Reducing Nurse Burnout Using a Psychiatric Acuity Tool

Abstract

Problem and Purpose: The setting for this quality improvement project was an inpatient psychiatric unit at a large, urban medical center. In 2022, this unit lost 30% of its nursing staff, leading to significant under-staffing. Exit interviews indicated that nurses were seeking new employment due to excessively high levels of acuity on the unit and subsequent nurse burnout. A literature review found that acuity tools may increase satisfaction among nurses and can be useful in mitigating sentinel events. This Quality Improvement (QI) project implemented an evidence-based tool to assess and manage acuity with the intention of decreasing nurse burnout and seclusion and restraint events. The project was implemented over a 15-week period in the Fall of 2023. Methods: The Project Lead mobilized an interdisciplinary team of invested stakeholders at the project site to integrate the Vanderbilt Acuity Tool (VAT) into the mandated charge nurse documentation each shift. New protocols included scoring the VAT each shift and communicating the score during handoff to the oncoming charge nurse and during discussions with the admitting physician, nurse manager, and admissions officer to ensure all relevant stakeholders were aware of the acuity levels in the context of the ability to continue taking admissions. Results: Seclusion and restraint incidence showed significant variability with no interpretable trends. There was a 20% decrease in emotional exhaustion scores (consistent with overall decrease in burnout), a 29% decrease in depersonalization scores (consistent with overall increase in burnout), and a 5% decrease in personal accomplishment scores (consistent with overall increase in burnout). Informal feedback from nurses suggests staff were largely satisfied with the tool’s applicability and usefulness, however the compliance rate for completion of the VAT was only 56.5%. Conclusions: There was an overall decrease in nurse burnout following the intervention period, suggesting the VAT may have been useful in managing acuity and subsequently decrease nurse burnout. The VAT did not, however, have a measurable impact on seclusion/restraint incidence. Data supports the conclusion that the VAT may be a successful way to measure acuity, however further research is needed to determine how to better integrate the VAT into the nurse workflow. Keywords: nurse burnout, acuity, acuity tool, seclusion, restraint