2003 Mean Scores Mean Scores

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Amber Carson
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1 RD 6 Results of the Nursing Staff Satisfaction survey over the last four years and describe trends, interventions implemented, and their impact on nursing practice. As noted in Force 1.8, once the Professional Practice Model was developed for Patient Care Services (PCS), evaluating its effectiveness became an important goal and led to the creation of the first version of the Staff Perceptions of the Professional Practice Environment Survey (SPPPE). In 1999, the SPPPE (refer to OOD 16 for a copy of the survey tool) was first administered to provide an assessment of eight organizational characteristics determined to be important to clinician satisfaction; allow clinicians an opportunity to participate in setting the strategic direction for Patient Care Services (PCS); trend information; receive feedback on PCS goals; identify frequency, preparation and access to resources in managing common patient problems (nursing only) and identify opportunities to improve the environment for clinical practice. The survey data is used to identify strengths, as well as, opportunities, to continuously improve the environment of care for MGH clinicians, patients and families. Survey results for Nursing from are presented in the table below. Detailed information about the analysis of these data is discussed in Force 1.8. Nursing: Organizational Characteristics and Mean Scores 2002 Mean Scores 2003 Mean Scores 2005 Mean Scores 2006 Mean Scores Characteristic N=705 N=763 N=1128 N=1608 Autonomy* ** Clinician/MD Relationships*** Control Over Practice* ** *** Communication* ** Teamwork/Leadership* ** Conflict Management NS Internal Motivation* ** Cultural Sensitivity* ** *= p<.05 between 2002 & 2003 ** = p<.05 between 2002 & 2005 *** =p<.05 between 2003 & 2005 The Senior Vice President for Patient Care andchief Nurse views the SPPPE as a report card for Patient Care Services and uses data to inform the strategic direction for PCS. Data are reported at three organizational levels: Patient Care Services, discipline-specific and unit-level data. 1

2 One important use of this survey is the dialogue that leadership and clinicians engage in around the results of the survey. Identification of improvements that occurred as well as areas for potential change within their practice environment are important outcomes. Multiple strategies used over the years that have proven useful in achieving these goals include: Using results at staff meetings to generate a discussion Identifying areas for change and innovation linking specific strategies to outcomes Trending data over time Evaluating the impact of changes made based on survey results Identifying best practice environments The Senior Vice President for Patient Care and Chief Nurse carefully reviews all data and feedback from staff and presents the data personally in a variety of forums so that clinicians throughout Patient Care Services receive timely results, and more importantly, have the opportunity to share ideas on how to address any issues that were identified. Realistic goals with specific interventions can be identified, implemented and then evaluated over time for effectiveness. MGH Patient Care Services experience with the SPPPE was presented in the article, Development and Psychometric Evaluation of the Professional Practice Environment Scale, in the Journal of Nursing Scholarship, 2004 (attachment RD 6.a). Recognizing that there is the potential for widespread replicability, a link on the PCS website was created to channel inquiries to The Yvonne L. Munn Center for Nursing Research where the resources that support the administration of the SPPPE are housed. To-date, consultation has been provided 29 healthcare institutions nationally and internationally. Internationally, the tool is being used by the University of Ulster in Northern Ireland, University of Western Sydney in New South Wales, the University of Navarra in Pamplona, Spain and most recently translated into Chinese for use at the Chang-Chung Memorial Hospital of Taiwan (attachment RD 6.b). An initiative is currently underway to contact all the institutions currently using the SPPPE tool to obtain their data so that cross-institutional results can be generated. The MGH address to obtain more detailed information for the PPE is: What follows is a sampling of issues and concerns identified through the SPPPE survey since it s inception with respective interventions and outcomes. 2

3 SPPPE Survey Issue Identified (survey year) Need for recognition of clinical work (1998) Requests for additional educational opportunities (1998) Improve access and communication within Social Services (2000) Concerns identified with supplies and linen (2000) Need for more inservices on various cultures to deliver culturally competent care (2001) Request for increased Nursing Director availability (2001) Need to enhance communication (2002) Request for cultural sensitivity discussions in Social Services (2003) Concerns identified regarding support from the Department of Food and Nutrition ( ) Common Patient Problems* ( ) Interventions/Outcomes The Senior Vice President and Chief Nurse charged the Professional Development Committee within Collaborative Governance with the responsibility to design an interdisciplinary recognition program. The first-of-its kind interdisciplinary Clinical Recognition Program was implemented in 2002). The Center for Clinical & Professional Development was expanded to include orientation, training and continuing education opportunities for clinical and support staff. Beepers assigned to all Social Workers. Materials Management/Nursing Task Force established. The Culturally-Competent Lecture Series was launched to augment the day-long culturally-competent care curriculum offered by The Center for Clinical & Professional Development. Developed unit/department culturallycompetent care resource manuals. Nursing Director span-of-control was analyzed and reduced. Numerous communication strategies employed: - Increased use of to improve communication - Creating the Fielding the Issues column in Caring Headlines (a question and answer column presenting timely information) Establishment of a Cultural Competence Committee to explore issues and assess learning needs within the Department regarding cultural sensitivity. Food and Nutrition/Nursing Task Force established. Interventions occur at the unit level led by unit-based CNSs. Examples include: Pain management (standard was articulated; CNS was hired). Skin care (wound care task force/education program launched 3

4 SPPPE Survey Issue Identified (survey year) *nursing only Request for assistance re: public speaking and talking to the media (2004) Request for conflict resolution skills training ) Need to identify strategies to support the aging nursing workforce (2006) Interventions/Outcomes Respiratory care (tracheostomy rounds implemented Presented findings of SPPPE Common Patient Problem Survey at the National Association of Clinical Nurse Specialists NACNS). Subsequently, the survey was completed nationally by the NACNS membership to determine common patient problems on the national level. Launched media and public speaking programs through The Center for Clinical & Professional Development The program, Workforce Dynamics: Skills for Success was launched through The Norman Knight Nursing Center for Clinical & Professional Development to present information/skills to work with a multigenerational workforce, negotiation, and preparing for and effectively engaging in difficult conversations. Focused conflict resolution interventions implemented (Refer to Force 13.17). Multi-site qualitative study designed to explore concerns of the aging nursing task force (with University of Michigan Health Care System and Shands at the University of Florida). Results are currently being analyzed. Applied for and received a grant ($10,000) from the Center for Integration of Medicine & Innovative Technology (CIMIT) to host a summit to more fully explore the opportunities to support the aging nurse population with emerging technologies. The coming of age summit will be held on November 15, 2007 (attachment RD 6.c). 4

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The relationship and collaboration between the nurse, patients, families and other providers, enhances problem-solving and promotes dialogue and

The relationship and collaboration between the nurse, patients, families and other providers, enhances problem-solving and promotes dialogue and OOD 14 Theoretical/practice framework(s) stylized within the nursing services that structures various aspects of professional practice (e.g., patient care, nursing research, staff development, and performance