Impacting Nursing Stress: The Implementation of a Standardized Referral Process in the Outpatient Pediatric Care Setting

Abstract

<p><strong>Aim.</strong> This DNP project was aimed at reducing process time and stress levels perceived by nurses working in three outpatient pediatric offices.</p> <p><strong>Background.</strong> Nursing stress has been studied for decades. Research studies have supported several factors that contribute to nursing stress such as work environment, job demands, job responsibilities, physical labor, work hours and work pressure. Along with expected job performance that includes ever increasing workloads due to staff shortages and increasing standards of quality patient care are just a few (Roberts, Grubb & Grosch, 2012). Elevated stress levels result in detrimental consequences for nurses, including the development of physical and psychological illnesses the nurses’ ability to provide high quality care.</p> <p><strong>Methods</strong>. A process improvement project was developed and implemented within three outpatient pediatric offices in Northwest Ohio. A standardized referral process was guided by using The Institute for Healthcare Improvement “Model for Improvement”. Data was collected through pre and post-implementation surveys and timed observations. Data analysis was done using descriptive and non-parametric tests.</p> <p><strong>Results.</strong> A total of fifteen nurses (60%) volunteered to participate in the project. After implementation of a standardized referral system, there was a notable improvement in the actual time the office nurses spent completing the referral process. The office staff’s perceptions of how well the referral system was working within the office regarding making referrals to specialists or patients improved. The office staff’s perceptions of recent and current stress levels at work and when making referrals in the office also improved.</p> <p><strong>Conclusion.</strong> A decrease of time and stress level was observed between the pre and post-implementation outcome measures within the timed observations and surveys. The results demonstrate that the implementation of a standardized referral process does have an impact on office nurses use of time and level of stress.</p>