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Productive Ward Program for Quality Improvement

Increased job stress is a characteristic feature of many care facilities, which is largely experienced by nurses in their daily practices. A lack of proper management of triggering factors as well as an imbalance between necessary care quality and staff training create an additional threat of burnout (Gulavani & Shinde, 2014). In this connection, special quality improvement initiatives should be conducted to help nurses in avoiding and coping with workplace challenges. This paper aims to propose the implementation of the Productive Ward program that implies assistance to nurses in redesigning the way they work to have more time to interact with patients and combat additional stress.

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Problem Background

Currently, stress is a challenge to the nursing profession since the rate of burnout among nurses remains high. As reported by Gulavani and Shinde (2014), occupational stress is intrinsic to nursing that works with patients and their health outcomes. In addition, heavy workloads due to staff shortage and limited resources, nurses have to face difficulties with providing safe and high-quality care. In turn, they often feel helpless, frustrated, and overloaded with duties to spend enough time with all their patients. The setting of the problem is associated with a poor working environment since it causes potentially harmful responses towards the needs of the patients (Keil & Hober, 2018). The inability to handle work-related stress creates issues with the safety of care delivery.

Quality Improvement Initiative

To reduce stress levels and contribute to its minimization in a long-term period, an evidence-based quality improvement initiative is essential. The introduction of change in the practice of nurses is expected to make their work less stressful using educating them to use special tools. In this case, the opportunity to address excessive workplace tension can be regarded as a pertinent way to increase patient outcomes and staff satisfaction. In particular, the Productive Ward can be used to elaborate on the engagement of nurses as the basis for altering the very approach to stressors. This initiative clarifies specific response patterns that can be applied by nurses to reduce their stress levels in situations like patient death, no progress in treatment, and other critical concerns.

The academic literature accumulated significant evidence that supports the effectiveness of the Productive Ward program. Keil and Hober (2018) conducted the descriptive, observational study in the acute care unit of the Midwestern hospital and found that nurses need to be empowered to resolve complicated situations and remain competent, which is the responsibility of a leader. The mentioned authors introduced the following intervention: in case a patient failed to enhance or died, management communicated the best practices to the corresponding nurse. If a mistake was made in the work of nurses, educational services were provided to facilitate the emotional strain of a nurse and prevent similar cases in the future. As was expected, nurses were engaged in change, and the number of reported stressors decreased (Keil & Hober, 2018).

In their turn, White, Wells, and Butterworth (2014) identified the positive impact of the given program on staff involvement that was expressed in the increased satisfaction grades, both self-reported and assigned by managers. The evidence also shows that the utilization of the program contributes to the establishment of a culture of improvement, which means constant change based on reliable interventions. It is also important to mention the perspective of nurses, which is explored by the recent article by White and Waldron (2014). The authors suggest that stress is closely associated with social and cultural factors, and the focus on them can maximize quality improvement initiatives. The systematic review revealed that nurses reported about their feelings of increased leadership and engagement in the work processes, which allowed them to become more proficient in responding to challenging cases.

Based on the literature that proves the effectiveness of the Productive Ward program and its principles, one may formulate the key steps to be used to implement it in practice. According to Van Bogaert et al. (2014), it is not always easy to recognize stress symptoms in nurses since their focus can rapidly change from patient to patient. In this connection, the first step is to design specific areas that need enhancement, such as handovers, patient death, et cetera. After that, a strategic and leadership plan needs to be developed to outline the key milestones of the intervention, evaluation tools, and responsible parties. The second step implies that the adjusted vision and goals of an organization are delivered to nurses on the course of several educational sessions that would explain how to act in one or another case. This can be achieved during unit meetings and discussions of mistakes that were made by the personnel in the past. A leader needs to remain nonjudgmental and objective to show that a constructive view of the problem is the best way to address it.

The third step is providing feedback about the performance of nurses within several months of the program adoption. White et al. (2014) point out that safety incidents should be discussed with staff and the reporting system needs to be intensified to ensure that early stress symptoms would not deteriorate in depression and burnout among nurses. The last step is to continuously review the entire program, conduct surveys, and adjust those issues that do not meet their initial purpose and contradict the goals of the organization it was introduced in.

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Staff satisfaction measures should be provided once in 3 months to make sure that the proposed intervention works. White and Waldron (2014) state that no specific instruments were elaborated to assess nurse satisfaction after the implementation of the Productive Ward program, yet they mention lean tools that can be used. Open-ended interviews and a survey can be applied to collect the perceptions of nurses regarding their feelings. Also, patient data can be examined to identify any change in their states after the program implementation. The combination of qualitative and quantitative analysis methods seems to be the most comprehensive way of obtaining reliable findings. The levels of staff stress and satisfaction will be dependent variables, while stressful cases will compose the independent variable. ANOVA will be used for hypothesis and statistical testing of experimental data.


To conclude, this paper proposes the implementation of the Productive Ward program in the nursing area intending to reduce stress in nurses. The evidence demonstrates that this problem is important as it affects not only staff but also patients and their families, threatening their health outcomes and care quality and safety. The proposed program is expected to optimize responses of nurses towards critical issues in their work, thus making their daily practices more holistic, patient-oriented, and effective in terms of a balance between care and personal harmony.


Gulavani, A., & Shinde, M. (2014). Occupational stress and job satisfaction among nurses. International Journal of Science and Research (IJSR), 3(4), 733-740.

Keil, S., & Hober, C. (2018). Nurse leader initiatives to decrease job stress on the acute care unit. International Journal of Innovation Education and Research, 6(12), 167-175.

Van Bogaert, P., Somers, A., Tegenbos, M., Wouters, K., Van der Straeten, J., Van Aken, P., & Havens, D. S. (2014). The Productive Ward program™: A longitudinal multilevel study of nurse perceived practice environment, burnout, and nurse-reported quality of care and job outcomes. The Journal of Nursing Administration, 44(9), 452-461.

White, M., & Waldron, M. (2014). Effects and impacts of Productive Ward from a nursing perspective. British Journal of Nursing, 23(8), 419-426.

White, M., Wells, J. S., & Butterworth, T. (2014). The impact of a large-scale quality improvement program on work engagement: Preliminary results from a national cross-sectional-survey of the ‘Productive Ward’. International Journal of Nursing Studies, 51(12), 1634-1643.

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