Implementation and case-study results of potentially better practices for staffing in neonatal intensive care units.

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.