Reducing Employee Injury Rates with a Hospital-wide Employee Safety Program.

Introduction: Despite the well-known dangers of working in the healthcare industry, healthcare organizations have historically accepted workplace injuries as business as usual. In 2017, Children's National Hospital began our Employee and Staff Safety program to drive down the employee injury rate and address this disturbing industry trend. Methods: With guidance and support from executive leadership, we created an Employee and Staff Safety program that aligned employee safety work with existing patient safety and quality improvement efforts. Team leads collected and analyzed baseline employee injury data and identified areas of highest injuries. Dedicated subcommittees focused on five specific areas: slips, trips, and falls; sharps injuries; blood and body fluid exposures; verbal and physical violence; and overexertion injuries. Subcommittees established aims, identified key drivers, and brainstormed interventions for tests of change. Results: Because the inception of the Employee and Staff Safety program, Children's National has seen significant reductions in our Days Away Restricted or Transfer (DART) rate. The DART rate shows a sustained 37% reduction since the baseline period of FY16-FY17 (1.48 injuries/200,000 h worked to 0.93 injuries/200,000 h worked). The regression trend shows a significant decrease (38.3%) in DART injuries, from 1.544 to 0.952 over 56 months; P = 0.016. Conclusions: Active leadership support and analyzing data on specific employee harm areas coupled with targeted interventions, helped improve Children's National's DART rate. The Employee and Staff Safety program's success in utilizing patient safety and quality improvement tools creates a generalizable framework for other hospitals to advance their high-reliability journey.

Creating a career legacy map to help assure meaningful work in nursing.

When nurses declare a professional legacy (or what they intend to be better in health care because of their efforts), they are likely to maintain a focus on achieving their legacy and to experience meaning in the process. We depict the legacy and involved steps in creating a legacy map, which is a concrete guide forward to intended career outcomes. Informed by the "meaningful work" literature, we describe a legacy map, its function, the process to create one, and the application of a legacy map to guide careers. We also describe an administrative benefit of the legacy map-the map can be used by team leaders and members to secure needed resources and opportunities to support the desired legacy of team members. Legacy mapping can be a self-use career guidance tool for nurses and other health care professionals or a tool that links the career efforts of a team member with the career support efforts of a team leader.

Patient safety, error reduction, and pediatric nurses' perceptions of smart pump technology.

Patient safety and error reduction are essential to improve patient care, and new technology is expected to contribute to such improvements while reducing costs and increasing care efficiency in health care organizations. The purpose of this study was to assess the relationships among pediatric nurses' perceptions of smart infusion pump (SIP) technology, patient safety, and error reduction. Findings revealed that RNs' perceptions of SIP correlated with patient safety. No significant relationship was found between RNs' perceptions of SIP and error reduction, but data retrieved from the pumps revealed 93 manipulations of the pumps, of which error reduction was captured 65 times.

Effects of leadership characteristics on pediatric registered nurses' job satisfaction.

Job satisfaction levels among registered nurses (RNs) influence RN recruitment, retention, turnover, and patient outcomes. Researchers examining the relationship between characteristics of nursing leadership and RN job satisfaction have treated RNs as a monolithic group with little research on the satisfaction of hospital-based pediatric RNs. This study assessed the relationship of transformational and transactional nursing leadership characteristics and RN job satisfaction reported by pediatric RNs. This single site study included 935 hospital-based pediatric RNs who completed validated survey items regarding nursing leadership and job satisfaction. A structural equation model (SEM) was applied to assess how autonomy (transformational leadership) and distributive justice (transactional leadership) influence RN job satisfaction, and how RN socio-demographic characteristics influence job satisfaction via autonomy and distributive justice. Findings revealed that both autonomy and distributive justice had significant positive effects on RN job satisfaction but the largest source of influence was autonomy.

Implementing and sustaining evidence-based nursing practice to reduce pediatric cardiopulmonary arrest.

Rapid response teams (RRTs) improve outcomes for patients through early escalation of care. However, subtle signs of clinical deterioration in children may not be consistently recognized by the bedside acute care nurse and therefore the RRT may not be activated. The Pediatric Early Warning Score (PEWS), an evidence-based tool, provides nurses with a mechanism for early detection using quantitative data. We describe our process and outcomes of implementing and sustaining the use of PEWS at the unit and organizational level using the Plan-Do-Check-Act methodology for performance improvement. Our outcome data indicate that cardiopulmonary arrests were reduced by 31% at the pilot unit level and subsequently 23.4% at the organizational level. Data also suggest that bedside nurses effectively escalated patient care needs without activating RRTs (19.4% reduction in RRT activations after PEWS implementation). Strategies to sustain the positive outcomes of PEWS at the unit and organizational levels are also described.