Stress on the Unit: Team of Nurses Tackles Workplace Pressure

Nurses on the 14-bed surgical short stay unit at Cleveland Clinic’s main campus work in a fast-paced environment with quick patient turnover. On most days, the unit starts receiving patients around 10 a.m. and many are discharged the same day. Workplace stress levels often run high.

“A couple years ago, things were so busy on the unit that people didn’t even have time to take a lunch,” says Julie Green, RN, a clinical nurse on the surgical short stay unit. “So we had to take a look at how we were running our unit – what was causing the issue, and what we could do to fix it.” They ultimately implemented a buddy system.

Gauging workplace stress

In May 2015, the unit’s Shared Governance team surveyed nurses about their stress levels using The Workplace Stress Scale™ created by the Marlin Company and the American Institute of Stress. The tool describes eight scenarios and asks respondents how often each statement describes how they feel at work using a Likert scale from 1 (never) to 5 (very often). Some of the statements include the following:

• I feel that my job is negatively affecting my physical or emotional wellbeing.
• Conditions at work are unpleasant or sometimes even unsafe.
• I have too much work to do and/or too many unreasonable deadlines.

The results indicated that half the nurses who responded had moderate stress levels. While this may not seem dire, the unit wanted to reduce stress for all of its nurses.

When Shared Governance asked for ideas on how to reduce stress, two main causes of stress were repeated by nurses: the admission process and the inability to take a break for lunch. Among the clinical nurses on the short stay surgical unit who worked on solutions to the problems were Green, Michelle Piatt, BSN, RN, CMSRN, and Ericka Frank, BSN, RN, CMSRN.

Adjusting the admission process

Prior to the survey, the four nurses on duty during each shift received patients in batches. For instance, one nurse might be assigned the first three patients, then the next nurse would take patients four through seven. “But if you start out with three patients and discharge them all quickly, depending on how the admitting department pends beds, you might get sent more patients while another nurse on the unit has only one patient,” Green explains.

Assignments were often lopsided, so Shared Governance developed a rotating admission process. Now the unit looks at the patients coming to surgical short stay and rotates admissions among all four nurses based on how many patients each nurse currently has. They examine the census and list on a whiteboard who will get which admissions, and they remain flexible as circumstances change.

“The old process wasn’t good for patients because one nurse may have two patients rolling in the door at the same time,” says Piatt. “This process has definitely made it better for the patient.”

In addition, any available nurses help with each admission to make the process more efficient. For example, if three nurses are available, the first may assess the patient, the second may take notes in the electronic medical record and the third may educate the patient. “We can actually get patients admitted much more quickly by helping each other,” says Piatt. “It’s all part of the buddy system.”

Implementing a buddy system

The unit adopted a buddy system, partnering two nurses on each shift so they can cover for each other during breaks and lunches, lend a hand with admissions, help with patient care and so on. “We are now a more team-oriented unit,” says Green. “Nurses’ stress levels have decreased, and it’s benefitted the patients, too.”

The surgical short stay unit conducted two post-intervention surveys using the Workplace Stress Scale, both of which confirmed decreased stress levels. In the latest survey, done in March 2016, stress was “not an issue” for two-thirds of the respondents.

The unit continues to utilize the revamped admission process and buddy system. Frank, Green and Piatt submitted a poster presentation on the unit’s changes for the 2016 Shared Governance Day, and they presented at a Practice Council meeting in March 2017, where other units expressed interest in adopting a buddy system, too.

Says Green, “Stress is not an issue anymore.”