Abstract
BACKGROUND: Prior to the COVID-19 pandemic, the work environment was already associated as a contributing factor to nurses’ intention to leave the workplace (Nantsupawat et al., 2016; Shah et al. 2021). Additionally, peer-to-peer nursing isolation is a problem within ambulatory nursing (Allen, 2016). However, specific investigation into intent to leave in ambulatory nursing is limited. The National Database of Nursing Quality Indicators (NDNQI) survey was first used in this setting’s ambulatory clinics in 2021. The Orthopedic Clinic RN Coordinators (RNC) initial 2021 NDNQI scores on the specific metric exploring nurses’ intentions to leave their current workplace within 3 years was poor with 50% of staff reporting planning on leaving. Since this department scored 20.7% higher than the mean on the 2021 NDNQI intention to leave, the RNC in the Orthopedic Department identified that the pre-existing work environment for RNC was a contributing factor to work environment dissatisfaction.
PURPOSE/ AIM: The purpose of this project is to reduce work environment dissatisfaction by assessing the current state of the work environment, identifying contributing factors, and implementing innovative interventions.
METHOD: Using the Plan Do Study Act cycle, the RNC group identified 3 key drivers that impacted the work environment within orthopedics: the physical environment, lack of opportunities for professional development, and lack of RNC-to-RNC connection. The first intervention the clinic implemented was a hybrid remote work plan effective May 2022. Each RNC is now working 1-2 days remotely from home. The second intervention was a plan for each RNC to dedicate up to 4 hours a month for any professional development during clinic hours. There were two interventions developed to address the lack of connection: a) implementing monthly RNC meetings and b) coordinating events outside of the workplace.
RESULTS: The Orthopedic Clinic RNC 2022 NDNQI intention to leave the current workplace results improved to 0% intention to leave within 3 years. In addition to the NDNQI progress, the RNC group reports that the hybrid remote work plan allows for a better work-life balance. The productivity in RNC monthly meetings surpassed expectations. These monthly meetings not only facilitated continued work on the NDNQI initiatives, but also resulted in the development of Code Lavender Kits used for staff decompression in high-stress situations, staff wellness resource discussions, official team building exercises, and started wellness challenges.
IMPLICATIONS for Practice: The orthopedic clinic RNC team successfully transformed the nursing workforce culture by implementing a) hybrid remote work up to 2 days per week, b) offering professional development time during clinic hours, c) monthly RNC meetings, and d) coordinating events outside of work. Although NDNQI results improved to 0% intention to leave, continual monitoring and proactive responses are required to maintain this result as new challenges arise and environmental changes evolve.
Notes
Presenter notes available in attached slide deck.
Reference list included in attached slide deck.
Sigma Membership
Alpha Alpha Lambda at-Large
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Quality Improvement
Research Approach
Other
Keywords:
Orthopedic Care, Ambulatory Care, Organizational Culture, Work Environment, Registered Nurses, Personnel Turnover, Personnel Turnover
Recommended Citation
Golo-Atkin, Tania Mae; Shiba, Jodie Mae B.; Collins, Daniel A.; and Lewis, Chrystal Leigh, "Transforming Orthopedic Clinic Workplace Culture Using the PDSA Cycle" (2026). Creating Healthy Work Environments (CHWE). 104.
https://www.sigmarepository.org/chwe/2024/presentations_2024/104
Conference Name
Creating Healthy Work Environments
Conference Host
Sigma Theta Tau International
Conference Location
Washington, DC, USA
Conference Year
2024
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-03-02
Transforming Orthopedic Clinic Workplace Culture Using the PDSA Cycle
Washington, DC, USA
BACKGROUND: Prior to the COVID-19 pandemic, the work environment was already associated as a contributing factor to nurses’ intention to leave the workplace (Nantsupawat et al., 2016; Shah et al. 2021). Additionally, peer-to-peer nursing isolation is a problem within ambulatory nursing (Allen, 2016). However, specific investigation into intent to leave in ambulatory nursing is limited. The National Database of Nursing Quality Indicators (NDNQI) survey was first used in this setting’s ambulatory clinics in 2021. The Orthopedic Clinic RN Coordinators (RNC) initial 2021 NDNQI scores on the specific metric exploring nurses’ intentions to leave their current workplace within 3 years was poor with 50% of staff reporting planning on leaving. Since this department scored 20.7% higher than the mean on the 2021 NDNQI intention to leave, the RNC in the Orthopedic Department identified that the pre-existing work environment for RNC was a contributing factor to work environment dissatisfaction.
PURPOSE/ AIM: The purpose of this project is to reduce work environment dissatisfaction by assessing the current state of the work environment, identifying contributing factors, and implementing innovative interventions.
METHOD: Using the Plan Do Study Act cycle, the RNC group identified 3 key drivers that impacted the work environment within orthopedics: the physical environment, lack of opportunities for professional development, and lack of RNC-to-RNC connection. The first intervention the clinic implemented was a hybrid remote work plan effective May 2022. Each RNC is now working 1-2 days remotely from home. The second intervention was a plan for each RNC to dedicate up to 4 hours a month for any professional development during clinic hours. There were two interventions developed to address the lack of connection: a) implementing monthly RNC meetings and b) coordinating events outside of the workplace.
RESULTS: The Orthopedic Clinic RNC 2022 NDNQI intention to leave the current workplace results improved to 0% intention to leave within 3 years. In addition to the NDNQI progress, the RNC group reports that the hybrid remote work plan allows for a better work-life balance. The productivity in RNC monthly meetings surpassed expectations. These monthly meetings not only facilitated continued work on the NDNQI initiatives, but also resulted in the development of Code Lavender Kits used for staff decompression in high-stress situations, staff wellness resource discussions, official team building exercises, and started wellness challenges.
IMPLICATIONS for Practice: The orthopedic clinic RNC team successfully transformed the nursing workforce culture by implementing a) hybrid remote work up to 2 days per week, b) offering professional development time during clinic hours, c) monthly RNC meetings, and d) coordinating events outside of work. Although NDNQI results improved to 0% intention to leave, continual monitoring and proactive responses are required to maintain this result as new challenges arise and environmental changes evolve.
Description
Nurse coordinators’ three-year intention to leave the workplace in an ambulatory care orthopedic clinics was high as reported by an NDNQI survey. The coordinators transformed their workplace culture and eliminated the three-year intention to leave the workplace on the next NDNQI survey.