Julie Holt, director of patient services at Jewish Hospital in Cincinnati, was walking through the parking garage on her way into work about two years ago.
"One of the (registered nurses) from night shift was coming out," Holt says. "She stopped me and told me what a terrible night it was, and that people were talking about leaving."
Those "people" were mostly a cadre of newly hired licensed practical nurses brought in to staff a then-brand-new, 40-bed telemetry/pulmonary-care unit. The 200-bed hospital thought it had adequately educated and integrated the LPNs into the unit, but confusion over roles and practical problems like disorganized supply closets had given the unit "a reputation as a toxic place to work," says Vickye Payton, an education specialist.
Through focus groups, problems bubbled up and an Outstanding Work Life (OWL) team composed of RNs, LPNs and others was formed to address the issues. This effort has led to Jewish earning an honorable mention in the Spirit of Excellence Award for Team.
"I wouldn't say we were shocked by anything that came up in the focus groups," says Gina Witko, clinical coordinator and team lead. "They reflected what was said anecdotally in the garage."
Adds Betty Mitchell, nurse manager of the unit, "It wasn't necessarily personal issues. They were trying to learn a new unit, a new computer system and a new relationship with their peers."
The OWL team achieved quick wins on some of the practical issues and created momentum to tackle the confusion about roles over a period of several months. Results have included a drop in vacancies from 21 to nine, the decision not to resign from previously disgruntled LPNs, and requests to work on the unit from student nurses and floaters.