title: Implementation and case-study results of potentially better practices for staffing in neonatal intensive care units.
abstract: 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.
authors.affiliation: Neonatal Center, DeVos Children's Hospital, Neonatal Center, 100 Michigan St E, Grand Rapids, MI 49503, USA. joan.rikli@spectrum-health.org
authors.forename: Joan
authors.initials: J
authors.lastname: Rikli
authors.forename: Pat
authors.initials: P
authors.lastname: Hegwood
authors.forename: Amy
authors.initials: A
authors.lastname: Atwater
authors.forename: Barbara
authors.initials: B
authors.lastname: Bauman
authors.forename: Betty Beverly
authors.initials: BB
authors.lastname: Brown
authors.forename: Pat
authors.initials: P
authors.lastname: Carteaux
authors.forename: Elaine
authors.initials: E
authors.lastname: Hartmann
authors.forename: Shadin
authors.initials: S
authors.lastname: Hilton
authors.forename: Laura
authors.initials: L
authors.lastname: Michael
authors.forename: Lori
authors.initials: L
authors.lastname: Norton
authors.forename: Joel
authors.initials: J
authors.lastname: Secrest
authors.forename: Pam
authors.initials: P
authors.lastname: Sprague
authors.forename: Paul
authors.initials: P
authors.lastname: Plsek
mesh_terms: D017144:Focus Groups; D006801:Humans; D007318:Inservice Training / Q000379:methods; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration*; D007588:Job Satisfaction; D017283:Neonatal Nursing; D010561:Personnel Staffing and Scheduling; D010563:Personnel Turnover; D019555:Physician-Nurse Relations; D017009:Professional Autonomy; D011785:Quality Assurance, Health Care; D012201:Reward; D014481:United States; D017132:Workplace