Published online November 1, 2006
PEDIATRICS Vol. 118 Supplement November 2006, pp. S141-S146 (doi:10.1542/peds.2006-0913K)
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ARTICLE


Implementation and Case-Study Results of Potentially Better Practices for Staffing in Neonatal Intensive Care Units

Joan Rikli, RN, MS, CPNPa, Pat Hegwood, RN, BSN, MAb, Amy Atwater, RN, BSNa, Barbara Bauman, RN, BSN, MS, MPAc, Betty Beverly Brown, RN, MSHAd, Pat Carteaux, RNe, Elaine Hartmann, RN, MS, NNPb, Shadin Hilton, RNf, Laura Michael, RNe, Lori Norton, RN, BSe, Joel Secrest, MDe, Pam Sprague, RNf and Paul Plsek, MSc

a Neonatal Center, DeVos Children's Hospital, Grand Rapids, Michigan
b Neonatal Intensive Care, Children's Hospital of Illinois at OSF St Francis Medical Center, Peoria, Illinois
c Vermont Oxford Network, Burlington, Vermont
d Neonatal Unit, Jackson-Madison County General Hospital, Jackson, Tennessee
e Neonatal Intensive Care Unit, Parkview Hospital, Ft Wayne, Indiana
f Baylor University Medical Center, Houston, Texas

Objective. Five NICUs that participate in the Vermont Oxford Network Quality Improvement Collaborative have implemented several potentially better practices in an attempt to decrease nurse turnover by 50%. These potentially better practices focus on orientation, rewards and recognition, healthy work environment, nurse–physician collaboration, and nursing autonomy.

Methods. Each unit implemented some or all of the potentially better practices. An Excel spreadsheet tool for tracking turnover rates was developed and used to measure the impact of the potentially better practices on retention. Rates were measured quarterly.

Results. After implementation of the potentially better practices, turnover rates fell at all of the NICUs ranging from 13% to 64%.

Conclusions. Nurse retention is multifactorial. Implementation of the potentially better practices had a positive influence on nurse satisfaction but a varied impact on nurse retention. The impact of larger issues such as pay and staffing levels is significant and may not be influenced at the unit level.

Key Words: nurse retention • turnover • orientation • recognition and rewards • work environment • collaboration • autonomy

Abbreviations: STARS—Staffing Turnover and Retention Strategies • PBP—potentially better practice

Accepted Jul 18, 2006.