efficiency for the selected target area; and (3) to evaluate the nurses' satisfaction and perception of improved efficiency following intervention implementation. Project leaders conducted nurse surveys, staff observation, and focus groups to identify documentation as the most inefficient nursing activity and a Computer Resource Nurse (CRN) role was developed to provide computer/documentation expertise at the unit level.

Final Project Outcome: Post-study survey results revealed no difference in reported satisfaction between the three areas of medication administration, coordination of care, or documentation. However, comparison of responses between the pre- and post- documentation-specific survey items revealed improvement in scores for every item. Two of these items were significantly improved: "I am able to complete all components and requirements of the documentation for each assigned patient" and "My documentation is an important tool to communicate to other medical staff my patient's progression and needs." The post-study survey results showed significant improvement in staff perception of efficiency in several documentation areas and improvement in all areas. The amount of time that staff reported for documentation did not decrease post-study. The staff perception of the efficiencies of each area however, did change post-study. The CRN model will be implemented throughout the institution.

Using a resource nurse model, all registered nurses were provided additional education related to capabilities already in existence within our documentation system to address specific problems they had identified. When developing the action plan and investigating what could be done within the functionality of the current computer system, the research team discovered that many of the "suggestions for improvement" were already functions within our systems. Other suggestions identified by staff were not possible within our current systems. Project leaders reported several key lessons, namely that computerized documentation systems are complex and when staff are trained to use the systems, frequently only portions of the educational components are retained. Staff need colleagues who are readily available at the unit level for consultation and help to advance their skills in using the systems. The research team felt that the education, along with improved communication, led to the more positive assessment of documentation efficiency in the post-study survey.

University Community Hospital (Tampa, FL)
Project Title: The Admission Nurse Program for the Older and Experienced Nurse

Brief Description: The Admission Nurse Program for the Older and Experienced Nurse will allow the older, experienced nurse to continue working at the bedside while maintaining flexible scheduling, and to use their clinical experience, communication skills, assessment and understanding of total care issues, collaboration/coordination of care skills, and commitment to the nursing profession in order to assist meeting regulatory requirements at admission. This position will impact patient satisfaction by providing continuity of care as well as increasing staff satisfaction by taking the burden of the admission process off of the staff nurse.

Final Project Outcome: Eight RNs (average age of 50 years old) were "hired" into the pilot Admission Nurse Program and participated in a 4-hour didactic program that reviewed all aspects of the role as well as 36-hours of mentored on-unit training; the program was then piloted to five units. Each nurse submitted a daily log sheet to track the number of completed admissions and to identify challenges or positive outcomes of the role. RN job satisfaction on the pilot units changed dramatically after implementation of this program. The percentage of RNs reporting that that the patient admission paperwork/process affected their job satisfaction highly/moderately dropped from 90% to 18% on the post-implementation survey; conversely, the number increased from 76% to 82% on the control units.

Prior to implementation, 78% of RNs on the pilot units and 65.5% on the control units admitted that the admission process "sometimes to always" discouraged them from accepting new patients in a timely way. Post-implementation data showed that only 36% of the pilot unit RNs admitted to not accepting patients in a timely way while 58% of the control unit RNs still admitted that the process discouraged them from accepting patients. Pre- and post-implementation patient satisfaction scores with the admission process demonstrated that four of the five pilot units had significant improvements; one pilot unit did not change. Three of the control units showed a gain in scores and two control units showed a decrease.

Project leaders reported that the overall voluntary turnover rate for the entire hospital fell from 29% and to < 1% following the pilot implementation, though they report that the economy may have significantly impacted turnover. However, there was no change in turnover for the pilot units, while turnover for the control units doubled from pre- to post-implementation.

Project leaders reported the program was a success. Admission Nurses loved the role and felt it was physically less demanding and having an Admission RN increased the unit's ability to meet the needs of the patient. Though budgetary constraints prevented the role from being implemented hospital-wide, two of the pilot units elected to keep the Admission Nurse and changed their staffing matrix in order to accommodate the role.

Baptist Health South Florida (Coral Gables, FL)
Project Title: Nursing Retention: It's a Leadership Thing!

Brief Description: The goal of this project was to create nursing leadership training and development that directly improves direct patient care nursing retention rates at Baptist Health utilizing the Love 'Em or Lose 'Em program, an engagement and retention program widely used by Fortune 400 corporations. Project leaders adapted the program to train participants in issues that directly impact the retention of nurses.

Final Project Outcome: Project leaders held multiple focus groups with nurse managers to acquire qualitative data on specific challenges with nursing retention; Nurse Manager Onboarding, Nurse Manager Development, Nurse Manager Challenges, Retention Challenges, and Retention Strategies were the main themes from the focus groups. Based on these results, the project leaders deployed the following three interventions: Nurse Manager Forums to help nurse managers network with other nurse managers across the hospital system, a Nurse Manager Mentorship Program, and re-designed nurse leadership onboarding. An expert panel of speakers was invited to conduct training at a summit for nursing leaders using the Love 'Em or Lose 'Em program. At the end of the year, the results of the qualitative data gathered was used to create strategies to better support the nurse manager in retaining nurses.

