Stepping Stones to Wellness - Unit Based Health Promotion

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

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

3. 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 health1. The physical work of nurses is dangerous and is highly ranked for work related injury2. Older nurses’ workplace injuries are the main cause of their early exit from the workforce3.

4. 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.

5. Background With the relationship of work stress and musculoskeletal injury to absenteeism and turnover well documented4, the financial case for nurse health promotion is sound; but what are the most effective methods and how should outcomes be measured?

6. 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.

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

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

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

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

11. Methodology The “wellness cart” displaying a physical activity theme

12. Methodology Graduate nursing students visited the unit each week on three shifts

13. Results Participation increased in the Wellness Program – “Know Your Numbers” from 0participants in FY10 to 60 out of 77 employees participating in Biometric Screening in FY11 (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.

14. 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.

16. 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 per 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)

17. 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.

18. 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.

19. 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.

20. 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.

21. Implications Creating a comprehensive, visible, and easily accessible program of evidence-based 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.

22. Acknowledgements John Herko, HR Manager, Benefits Cindy MacKechnie, Coordinator, Employee & Family Assistance Program Kristine Buck, Community Health Educator, Frymoyer Community Health Resource Center Peter MacDonald, Financial Specialist, Business Analysis

23. 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.

24. Questions