The L& D unit faced critical organizational and cultural challenges despite its clinical excellence and prestigious accolades.
The primary issues were leadership instability due to frequent changes in leadership, which contributed to a lack of continuity and consistency in the unit’s operations and culture. This instability undermined efforts to establish a cohesive team environment and effectively address behavior issues. As a result, the unit experienced significant staff turnover and high vacancy rates, disrupting patient care and contributing to a strained work environment. A pervasive absence of clear behavioral standards led to widespread incivility and unprofessional conduct among staff. Issues included disrespectful interactions such as eye-rolling, name-calling, exclusion, and general unwelcoming behavior, particularly towards new graduate RNs. The lack of accountability meant these behaviors were unaddressed, further exacerbating the workplace climate. The unit struggled with a fragmented and unhealthy work culture characterized by a lack of teamwork and support, hindering effective communication and collaboration. The team reported a general sense of disconnection and dissatisfaction, negatively impacting engagement and morale.
The overarching goal was to establish a foundation for addressing behavioral issues, creating a culture of accountability, improving overall team performance, and fostering a healthy, respectful work environment.
Facing significant cultural and operational challenges, the Labor & Delivery unit at Inova Fair Oaks Hospital enrolled in the Healthy Workforce Culture Change Certification Program, a comprehensive initiative. The program, implemented in four strategic phases, began with heightening awareness through open dialogue to identify and address disruptive behaviors. It then created and communicated a powerful vision, establishing a compact of professional behaviors to set clear expectations. The following phase focused on developing interprofessional team skills through targeted education, promoting professionalism, and reducing incivility. Finally, the program hardwired and sustained these changes with ongoing actions, reinforced by a dedicated Healthy Workforce Committee. This team met regularly to focus on professional behaviors, share successes, and ensured continuous cultural improvement. Regular huddles further embedded these shifts, encouraging open communication and accountability and fostering a lasting transformation.
The program began by opening honest conversations across the team to identify and confront disruptive behaviors. This shared awareness laid the groundwork for addressing incivility and setting the stage for lasting cultural change.
Leaders established a clear compact of professional behaviors, setting explicit expectations for how team members treat one another.
Targeted education strengthened collaboration, promoted professionalism, and reduced incivility across the unit.
Nursing turnover dropped from 25.32% to 12.44%. Contingent workforce reduced from 7 to 0. Vacancy rate at 15.38 dropped to 5.05% Intention to stay improved to +21.9%.
Decrease in nursing turnover
Cardiac Intensive Care Unit (CICU)
Rise in TMXS score in 2024 — the most improved department at Inova Fair Oaks.
Community Hospital Labor & Delivery Unit (L&D) Obstetrics Maternity Care
Nurse turnover dropped on 6B
Magnet-Designated Hospital — Intermediate Care Unit (6B)
Tell us where disruptive behavior is costing you nurses, safety, or trust — and we’ll show you the path other health systems have already walked.