Project leaders reported pre-implementation turnover rates for direct patient care nurses at 15.9% and the vacancy rate at 13.5%. Post-implementation turnover results were reported at 8.41% and vacancy rates were 5.55%. Project leaders noted that other initiatives, implemented at the same time as the grant project, may have contributed to turnover metrics improvement. The economic recession may also have impacted results. However, project leaders reported that this project brought about much needed attention to the development and support of the front line nurse manager which may have contributed to retention and engagement. Furthermore, project leaders reported that it was clear nurse leaders were eager for the opportunity to address their needs as frontline managers. The key lesson learned was that no strategies affecting the nursing workforce should be implemented and deployed without participation of frontline managers.

Florida Hospital Center for Nursing Research & Innovation (Orlando, FL)
Project Title: Managers' Strategic Communication and Nurse Retention

Brief Description: This project aimed to improve nurse managers' communication competencies to foster shared organizational values and increased retention among nurses. The project used nurse manager education to improve managers' practice of Motivational Language (ML), a set of specific strategic communication techniques. Project leaders developed a detailed curriculum in collaboration with the original developers of ML (Drs. Mayfield and Mayfield, A & M University); the curriculum featured increased focus on the acute care setting and nurse managers.

Final Project Outcome: A four-hour workshop was developed and three sessions were conducted with 90 attendees. Two rounds of surveys were conducted, during which nurses rated their managers' use of ML in addition to other information; the response rate was 34.2% and results were presented to workshop participants. The Vice President of Nursing incorporated opportunities for managers to reflect on the use of ML into leadership meetings and leadership stories were used to depict use of ML in practice. A story template was developed to guide storytelling, so that stories could be collected using a common structure. Three follow-up workshop sessions were used to discuss primary ways to effectively put ML techniques into practice.

Though participant ratings of the ML workshops increased over previous non-nursing specific ML pilots, the final report indicated that neither managers' use of ML nor Intent to Leave changed during the project. Project leaders report that the measure of separation rates may not be robust due to measurement issues and/or the fact that the study period was shortened due to unforeseeable delays. Based on analysis of this project, project leaders report that ML Empathetic Language predicts lower intent to leave, less thinking of quitting, and less looking for another job. Project leaders reported that project results demonstrated that intentions to leave or quit do not necessarily translate into actual separations.

A Mindmap was developed in a session subsequent to the final workshop to ensure that all parties were aware of ways motivational language could be used in practice. In addition, a framework on how to communicate change and reflect on actions was developed by a nursing director in combination with the principle investigator. This demonstrates that leadership has found practical ways to embed the use of motivational language in practice with the goal of increasing satisfaction and intent to stay and reducing turnover.

In spite of limited findings, project leaders report that the project was a success and will be continued. Project leaders report that the results suggest that embedding strategic communication requires an ongoing process of culture change and that, in addition to other strategies, workshops may need to be repeated. The reflective exercises for increasing mindfulness and the practice of ML among nurse managers may require regular attention to ensure continued implementation. Additionally, if nursing is adopting a new mindset - for example, a more relational type of leadership founded on values and Motivational Language - it may be essential that other departments that interact with nursing also be adopt this mindset in order to foster the desired culture change.

Workforce Central Florida (Orlando, FL)
Project Title: Sparking Youth Interest in Healthcare Careers: SimMan® Exhibit and Outreach Program

Brief Description: This partnership between Workforce Central Florida and Orlando Science Center kicked off a long-term recruitment initiative by exciting youth about careers in healthcare, particularly nursing, through a demonstration of experiential learning. A portable patient simulation exhibit, SimMan®, was installed at the Science Center and provided a platform for presenting hands-on interactive healthcare scenarios to students connecting them to healthcare workplace settings in a new way.

Final Project Outcome: Project leaders led discussions between the Orlando Science Center (OSC) and Partners for a Healthy Community (PHC), a WCF-funded consortium of hospital, educational, and community partners, to finalize details on exhibit design, panel text, and featured professions. Once careers were selected and labor market information was collected, the OSC then constructed the exhibit and unveiled the SimMan exhibit to the public at the April 2009 Mission Nutrition II: This Time It's Personnel event funded by WCF. In addition to the exhibit, project leaders developed an interactive outreach program for K-12 students. With assistance from members of PHC, OSC developed an age-appropriate program which included role playing by students, a PowerPoint presentation, and a question/answer segment. This pilot outreach program was presented to the freshman class at the Seminole High School Health Academy in September 2009.

