Quality Improvement Project to Increase Meaning and Joy at Work and Reduce Nursing Turnover

Abstract

Problem and Purpose: Nationwide, nursing turnover is 23%. Chronic fatigue, low meaning and joy at work are high contributors. On a 30 bed Medical Surgical (MSU) the turnover rate was 30%. The purpose of this quality improvement (QI) project was to assist nurses to identify and eliminate barriers to achieving meaning and joy at work with a goal of reducing turnover. Methods: Project launched with the Meaning and Joy at Work Questionnaire (MJWQ) presurvey (two supplemental questions about Intent to Leave), followed by focus groups, action plans and a post intervention MJWQ. Turnover was measured monthly. Results: Of the 45 eligible nurses on MSU, 38% completed the pre-survey. The highest percentage of nurses completing the survey indicated no intent to leave their position, 47.1% or the profession in the next year, 94.1%. Many of the MJW questions scored positively, with most staff reporting they agree or strongly agree. Resulting interventions included staff recognition, coordination with departments to ensure supply delivery, and launching a Disruptive Behavior Policy. Post-Survey: Of the 45 eligible nurses, 17.8% completed the post-survey. Scores decreased in areas of feeling respected and meaning for the work, all other questions improved. The Intent to Leave data showed a 28% increase in staff indicating they did not intend to leave, a total of 75.1%. A slight increase in staff reporting they would leave the profession within the next year, from 5.9% pre to 12.5% post intervention. Turnover decreased over several months to 26.94%, and then 23.35%. Conclusions: Reasons nurses find meaning and joy at work are a sense of purpose and being present for patients. Teamwork, support and adequate staffing drive a sense of purpose. Facilitated focus groups provide nurses with an opportunity to explore perceptions of meaning, joy at work and to identify barriers. Barriers include staffing, resources, communication recognition, and disruptive behavior by patients and families. Staff and leadership interventions that address barriers are an effective tool to improve meaning, joy and reduce turnover.