The Implementation of a Cultural Change Toolkit to Reduce Nursing Burnout and Mitigate Nurse Turnover in the Emergency Department

J Emerg Nurs. 2019 Jul;45(4):452-456. doi: 10.1016/j.jen.2019.03.004. Epub 2019 Apr 15.


Problem: Nursing burnout and high levels of nursing turnover contribute to negative work environments, diminished patient care, and increased health care costs. There is a gap in literature regarding cost-effective, easily implemented interventions to address burnout and turnover. The purpose of this project was to determine if the implementation of evidence-based interventions would improve the perception of the practice environment, decrease the levels of nursing burnout, and decrease the voluntary nurse turnover rate in the emergency department.

Methods: The Cultural Change Toolkit was developed based on current recommendations in literature and implemented within an emergency department in southeast Texas. The toolkit included specific interventions related to meaningful recognition, shared decision making, and increased leadership involvement and support. Nursing burnout and anticipated turnover were measured using the Anticipated Turnover Scale and the Oldenburg Burnout Inventory both before and after implementation of the project. Participants (n = 30) included nursing staff employed in the emergency department.

Results: There was a reduction in both the anticipated turnover (mean anticipated turnover score, preimplementattion = 3.133, postimplementation = 2.989) and burnout scores among nursing staff (mean burnout score, preimplementation = 4.808, postimplementation = 4.463). The reduction in overall burnout scores were statistically significant following a paired t-test analysis (P = 0.004). There were no resignations among nursing staff throughout the project period.

Discussion: Nursing burnout and turnover are frequently discussed topics. The results support the use of cost-effective interventions outlined in the Cultural Change Toolkit to address nursing turnover and burnout.

Keywords: Nursing burnout; Nursing turnover; Process improvement; Workplace culture.

MeSH terms

  • Burnout, Professional / prevention & control*
  • Burnout, Professional / psychology
  • Emergency Nursing / statistics & numerical data*
  • Emergency Service, Hospital
  • Humans
  • Nursing Staff, Hospital / psychology*
  • Organizational Culture*
  • Personnel Turnover / statistics & numerical data*
  • Surveys and Questionnaires
  • Texas
  • Workplace / psychology*