the turnover rate ( employee separations ) of healthcare workers has created a cycle of exhaustion and discontent . high turnover affects the institution 's ability to consistently provide high - quality care and increases institutional costs related to the recruitment , orientation , and lower productivity of newly hired staff . this is an oklahoma university medical system ( oums ) performance improvement educational intervention study . we will use a 5-year longitudinal design with repeated measures to examine the effect of diffusion of the heartmath healthcare program revitalizing care techniques within oums . the variables include pre and post training scores on the personal and organizational quality assessment questionnaire ( poqa - r ) , scores on the independently administered oums annual employee engagement survey , and separations from oums as reported by the human resources department as turnover rates . the training sessions included a 5-hour presentation with a 2-hour follow - up program provided 2 or more weeks later . participants received an emwave2 training reinforcement device to use during the time period between the first training and the follow - up training . data from the emwave2 will provide personal reinforcement to the user and will not be collected or analyzed by the investigators . the most significant measured result noted after training 90% of the nursing leadership , vice presidents , directors , and managers and 93% of the oncology staff was the continued decline of the turnover rate to < 14% for the overall oncology oums service line within the first year of the program being instituted . this was an improvement from a 2009 high of 73% for one of the oncology service lines with a 34% at the time of training , when newly hired people were beginning to leave again , plateauing and even increasing the rate at that time . engagement scores for the oncology unit improved from the previous year , and the poqa scores for both the leadership group and the oncology group showed many significant improvements during the time of measurement .
background : the turnover rate ( employee separations ) of healthcare workers has created a cycle of exhaustion and discontent . 
 high turnover affects the institution 's ability to consistently provide high - quality care and increases institutional costs related to the recruitment , orientation , and lower productivity of newly hired staff.methods:this is an oklahoma university medical system ( oums ) performance improvement educational intervention study . 
 we will use a 5-year longitudinal design with repeated measures to examine the effect of diffusion of the heartmath healthcare program revitalizing care techniques within oums . 
 the variables include pre and post training scores on the personal and organizational quality assessment questionnaire ( poqa - r ) , scores on the independently administered oums annual employee engagement survey , and separations from oums as reported by the human resources department as turnover rates.employees of the oums were trained in cohorts of less than 20 . 
 the training sessions included a 5-hour presentation with a 2-hour follow - up program provided 2 or more weeks later . 
 participants received an emwave2 training reinforcement device to use during the time period between the first training and the follow - up training . 
 data from the emwave2 will provide personal reinforcement to the user and will not be collected or analyzed by the investigators.results:the most significant measured result noted after training 90% of the nursing leadership , vice presidents , directors , and managers and 93% of the oncology staff was the continued decline of the turnover rate to < 14% for the overall oncology oums service line within the first year of the program being instituted . 
 this was an improvement from a 2009 high of 73% for one of the oncology service lines with a 34% at the time of training , when newly hired people were beginning to leave again , plateauing and even increasing the rate at that time . 
 engagement scores for the oncology unit improved from the previous year , and the poqa scores for both the leadership group and the oncology group showed many significant improvements during the time of measurement .