Nurse accountability program improves satisfaction, turnover

St. Mary's Hospital and Health Center, Tucson, AZ, responding to changes in health care reimbursement and the need to maintain quality, developed a comprehensive program to improve nurses' professional accountability. The project was based on the assumption that increased job satisfaction and decreased job stress for nurses in an acute care facility would improve retention and recruitment and facilitate decentralization of care delivery. The plan included the following components: Identify and enhance qualifications of nurses through a credentialing mechanism. Restructure nurses' employment terms to professional salaried status. Implement a spiritual, holistic framework for nursing. Identify programs to extend nursing's sphere of influence to activities that promote a continuum of care. Use the patient classification staffing tool as an acuity billing system. Decentralize the nursing organization and move it into the community. Promote an environment conducive to two levels of nursing practice--professional nurse case managers and associate registered nurses. The program's effectiveness was evaluated by measuring nurses' job stress and job satisfaction in 1983 (before the program's implementation), 1985, and January 1987. In 1985, compared with 1983, job stress was significantly lower in several areas measured, while job satisfaction was higher in four of six areas measured. Turnover rate of nurses decreased from 15.2 percent in 1983 to 5.4 percent in 1986. Financial savings from the program also hve been substantial: more than $500,000 for the last two fiscal years.