EP11EO Nurses participate in recruitment and retention assessment and planning activities.

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1 EP11EO Nurses participate in recruitment and retention assessment and planning activities. Provide one example of clinical nurses participation in nursing retention activities and the impact on turnover rates. Turnover Rate: BACKGROUND/PROBLEM: SJO s (ECC) is one of the largest and busiest in Southern California with 65 beds and daily patient visits on average. This patient volume variability creates a fast-paced environment that can impact staff decision making and patient-driven outcomes. The size of the ECC and the complexity of its patients challenge management and staff in being able to meet and address staff concerns effectively. In 2013 many organizational changes directly impacted the ECC. The biggest change occurred in the second quarter of 2013 when CHOC Children s (Children s Hospital of Orange County) separated from SJO as a contracted entity. CHOC transitioned from a shared service to a fully licensed, acute care facility and opened its own pediatric Department. This change impacted the volume of pediatric patients seen at SJO and, as a result, created a challenge for SJO to adjust resources to account for the loss in volume. As part of our commitment to the community, SJO nurses, staff and physicians partnered with CHOC to assist in educating their new staff. In addition, job opportunities opened up for SJO staff due to their expertise in pediatric emergency nursing practices. This commitment created both positive and negative challenges for the SJO team. On one hand, the job opportunities ensured that few people as possible would be displaced from SJO; however, this also meant that some very experienced staff was recruited by CHOC. During this same time there were simultaneous changes in key leadership roles within the ECC that resulted in open positions for executive director, manager, and two charge nurses. This created additional stress during the CHOC transition. These constant changes prompted staff to voice concerns to their leaders; they felt that their concerns were not being heard. In addition, the existing Unit-Based Council (UBC) membership diminished as many of its members moved to CHOC and the remaining staff began to withdraw from participating in the UBC. All of these changes proved to be too much for staff, and many began to search for positions outside of SJO. Two leaders were engaged by CNO Katie Skelton, MBA, RN, NEA-BC, to assist with the change process that specifically incorporated clinical nurse input and feedback to address the turnover rate. Sherri Lynne Almeida, RN, Dr.Ph, MSN, Med, CEN, served as an interim ECC director and change consultant, and Robert

2 Garcia, MSN, RN, CMSR, who had extensive experience in St. Joseph Way methodology, served as an interim ECC manager. Sherri and Robert began implementation of short-term goals (implement methods to incorporate staff nurse participation in retention-driven activities and recruit a new leadership team with significant staff nurse input) and long-term goals (develop and implement sustainable staff nurse retention activities). GOAL STATEMENT: Decrease registered nurse turnover rate. DESCRIPTION OF THE INTERVENTION/INITATIVE/ACTIVIT(IES): The following four interventions were implemented between July and September 2013 to decrease RN turnover rates and improve staffing engagement through participation in recruitment and retention decision-making activities: #1 Reinvigorate ECC Code of Conduct short term: In August 2013 the ECC UBC was reorganized and clinical nurses elected a key group of peer champions to redesign and reinvigorate an ECC Code of Conduct. This set of staff-driven expectations served as the foundation for expectations between each other and management for the purpose of driving engagement, satisfaction and ultimately retention. Dixie Stiles MSN, RN, CEN V Co-Chair, UBC Marie Coley BSN, RN, CEN Clinical Nurse II Co-Chair, UBC Amy Soto BSN, RN II Valerie Puruganan BSN, RN, CEN II Nicole Hooper BSN, RN I Leanne Prochnow BSN, RN I Jeff Silberman BSN, RN I Jennifer Johnson Nursing Patient Care James McCray Nursing Patient Care Silveo Vega Nursing Unit Secretary Kathie Mullin Volunteer Volunteer Raj Mittal MD Physician Yvette Boyle BSN, RN, CEN Clinical Coordinator, Robert Garcia MSN, RN, CMSRN Interim Manager

3 #2 Involve staff in leadership selection - short term: In July 2013 front-line ECC nursing staff was selected to participate in the ECC leadership interview process and provide a vote on whom their leaders would be as they embarked on this change process. This had an immediate and direct impact on staff retention as it was made clear to all clinical nurses in the department that their voice was being heard in the direct selection of new leadership for the department. The individuals involved in the searches for a director, manager, and new clinical coordinators included the following participants. Inez White BSN, RN II Amy Soto BSN, RN II Valerie Puruganan BSN, RN,CEN II Stephanie Galan BSN, RN I Leanne Prochnow BSN, RN I Leslie Critz BSN, RN I Laura Derr BSN, RN,CEN II Justin Anderson Nursing Patient Care Lori Shartrand Nursing Unit Secretary James Pierog MD Physician Yvette Boyle BSN, RN, CEN Clinical Coordinator, Robert Garcia MSN, RN, CMSRN Interim Manager #3 Revamp the new graduate residency - long term: In September 2013 the new graduate clinical nurse selection process was revised to specifically identify strong nursing students interested in a career in emergency nursing from the 17 schools that complete their rotations in the ECC. The preceptors met with the department educator and leadership team to provide feedback designed to embrace and enhance clinical performance of the new graduate nurse and allow for modification of the structured ECC residency program to prepare these clinical nurses to come into the ECC. Critical thinking competencies and clinical reasoning skills were addressed through numerous delivery methods such as: e-learning, reformatted on-campus orientation classes, and on-the-job training with focused 1:1 preceptorship training. These modifications would result in a well-prepared clinical nurse upon completion of the orientation process (the long-term goal being improved staff nurse retention.) The following are the participants involved.

4 Name Discipline Title New Graduate Nurse Department Leon Vong BSN, RN,CEN II Jamie Bacani, BSN, RN, Valerie Puruganan BSN, RN,CEN II Christianne Pepitone, BSN,RN, Camille Katigbak MSN,RN,CEN I Sherrie Endo, BSN, RN, Jeanine Cevallos BSN, RN II Belinda Leos, BSN, RN, Leon Vong BSN, RN,CEN II Alain Broulard, BSN, RN, #4 Recognition - long term: In August 2013 to sustain the momentum of these staff-driven activities targeted to improve retention, the UBC developed a celebration plan. The focus of the plan was to keep awareness of all staff on the positive changes being made to improve and maintain retention. A calendar was developed by clinical nurses, and each month activities were planned that reinforced the message that the voice of the clinical nurse had an impact on making positive changes in the practice environment that led to improved clinical nurse retention. Besides the monthly celebrations, a targeted focus to celebrate national events such as Nurses Day and Nurses Week were incorporated into the recognition activities that would eventually add to the processes already initiated and stabilize the staff retention rate by decreasing the voluntary clinical nurse turnover rate. Individuals serving on the retention celebration activities committee include the following. Dixie Stiles MSN, RN, CEN V Co-Chair, UBC Leo Burris BSN, RN I Julie Hensley BSN, RN I Amy Soto BSN, RN II Valerie Puruganan BSN, RN, CEN II Nicole Hooper BSN, RN, CEN I Leanne Prochnow BSN, RN I James McCray Nursing Patient Care Lori Shartrand Nursing Unit Secretary Kathie Mullin Volunteer Volunteer Yvette Boyle BSN, RN, CEN Clinical Coordinator, Robert Garcia MSN, RN, CMSRN Interim Manager

5 OUTCOMES: The combined interventions of changes in department leadership and an increase of clinical nurse involvement in shared decision making resulted in 17.7% reduction in registered nurse turnover rate in the ECC. EP11EO Figure 1 RN Turnover Rate Return to EP home page