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Improved nurse job satisfaction and job retention with the transition from a “mandatory consultation” model to a “semiclosed” surgical intensive care unit: A 1-year prospective evaluation*

Haut, Elliott R. MD; Sicoutris, Corinna P. CRNP; Meredith, Denise M. CRNP; Sonnad, Seema S. PhD; Reilly, Patrick M. MD; Schwab, C William MD; Hanson, C William MD; Gracias, Vicente H. MD

doi: 10.1097/01.CCM.0000198104.28666.C0
Clinical Investigations

Objective: The change from a “mandatory consultation” to a “semiclosed” surgical intensive care unit (SICU) model will impact nurses considerably. We hypothesize that nurse job satisfaction, job turnover rates, and hospital costs for temporary agency nurses will improve and these improvements will be more dramatic in SICU sections with greater involvement of a dedicated surgical critical care service (SCCS).

Design: Prospective longitudinal survey.

Setting: Tertiary-care university hospital.

Subjects: SICU staff nurses.

Interventions: Change from mandatory consultation to semiclosed SICU.

Measurements and Main Results: We surveyed SICU nurses during the year-long transition to a semiclosed SICU service (five time points, 3-month intervals). The first four surveys included ten questions on nurse job satisfaction. The final survey included two additional questions. All questions were on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). Nurse job turnover rates and money spent on agency nurses were compared over time; 503 of a possible 914 surveys were completed (55% overall return rate). Nurse job satisfaction scores significantly improved over time for all questions (p < .05). Hospital spending on agency nurses decreased significantly (p = .0098). The yearly nurse job turnover rate dropped from 25% to 16% (p = .15). The scores for both year-end statements (“I am more satisfied with my job now than 1 year ago” and “The SCCS management of all orders has improved my job satisfaction”) were significantly higher in sections with greater SCCS involvement (p = .0070 and p < .0001).

Conclusions: Nurse job satisfaction improved significantly with the transition to a semiclosed SICU. This higher satisfaction was associated with a significant decrease in spending on temporary agency nurses and a trend toward increased staff nurse job retention. SICU sections with greater SCCS involvement had more dramatic improvements. This semiclosed SICU model may help retain SICU nurses in a competitive job market in which experienced nurses are in short supply.

From the Department of Surgery, The Johns Hopkins University School of Medicine (ERH), Baltimore, MD; the Division of Traumatology and Surgical Critical Care (VHG, PMR, CWS), Department of Surgery (SSS), and the Department of Anesthesia (CWH), The University of Pennsylvania School of Medicine, Philadelphia; and Department of Nursing, The Hospital of the University of Pennsylvania (CPS, DMM), Philadelphia, PA.

No author has a financial interest with a commercial entity with any interest in this article.

© 2006 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins