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Stepping Stones to Wellness Unit Based Health Promotion Mary Val Palumbo DNP, APRN Barbara Stepping Stones to Wellness Unit Based Health Promotion Mary Val Palumbo DNP, APRN Barbara Liberty, RN Evelyn Sikorski CSW, CEAP www. Fletcher. Allen. org 1

Project Team Fletcher Allen Health Care UVM College of Nursing and Health Sciences § Project Team Fletcher Allen Health Care UVM College of Nursing and Health Sciences § Barbara Liberty RN, FAHC § Mary Val Palumbo DNP, RN Lead Employer Health Management, Community APRN, GNP-BC Health Improvement Associate Professor UVM § Evelyn Sikorski CSW, CEAP, CNHS Mgr Employee and Family § Nurse practitioner Assistance Program & Health Management students in GRNU 396, Optimizing Health Course § Lindsay Harbour, Safety Specialist, Safety & Industrial -Service Learning Hygiene Component § Cathy Hamilton, Ergonomic Specialist, Safety & Industrial Hygiene www. Fletcher. Allen. org 2

Background § When exposed to work related stressors, nurses employing ineffective coping strategies, coupled Background § When exposed to work related stressors, nurses employing ineffective coping strategies, coupled with poor self-care, are at risk for developing stress symptoms, health related problems, and burnout. § Young nurses balancing work and home responsibilities are particularly vulnerable to poorer emotional health 1. § The physical work of nurses is dangerous and is highly ranked for work related injury 2. §Older nurses’ workplace injuries are the main cause of their early exit from the workforce 3. www. Fletcher. Allen. org 3

Background It is important for employers to recognize the connection between nurse’s physical and Background It is important for employers to recognize the connection between nurse’s physical and emotional health within the context of the nurse work environment. www. Fletcher. Allen. org 4

Background With the relationship of work stress and musculoskeletal injury to absenteeism and turnover Background With the relationship of work stress and musculoskeletal injury to absenteeism and turnover well documented 4, the financial case for nurse health promotion is sound; but what are the most effective methods and how should outcomes be measured? www. Fletcher. Allen. org 5

Purpose This quality improvement project evaluated a six month program initiative of unit-based psycho-educational Purpose This quality improvement project evaluated a six month program initiative of unit-based psycho-educational interventions offered in collaboration with Employee Wellness and the nurse practitioner student service learning project. www. Fletcher. Allen. org 6

Purpose It was hypothesized that this wellness protocol would demonstrate a unit level decrease Purpose It was hypothesized that this wellness protocol would demonstrate a unit level decrease in: 1. aggregate unscheduled time off 2. worker compensation claims 3. safety related injuries Satisfaction with the wellness program offered on the unit would be demonstrated. www. Fletcher. Allen. org 7

Methodology Unit based intervention delivered to one hospital medical unit with 80 employees including: Methodology Unit based intervention delivered to one hospital medical unit with 80 employees including: 1. an educational protocol detailing nutrition, stress management, relaxation techniques, safe patient handling and movement strategies 2. physical activity promotion 3. environmental redesign (signage) 4. incentives for participation and behavior change (average $35/unit employee). www. Fletcher. Allen. org 8

Methodology A comparison of aggregate organizational and subjective participant data in intervention year data Methodology A comparison of aggregate organizational and subjective participant data in intervention year data (FY 11) with preintervention data (FY 10) including: unscheduled time off, worker compensation utilization, safety information obtained from the Human Resource, and participant satisfaction. www. Fletcher. Allen. org 9

Methodology There were 210 staff interactions with the “Wellness Cart” over 8 weeks. www. Methodology There were 210 staff interactions with the “Wellness Cart” over 8 weeks. www. Fletcher. Allen. org 10

Methodology The “wellness cart” displaying a physical activity theme www. Fletcher. Allen. org 11 Methodology The “wellness cart” displaying a physical activity theme www. Fletcher. Allen. org 11

Methodology Graduate nursing students visited the unit each week on three shifts www. Fletcher. Methodology Graduate nursing students visited the unit each week on three shifts www. Fletcher. Allen. org 12

Results § Participation increased in the Wellness Program – “Know Your Numbers” from 0 Results § Participation increased in the Wellness Program – “Know Your Numbers” from 0 participants in FY 10 to 60 out of 77 employees participating in Biometric Screening in FY 11 (0% to 78%). § Worker compensation utilization – short term disability claims decreased to 0. § There was no significant change in patient handling incident reports and safety related injuries. www. Fletcher. Allen. org 13

