Abstract Body: Background and Issues
A neurovascular intensive care unit (ICU) had a large volume of employee turnover associated with burnout and moral distress. Literature suggested nurses caring for stroke patients experienced significant moral distress and secondary traumatic stress injuries. ICU leadership implemented a combined approach of Schwartz Center Rounds (SCR) Stress First Aid (SFA) and American Association of Critical-Care Nurses (AACN) 4-As methodology to support and improve staff resiliency.
Purpose
Would employees experience decreased moral distress, improved sense of resiliency, decreased burnout, and decreased turnover through a combined implementation of the SCR SFA and AACN 4-A’s process?
Methods
SFA and 4-As models were selected because they both aligned with project goals. They guided support for and educated on how to support one another. Models were launched one month apart via computerized learning modules. All employees were educated, but the measures focused on nursing. Techniques used for ongoing educational support included:
-Monthly newsletters
-Self-care and stress reduction tactics
-Awareness of hospital resources, including crisis resources
-Quarterly Mobile Town Hall: Unit rounding with therapy dogs, education, snacks, senior directors, chaplaincy, and employee assistance program director
Results
The annual employee engagement survey used a numeric rating scale of 0-5. The statement specific to this project was “This facility helps me deal with stress and burnout”. In fiscal year (FY)2021, the ICU scored 2.43. In FY2022, the score improved to 2.53. Unfortunately, the survey question changed in 2023 to “The amount of job stress I feel is reasonable”, so an equal comparison could not be made. The score for FY2023 was 3.06.
Turnover rates decreased from a high of 32.76% to a low of 26.87% one year following implementation.
Conclusions
Implementation of SFA and 4-As skills improved resiliency and the unit benefited in decreased turnover. Lessons learned included implementing both programs during the onboarding process and leadership role-modeling to support enculturation.
Initially, staff felt awkward approaching one another. Use of case studies would have improved confidence and comfort in approaching peers about their stress level.
A comprehensive list of hospital resources was essential.
Senior Directors played a valuable role in modeling new behaviors, increasing frontline visibility, budgeting, and supporting efforts.