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. Implementation of 5 PBPs is described. These address orientation, rewards and recognition, developing a healthy work environment, nurse-physician collaboration, and nursing autonomy. Case studies from several different centers are highlighted. Lessons learned and suggestions for application of the PBPs in other centers are included. METHODS Development of the Nurse Turnover ToolThe percentage of nurse turnover on a quarterly and annual basis was selected to measure retention. Interventions and strategies that resulted in decreased nurse turnover likely would have an impact on and improve other areas in the work environment. Use of Plan-Do-Study-Act and the Rapid-Cycle Model for Improvement Each center prioritized PBPs that were developed by the group and worked to implement these via the model for improvement (Table 1). 1 This process requires the team to set a local aim, identify a measure to track progress, and break down the PBP into a series of smaller changes. Each of these smaller changes then is tested in plan-dostudy-act cycles. On the basis of analysis of what happens when the change is tried on a small scale, the local team takes action to embed further, modify, or abandon the plan for implementing the PBP. The implementation of a given PBP typically requires multiple plan-do-studyact cycles. The following case studies demonstrate application of this method. CASE STUDIES PBP 1: Facilitate Professional Development and Expertise Through Orientation (DeVos Children's Hospital)A successful orientation program that leads to the retention of staff is one that facilitates the new employee's welcome and integration to unit culture and can improve retention. 2,3 Careful evaluation of the program, including feedback from recent orientees and preceptors, is the first step in determining whether changes are needed. The NICU at DeVos Children's Hospital performed such an evaluation and implemented the following changes to the orientation program.Hiring practices at ...

OBJECTIVE. Five NICUs that participate in the Vermont Oxford Network's Neonatal Intensive Care Quality Improvement Collaborative 2002 attempted to identify potentially better practices that would have a directly impact on nurse recruitment and retention. The group identified nurse recruitment and retention as an important initiative for many hospitals that face a nursing shortage.METHODS. The group analyzed information from hospital demographics, literature reviews, process analysis questionnaires, and site visits.RESULTS. The literature review, process analysis questionnaire, and benchmarking with magnet hospitals identified 5 drivers for retention and recruitment. The drivers evolved into 5 potentially better practices that cover orientation, recognition and rewards, work environment, nurse/physician collaboration, and nursing autonomy. The magnet hospitals, which are known to have the highest retention rate and the lowest turnover rate, have many of these potentially better practices in place.CONCLUSION. The 5 practices described herein have the potential to decrease nursing turnover in NICUs.www.pediatrics.org/cgi

Electronic documentation systems have become integral to improving the quality of healthcare, reducing medical errors, and advancing the delivery of evidence-based medical care. A smooth transition from paper charting to an electronic documentation system is challenging. Using quality improvement tools and building on the clinical microsystems concept can assist with a smooth transition. Specific strategies include involving all stakeholders in the development and implementation of the plan, assessing the culture of the department, and identifying processes and patterns that require attention. Specific steps include developing a statement of aim, formulating a specific path to reach the aim, evaluating the progress of implementation, and creating a template for future process improvement. This article describes the process used in one midwestern NICU to implement an integrated electronic documentation system using a clinical microsystems approach and quality improvement methods. Challenges encountered and lessons learned are discussed.