Nursing working style

1. Increasing Nursing
Satisfaction in a local
critical care unit


2. Edith Ogletree
Senior Project
Nursing 452
Melody Church
Lees McRae College

3. Purpose Statement
 The purpose of this project was to increase nursing satisfaction in a local critical care unit using
evidence base research.

4. Validating the problem
 Job dissatisfaction is strongly associated with nursing turnover.
 Evidence of the impact of healthy work environments on nurses and patients.
 Research shows decrease in patient ratio can decrease mortality rate in patients.

5. Why should we increase
satisfaction?
 In the case of this local CCU, the manager of the Telemetry unit was assigned to manage the critical
care unit after the resignation of the current manager. This change in management was an attempt to
stretch the budget but made communication much more challenging considering the added
responsibility of managing two units. The management styles of the current and former managers
differed greatly, and staff that was accustomed to having their issues addressed in a timely manner,
were forced to accept delays in response times.

6. Why should we strive
 When we strive to increasing satisfaction for nursing we can see improvement in patient care,
improve morale, and staff will want to stay longer in their positions held.
 Burn-out and fatigue can make it impossible to manage with their jobs. Nurses whom feel
overwhelmed tend to leave their field altogether. Burnout is a problem in all areas of nursing.
CCU nurses are noted to be more affected due to the state of patients critical needs.
Burn-out

7. Literature review
 The literature review presented three interventions that could be used to increase nursing
satisfaction in a local critical care unit.Aliterature search was conducted using the CINAHL online
database to find evidence for interventions that could increase nursing satisfaction in a local critical
care unit. Inclusion criteria were English resources from a healthcare discipline.
 Main search terms used were burnout in CCU to increase satisfaction in nursing. Secondary terms
included systematic reviews and random control trials and research.
 The search resulted in three articles. Publication years ranged from 2009 to 2014 including one
from 2009 one 2013, and 1 2014. All of the articles were from United States. One article was
nursing discipline and two from nursing and medicine disciplines. One article was a random
control trial single study experimental. One discipline was from nursing and two from both
medicine and nursing. Two articles were systematic reviews randomized control trials. One article
was a mixture of quantitative and qualitative descriptive. Hierarchies of evidence levels for these
articles included two level I, and one level IV (Melnyk & Fineout-Overhold, 2010).

8. Research-based intervention
 Three interventions that could be used to increase satisfaction in a local critical care unit
were found in the resources. Interventions included: 1) decreasing burnout, 2) team work,
and 3) improving work environment and job retention.

9. Intervention
 Survey was given to Nursing staff and management. Data was collected over three week time
period.All information remained anonymous. Short questions were given for time management
reason ; to encourage more interaction with staff.
 Surveys were collected in a locked box. Only the person given survey were allowed to remove and
see answers.

10. Addition information
 TeamSTEPPS- was used by the hospital to encourage team building, communication with staff.
This was a mandatory class.
 TeamSTEPPS –staff and encourage to use techniques daily.
 TeamSTEPPS- definition is debriefing in an informal session designed to improve communication
and teamwork between staff (AHRQ,2014)

11. Implementation
 Lewin’s Three-Step Change Theory will be used for this project (Kritsonis, 2004). Lewin’s theory
focuses on the identification of forces for and against change and using the three-step mold to “help
shift the balance in the direction of planned change”(p.1).

12. Implementation
 A force-field analysis is necessary to determine forces that affect change. Driving forces promote
change, and restraining forces restrict or inhibit change. Driving forces include the desire to provide
the highest level of satisfaction in nursing. Restraining forces would be increased the workload and
decrease satisfaction and burnout in nursing and staff unable to agree with guidelines promoted by
survey and committee.
 The first step is to ‘unfreeze’the current state by increasing driving forces and decreasing the restraining
forces. This can be done by building trust and acknowledgment of the importance of change, and allowing
the group to participate in decision-making. Nursing and Nurse Managers will receive information on
techniques and have the opportunity to provide a recommendation for decrease burnout and increasing
nursing satisfaction. The second step is ‘movement’ toward change through persuading participants that the
status quo is not beneficial and encourages them to work together. As a group, the nurses will work toward
a new way to decrease problems, and connect with Committee views with respected leaders who support
change.An in-service on guidelines will be provided to nursing staff and nursing management. Education
on the need to decrease burnout in nursing; while retaining staff and increasing satisfaction will be
emphasized during this study. The guidelines will emphasize why and what is needed and how to
accomplish these needs. The third step is ‘unfreezing’ to allow change to sustained long term through
reinforcement of formal and informal mechanics. The nurses will be evaluated, and education will be
provided to help promote positive outcomes for staff.

13. Checklist for survey
 Survey for Nurses in CCU please circle your answer
 Let’s examine what survey respondents had to say, starting with the “big picture” question: Overall, how do you rate
your job satisfaction in your present position? Using a 1-to-5 scale
Satisfied, somewhat satisfied, neither satisfied or not satisfied, not satisfied
 1-Looking at the big picture
 2-Professional practice environment: Do you get the respect you deserve?
 3-Does management have your back?
 4-Staffing levels: Akey controversy •
 5-Breaks and overtime (do you receive adequate compensation)

14. Evaluation
 In order for the survey to work in the CCU unit, nurses were asked to give their honest opinion in
the survey.
 There has been an improvement in morale in unit. Nurses are communicating more with each other.
Not sure if it has anything to do with mandatory seminar but staff do seem happier. This is
improvement for the unit.
 Management is listening more to staff about unit needs.

15. Conclusion
 The use of the survey has made an impact on the unit. The tool can help increase nursing
satisfaction in a local critical care unit. The nurses were given a chance to reflect on feedback. The
cost was minimal to paper use. The combination of the mandatory seminar from the hospital
probably help with increase of morale and teamwork. The tools are cost effective and can be
preformed by any staff member.

16. Recommendations
 I would recommend all nursing to incorporate some type team building tool in their practice.
Satisfaction is very important for everyone. Everything nurses do effect patient care. If satisfaction
can be improve then patient satisfaction can be improved also.