Abstract

The purpose of this project is to improve the retention of nurses and enhance patient care that is directly related to nursing activities in six hospital partners in rural and HRSA Bureau of Health Professions (BHPr) designated ?Nurse Shortage Counties? in Pennsylvania. The objectives are to: (1) to increase collaboration and communication among nurses and other health care professionals, (2) increase nurse involvement in the organizational and clinical decision making processes, and (3) increase cultural sensitivity and competency toward patients and other staff. While research informs us that these organizational features are associated with positive outcomes, we know little about ?how to make it happen? and less about ?how to make it stick?. Goal attainment will benefit rural and underserved populations, by preserving health system capacity through stabilization of the nurse workforce. Based on partner hospitals? 2003 statistics, this project has the potential to impact 1,937 RNs and 55,647 patients in rural counties and in BHPr-designated ?Nurse Shortage Counties? in PA. This impact will be demonstrated across all Healthy People 2010 objectives, most of which rely on a competent and stable health work force for their achievement. The University of North Carolina at Chapel Hill, the Pennsylvania State Department of Health--Bureau of Health Planning, and the Hospital & Health-system Association of Pennsylvania have formed a coalition to achieve the project goal. The study uses an innovative set of change strategies including positive organizational change concepts such as self-assessments, appreciative inquiry interviews, learning collaboratives, mentoring by magnet hospitals (hospitals known for attracting and retaining nurses and excellent patient care), and networking. Formative and summative evaluations will be conducted to assess project impact on nurses (satisfaction, burnout, and intent to stay); five core measures of nurse retention (vacancy rates, retention rates, voluntary turnover, and days to fill a vacant nursing position); and four core indicators of the quality of patient care (patient satisfaction, and nurse reports of quality, and frequency of adverse events [e.g., wrong medication or wrong dose]). Data were collected at baseline and then annually for 5 years. Trends over time in each hospital will be examined. Case studies will identify the change process within each hospital. Outcomes will be compared with the PA Department of Health data, other PA nurse studies, and magnet hospital research findings. Project deliverables include tools and assistive devices to increase communication/collaboration, nurse decisional involvement, and cultural sensitivity and competency. This project will add to the understanding of how hospitals can enhance patient care and nursing work, and serve as a model for replication and as the ?Tipping Point? for better nursing work and better patient care.