In today’s quality and data-driven healthcare environment, almost all large health systems have a formal nursing informatics department dedicated to the inpatient setting. In the ambulatory care arena, though, rarely does a formal nursing informatics position exist. In 2017, at one large academic medical system, the ambulatory care training and workflow group split into 2 different departments. The job description remained the same for both, leading to role ambiguity amongst the staff and the clients they served (clinical staff and leadership). By the beginning of 2019, the diverse workflow team, comprised of both licensed and non-licensed staff, experienced an 80% turnover in staff. Efforts were then turned to team education, training, team building, and retention for the remainder of 2019.
In the beginning of 2020, emphasis pivoted from team focused to an individualized focus. One-on-one discussions were implemented to gather appropriate feedback. Staff voiced concerns of not having a career path for advancement, no role distinction, and lack of a formal training plan to enhance skills. In February 2020, we engaged our human resource partners to redesign the job description, and develop an advancement program that would allow progression within the department and demonstrate leadership support for professional development.
In June 2020, a new staff engagement survey was adopted by the healthcare system. The targeted goal for overall engagement scores was set at 76 for the institution. The workflow team’s baseline score measured 67 in June 2020, and scores further decreased to 63 in June 2021. It was decided to perform skip level interviews amongst this team with their director. Skip level meetings have been shown to create a level of trust and open communication between leaders and employees (Yoho, 2016). These one-on-one conversations took place throughout the spring of 2021. By February 2022, scores jumped up to 68. With such tangible impacts on engagement, sustainment plans included continuing biannual skip level discussions. Additional tactics to maintain progress included honing in on one main theme that resurfaced during all discussions: internal career progression. Among the nursing industry, career development models have shown to directly impact engagement and retention (Bernard & Oster, 2018). In July 2021, we re-engaged our human resource team to continue the title change work effort from 2020. This work was completed and the job description and title change occurred on September 1, 2022. The October 2022 engagement scores increased to 78, exceeding benchmark for the first time.
In addition to increasing our engagement scores, our team of nine now includes three staff with a master's degree in nursing informatics and one with a bachelor's degree in health informatics. Four have achieved yellow belt lean six sigma. Three have advanced to a level II position on the team.