From the time the exhibit opened to the public, the total number of OSC visitors (and thus potential exhibit visitors) was 34,099. This number includes the approximately 500 visitors that attended the Mission Nutrition II: This Time It's Personnel event funded by WCF. OSC observed and evaluated visitors to the exhibit during July and August of 2009. Using tick marks, they counted how many visitors approached the exhibit, how many stopped, and how many appeared to attend the exhibit. Of the 80% who stopped at the exhibit, nearly 74% of them attended the exhibit - significantly higher than the industry average of 51%.

During the grant time period, OSC delivered 15 programs onsite and 14 offsite offerings for school groups. These programs, combined with the pilot program at Seminole High School, reached approximately 450 students. Additionally, WCF had plans to fund 47 off-site programs to K-12 students for the 2009-2010 school year, reaching over 2,500 students. OSC received financial support for the K-12 program, and so the number of students reached is expected to grow significantly. Finally, WCF sponsored a summer Medical Career Exploration Camp at OSC for 25 middle-school aged children and provided funding for five children from low-socio economic backgrounds to attend the camp.

With funding from a DOL Community-Based-Job Training grant awarded to Seminole State College, what was once a 4'x 8'x 8' exhibit will now become a 1000-square-foot exhibit with SimMan® as the focal point, a small theatre featuring a stroke scenario movie and kiosks where visitors will learn about the nurses and allied health professionals. This was scheduled to open in spring 2010, and the continuation of the excellent interactive OSC SimMan® onsite and outreach program will ensure that K-12 students will learn the rewards and benefits of becoming a nurse or allied health professional.

Hospice by the Sea (Boca Raton, FL)
Project Title: Caring for the Caregiver, A Holistic Approach to Healing Compassion Fatigue

Brief Description: The deleterious impact of stress faced by nurses who care for seriously ill patients and their families has been well documented. Recently, a Florida State University study found that 80% of hospice and palliative care nurses were at moderate to high risk for burnout and compassion fatigue resulting in increased absenteeism, a significantly compromised sense of well-being and an exodus from the profession. This project piloted a program that combines self-care education and complementary therapies to reduce the impact of stress and compassion fatigue among nurses at the inpatient Hospice CareCenter.

Final Project Outcome: Project leaders administered a self-care survey to assess demographics, complementary therapy (CT) service feedback, self-care and health habits, professional quality of life, and work place environment. Pre-project data on turnover rates and sick days was obtained. Nine self-care lectures were presented twice a month to accommodate both shifts and CEU's were offered; a knowledge survey was administered before and after each lecture. Several different complementary therapies were offered. Massage Therapy volunteers provided 15-20 minute chair massages in the Care Center twice a month, accommodating 12 staff each visit. Reiki/Healing Touch was offered directly at the nursing station and Stress Busters presentations were offered. Practitioners arranged their schedules to offer therapies for both shifts. Multiple yoga class times were offered to accommodate both shifts. A total of 13 50-minute Reiki/HT sessions were delivered to staff. 34 Stress Busters sessions and 107 chair massage sessions were delivered to staff. Levels of stress, pain, and fatigue were assessed before and after therapies.

Overall, the project was successful in regards to complementary therapies. Project leaders reported a significant increase in both day and night shift utilization of CT. Decreases in stress, fatigue, and pain as well as positive comments were reported overall. Staff preferred Stress Busters and Chair Massage because: the practitioner came to them, they did not have to leave the Care Center, and they had the opportunity to relax. There was limited participation in other CT classes. Attendance at self-care lectures was limited however; those who did attend reported increased knowledge on the lecture topic as a result of attending. Staff also provided qualitative feedback. Both chair massage and stress busters positively impacted their work day and increased awareness of the need for self-care. Participation in reiki, healing touch, and massage increased. Additionally, project leaders reported an increase in nursing staff-initiated Reiki/Healing Touch consults for patients, illustrating their recognition of the benefits of these therapies.

Participation decreased in the third quarter. Project leaders reported that a change in leadership likely impacted project participation as well as job satisfaction, as the change significantly impacted the culture and staff expressed concern about how participation in CT activities would be viewed. Project leaders reported that changes in staff morale likely contributed to the decrease in job satisfaction ratings identified in the study. Turnover rates were also higher post-study but were mostly related to staff resigning due to family/health/or career reasons. 46% of staff who participated in CT reported participating in complementary therapy sessions and classes decreased their level of sickness-related work absence.

The organization received the South Florida Business Journal Healthcare Employer of the Year award in recognition of the complementary therapies offered to staff, which contributed to staff recognizing this as a unique benefit at HBTS. Once the Interim Director was acclimated, project leaders identified nurse leaders to serve as advocates of complementary therapies. These individuals began educating and encouraging nursing staff to take time for self-care and participate in CT activities. Project leaders report that this made a significant impact on improving attendance. Additionally, a long-time Care Center RN completed her certification in Healing Touch. In addition to continuing her role as a Care Center nurse, she joined began to provide healing touch. Having an individual with pre-established relationships with the nurses was helpful in increasing interest and participation.