Results § Savings were calculated by using 75% of the difference in unscheduled hours Results § Savings were calculated by using 75% of the difference in unscheduled hours off between the mean of the previous three year and period of the intervention. Average hourly rate of pay including fringe ($48. 34) was then multiplied by the unscheduled hours off = $11, 409. 17 § In comparison with a unit of similar size, no decrease in total unscheduled time off was shown during the same timeframe. www. Fletcher. Allen. org 14

www. Fletcher. Allen. org 15 www. Fletcher. Allen. org 15

Results § Total cost of Wellness Program delivery = $7, 664. 00 § This Results § Total cost of Wellness Program delivery = $7, 664. 00 § This includes: § Biometric screening ($15. 00), § Wellness RN time for delivery and coordination ($45. 80), plus incentives ($35. 00) per unit employee. § Total cost person for the six month Wellness Program = $95. 80 $11, 409. 17 (difference in unscheduled time off) - $7, 664. 00 (cost of program) $3, 745. 17 (Return on Investment) www. Fletcher. Allen. org 16

Results Participant satisfaction survey results (n = 48 60% response rate) § 71% agreed Results Participant satisfaction survey results (n = 48 60% response rate) § 71% agreed that the screening and wellness coaching supported their health and wellbeing while at work; § 65% agreed that the program had a positive impact on the unit as a whole; § 64% agreed that their health knowledge increased; § 45% agreed that the program improved their work productivity. www. Fletcher. Allen. org 17

Conclusions This unit-based wellness program was a 6 month comprehensive and integrated program with Conclusions This unit-based wellness program was a 6 month comprehensive and integrated program with a primary focus on self-care and health education. The program paid for itself and may have contributed to a return on investment of $3, 745. 17 in unscheduled time off. This unit-based wellness program using incentives, yielded high participation and satisfaction. www. Fletcher. Allen. org 18

Limitations § This quality assurance project lacks the rigor and controls necessary for a Limitations § This quality assurance project lacks the rigor and controls necessary for a research study. § Since it was conducted on one hospital unit, replication is recommended. § Further research utilizing larger samples, testing unit-based nurse health promotion activities, is indicated. www. Fletcher. Allen. org 19

Implications This project found that bringing health promotion activities directly onto a hospital unit Implications This project found that bringing health promotion activities directly onto a hospital unit was cost effective and satisfactory to the participants, as well as, nurse practitioner students. www. Fletcher. Allen. org 20

Implications Creating a comprehensive, visible, and easily accessible program of evidencebased nurse wellness offerings, Implications Creating a comprehensive, visible, and easily accessible program of evidencebased nurse wellness offerings, ranging from interventions for nurses’ physical and emotional health to workplace safety and hazards protection would likely influence RNs’ health perceptions, create a safety climate, and impact retention. www. Fletcher. Allen. org 21

Acknowledgements § John Herko, HR Manager, Benefits § Cindy Mac. Kechnie, Coordinator, Employee & Acknowledgements § John Herko, HR Manager, Benefits § Cindy Mac. Kechnie, Coordinator, Employee & Family Assistance Program § Kristine Buck, Community Health Educator, Frymoyer Community Health Resource Center § Peter Mac. Donald, Financial Specialist, Business Analysis www. Fletcher. Allen. org 22

References § Palumbo, M. V. , et al. , Registered Nurses’ Perceptions of Health References § Palumbo, M. V. , et al. , Registered Nurses’ Perceptions of Health and Safety Related to Their Intention to Leave. AAOHN J, 2010; p. 95 -103 § Waters, T. , et al. , NIOSH research efforts to prevent musculoskeletal disorders in the healthcare industry. Orthop Nurs, 2006. 25(6): p. 380 -9. § Letvak, S. , Health and safety of older nurses. Nursing Outlook, 2005. 53(2): p. 66 -72. § Davey, M. , et al. , Predictors of nurse absenteeism in hospitals: a systematic review. Journal of Nursing Management, 2009. 17(3): p. 312 -30. § Gauci, B. and I. Norman, Factors influencing turnover and absence of nurses: a research review. International Journal of Nursing Studies, 1997. 34(6): p. 385 -94. www. Fletcher. Allen. org 23

Questions www. Fletcher. Allen. org 24 Questions www. Fletcher. Allen. org 24