HealthJune 06, 2023

A dual role nurse initiative to combat burnout raises retention

Burnout is a national risk facing healthcare workers and especially nurses practicing in complex care.

A cardiothoracic intensive care unit (ICU) at a large teaching hospital in Southwest Michigan implements a dual-role nurse pilot project whose intent it is to tackle the health system’s high turnover rate to offset costs for orientation and advanced training of every new nurse. The multi-year initiative sheds light on burnout, a national factor facing healthcare workers ─ and especially nurses whose patients require a high complexity of care.

Contributing factors leading to nurse burnout

For nurses, there are multiple contributing factors that lead to burnout, many of which were heightened by the COVID-19 pandemic. Included among these are high physical and psychological demands handling patients and families; increased patient acuity and the complexity of care provided;  added pressure and workload; and difficult-to-retain areas of support such as environmental services, nutrition services, and nurse technicians.  

In our post-pandemic world, authoritative sources reveal national data showing a disturbing effect related to the nursing shortage crisis. The statistics bring increased attention to a long-standing workforce problem and include:

The national data are telling, and illustrate what Spectrum Health’s Cardiothoracic Cardiac Care Unit (CCU) in Southwest Michigan was confronting: an all-time high level of burnout. The large teaching hospital and not-for-profit system’s Cardiothoracic ICU is a 22-bed CCU that provides care for critically ill medical and surgical cardiology and thoracic patients.

Testing a dual-role initiative to increase engagement and satisfaction

In an article in Nursing Management®️, Spectrum Health’s Cardiothoracic ICU averaged 25.7% nursing turnover. In 2018, the average cost of orientation for this unit was $800,000. This cost incurred by the unit was spent on educating and orienting new hires. The expense was one of many factors, including the high complexity of care, which propelled the leadership team to develop a dual-role initiative.

According to the article, the pilot project’s hypothesis was that full-time employees would benefit from a change in clinical setting, leading to increased engagement and job satisfaction. A dual-role is an employee who will work a portion of their FTE (full-time equivalent) in two different clinical units; in this instance, various departments, including the emergency department, labor and delivery (L&D), outpatient surgical services, and more, collaborated to create a dual role with Cardiothoracic ICU. The method allowed the employee to practice in ICU shifts to maintain their nursing competencies.  

Prior to the 2019 launch, leaders developed guidelines outlining their expectations for the employee, as well as the nurse’s expectations from the team. To support the nurse’s successful transition to the dual role, throughout the project leaders met with the employee and team members for feedback and shared learnings.

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Seven benefits of the dual-role approach 

During the dual-role pilot study period of 2018-2021, several successful outcomes emerged:

1. Increased job satisfaction

A team member shared the benefits of the dual role, which included a balance of chaotic environments, a decrease in moral distress and compassion fatigue, and an overall increase in job satisfaction. From a leader’s perspective, improved collaboration and enhanced staffing flexibility were advantages.

2. Reduced turnover

The Cardiothoracic ICU experienced decreased turnover among nurses in the dual role. Survey feedback illustrated a decrease in overall intent to leave and increased job satisfaction. The initiative allowed nurses to “mix up” their nursing care and their scheduled shifts in a week.

3. Enriched level of care and boosted confidence

Building on skills that may not be identical yet complement the overall nursing process was an advantage. Nurses with a dual role in the ICU and L&D offered an enriched level of care to a pregnant woman needing ICU support. Discussions with dual-role nurses revealed their ability to provide a dynamic level of care to different patient populations, which enhanced their overall confidence in caring for a wide range of patients.

4. Attracted younger generation of nurses

The dual role appealed to the younger generation of nurses entering the workforce who have an affinity for flexibility and constant growth. Offering variety and flexibility is vital to recruitment and retention. Providing the dual-role opportunity allows the nurse to become engaged in multiple areas and see things from a broader perspective.

5. Supported healthcare system’s needs

Operationally, the dual role supported the fluidity of the organization’s needs. When surgeries were canceled due to the increase in patients, staff with dual roles in surgical services were easily reallocated to the inpatient setting. The ability to flex these nurses to areas with the greatest needs was critical to staffing success during a surge.

6. Enhanced staffing flexibility

Before the pandemic, the dual-role initiative allowed staffing flexibility when census or acuity grew in one area vs another. If L&D had a higher-than-normal census, the team could call the Cardiothoracic ICU to request help from their dual-role employee. This flexible staffing also reaped financial benefits since the department wasn’t canceling staff when another department offered overtime and payment incentives.

7. Promoted collaboration and growth

Strong relationships were fostered with multiple departments through continuous collaboration. Dual-role clinical nurses worked in different areas beyond critical care to strengthen their professional growth and development. 

To learn more, read the full article in Nursing Management®️.

Read The Article In Nursing Management
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