RD 6 Results of the Nursing Staff Satisfaction survey over the last four years and describe trends, interventions implemented, and their impact on nursing practice.

As noted in Force 1.8, once the Professional Practice Model was developed for Patient Care

Services (PCS), evaluating its effectiveness became an important goal and led to the creation of the

first version of the Staff Perceptions of the Professional Practice Environment Survey (SPPPE). In

1999, the SPPPE (refer to OOD 16 for a copy of the survey tool) was first administered to provide

an assessment of eight organizational characteristics determined to be important to clinician

satisfaction; allow clinicians an opportunity to participate in setting the strategic direction for Patient

Care Services (PCS); trend information; receive feedback on PCS goals; identify frequency,

preparation and access to resources in managing common patient problems (nursing only) and

identify opportunities to improve the environment for clinical practice. The survey data is used to

identify strengths, as well as, opportunities, to continuously improve the environment of care for

MGH clinicians, patients and families.

Survey results for Nursing from 2002 – 2006 are presented in the table below. Detailed

information about the analysis of these data is discussed in Force 1.8.

Nursing: Organizational Characteristics and Mean Scores

2002 Mean Scores

2003 Mean Scores

2005 Mean Scores

2006 Mean Scores

Characteristic N=705 N=763 N=1128 N=1608 Autonomy* ** 3.1 3.2 3.2 3.1 Clinician/MD Relationships*** 3.0 3.1 3.1 3.0 Control Over Practice* ** *** 2.9 3.0 3.1 3.0 Communication* ** 2.9 3.1 3.1 3.1 Teamwork/Leadership* ** 2.8 2.9 2.9 2.9 Conflict Management NS 2.7 2.7 2.7 2.7 Internal Motivation* ** 3.4 3.5 3.5 3.5 Cultural Sensitivity* ** 3.1 3.2 3.2 3.2

*= p<.05 between 2002 & 2003 ** = p<.05 between 2002 & 2005 *** =p<.05 between 2003 & 2005

The Senior Vice President for Patient Care andChief Nurse views the SPPPE as a “report

card” for Patient Care Services and uses data to inform the strategic direction for PCS. Data are

reported at three organizational levels: Patient Care Services, discipline-specific and unit-level data.

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One important use of this survey is the dialogue that leadership and clinicians engage in around the

results of the survey. Identification of improvements that occurred as well as areas for potential

change within their practice environment are important outcomes. Multiple strategies used over the

years that have proven useful in achieving these goals include:

♦ Using results at staff meetings to generate a discussion

♦ Identifying areas for change and innovation linking specific strategies to outcomes

♦ Trending data over time

♦ Evaluating the impact of changes made based on survey results

♦ Identifying best practice environments

The Senior Vice President for Patient Care and Chief Nurse carefully reviews all data and

feedback from staff and presents the data personally in a variety of forums so that clinicians

throughout Patient Care Services receive timely results, and more importantly, have the opportunity

to share ideas on how to address any issues that were identified. Realistic goals with specific

interventions can be identified, implemented and then evaluated over time for effectiveness.

MGH Patient Care Services’ experience with the SPPPE was presented in the article,

Development and Psychometric Evaluation of the Professional Practice Environment Scale, in the

Journal of Nursing Scholarship, 2004 (attachment RD 6.a). Recognizing that there is the potential for

widespread replicability, a link on the PCS website was created to channel inquiries to The Yvonne L.

Munn Center for Nursing Research where the resources that support the administration of the SPPPE

are housed. To-date, consultation has been provided 29 healthcare institutions nationally and

internationally. Internationally, the tool is being used by the University of Ulster in Northern Ireland,

University of Western Sydney in New South Wales, the University of Navarra in Pamplona, Spain and

most recently translated into Chinese for use at the Chang-Chung Memorial Hospital of Taiwan

(attachment RD 6.b). An initiative is currently underway to contact all the institutions currently using

the SPPPE tool to obtain their data so that cross-institutional results can be generated.

The MGH address to obtain more detailed information for the PPE is:

http://www.massgeneral.org/pcs/CCPD/CPD_PPE_Form.asp

What follows is a sampling of issues and concerns identified through the SPPPE survey

since it’s inception with respective interventions and outcomes.

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SPPPE Survey Issue Identified (survey year) Interventions/Outcomes Need for recognition of clinical work (1998) The Senior Vice President and Chief Nurse

charged the Professional Development Committee within Collaborative Governance with the responsibility to design an interdisciplinary recognition program. The first-of-its kind interdisciplinary Clinical Recognition Program was implemented in 2002).

Requests for additional educational opportunities (1998)

The Center for Clinical & Professional Development was expanded to include orientation, training and continuing education opportunities for clinical and support staff.

Improve access and communication within Social Services (2000)

Beepers assigned to all Social Workers.

Concerns identified with supplies and linen (2000)

Materials Management/Nursing Task Force established.

Need for more inservices on various cultures to deliver culturally competent care (2001)

The Culturally-Competent Lecture Series was launched to augment the day-long culturally-competent care curriculum offered by The Center for Clinical & Professional Development. Developed unit/department culturally-competent care resource manuals.

Request for increased Nursing Director availability (2001)

Nursing Director span-of-control was analyzed and reduced.

Need to enhance communication (2002) Numerous communication strategies employed: - Increased use of email to improve

communication - Creating the Fielding the Issues column in

Caring Headlines (a question and answer column presenting timely information)

Request for cultural sensitivity discussions in Social Services (2003)

Establishment of a Cultural Competence Committee to explore issues and assess learning needs within the Department regarding cultural sensitivity.

Concerns identified regarding support from the Department of Food and Nutrition (2002-2003)

Food and Nutrition/Nursing Task Force established.

Common Patient Problems* (2002 – 2006)

Interventions occur at the unit level led by unit-based CNSs. Examples include:

• Pain management (standard was articulated; CNS was hired). • Skin care (wound care task

force/education program launched

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SPPPE Survey Issue Identified (survey year) Interventions/Outcomes *nursing only

• Respiratory care (tracheostomy rounds implemented

Presented findings of SPPPE Common Patient Problem Survey at the National Association of Clinical Nurse Specialists NACNS). Subsequently, the survey was completed nationally by the NACNS membership to determine common patient problems on the national level.

Request for assistance re: public speaking and talking to the media (2004)

Launched media and public speaking programs through The Center for Clinical & Professional Development

Request for conflict resolution skills training 2005 - 2006)

The program, “Workforce Dynamics: Skills for Success” was launched through The Norman Knight Nursing Center for Clinical & Professional Development to present information/skills to work with a multigenerational workforce, negotiation, and preparing for and effectively engaging in difficult conversations. Focused conflict resolution interventions implemented (Refer to Force 13.17).

Need to identify strategies to support the aging nursing workforce (2006)

Multi-site qualitative study designed to explore concerns of the aging nursing task force (with University of Michigan Health Care System and Shands at the University of Florida). Results are currently being analyzed. Applied for and received a grant ($10,000) from the Center for Integration of Medicine & Innovative Technology (CIMIT) to host a summit to more fully explore the opportunities to support the aging nurse population with emerging technologies. The “coming of age” summit will be held on November 15, 2007 (attachment RD 6.c).

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