Nursing Administration Commons^™

Measuring The Quality Of Postgraduate Physician Assistant Fellowship/Residency Programs With A Surgical Focus, Lesley Davies, Jacqueline Guarino, Caitlin Justus, Cassandra Mueller Pa-C, Ryan Krasnosky, Jordan Rodriguez, Angelo P. Giardino

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Introduction

Postgraduate programs for PAs provide formal postgraduate training for clinical specialty areas. These programs are intended to provide intense specialty training in various fields, as well as to standardize education beyond the entry level. The purpose of this descriptive study was to determine if there are consistent trends or clear differences in program length, approach to training, validation of learning, and accreditation through the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) for postgraduate programs with a surgical focus in the United States.

Methods

This study is a non-experimental and descriptive research design. Program directors were mailed …

Infusing Evidence-Based Practice Into The Cayman Islands Health Services Authority Nursing Culture, Melissa Ring

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Background: James Madison University and Cayman Islands Health Services Authority (HSA) entered into a collaborative agreement the summer of 2020. There was a lack of organizational structure surrounding implementation and systemization of evidence-based practice (EBP) models and a disconnect between nurse manager knowledge and EBP implementation within HSA.

Methods: The population for this evidence-based project was 21 HSA nurse managers from the inpatient setting. Pre-intervention survey results informed organizational readiness, nurse manager knowledge and ability to implement, and guided the intervention that included the creation and implementation of a website toolkit for EBP. An EBP model was selected for nursing. …

An Evidence-Based Project: Exploring Nurse Manager Communication Competencies And Skill Development, Micaela Ross

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Abstract

Evidence supports effective communication skills as essential for patient safety and organizational success. Evidence is also clear regarding ineffective communication and its negative impact. The purpose of this project was to determine an area of communication skill development needed among nurse managers of the participating island hospital and support positive change in knowledge, understanding, and ability to use effective communication skills. The aim was to improve communication skills among these nurse managers.The objectives were to determine a specific skill need, provide a focused educational intervention, and evaluate skill improvement. Pre-intervention survey results revealed a self-identified priority of effective communication …

Optimizing Interprofessional Rounds To Reduce Extended Length Of Stay In Complex Patients, Christina May P. Santiago

Master's Projects and Capstones

Problem: Organizations have taken measures to reduce the length of stay by addressing logistical issues such as care coordination across the continuum. This becomes especially important for patients being discharged to skilled nursing facilities (SNF), where placement can be impeded due to complex care needs. In March 2021, the facility accounted for 20% of all extended length of stay (ELOS) patients across the organization. The average ELOS was 36 days, with 42% of these patients being discharged to a SNF.

Context: The Extended Length of Stay (ELOS) team functions at a mesosystem level within twenty-one medical centers across Northern …

The Resilience Vaccine, Sara Horton-Deutch T. Duffy

Master's Projects and Capstones

Healthcare workers have been working in unprecedented circumstances since the declaration of the COVID-19 pandemic. Caregivers have been taxed with burnout. A large healthcare organization’s 26-bed, medical-surgical, telemetry, COVID-19 overflow unit was significantly impacted. Many healthcare organizations have adopted advocacy for attaining joy in work as an extra dimension of the Institute for Health Improvement’s Triple Aim. Adding this fourth aim supports averting caregiver burnout (CBO) while promoting joy in work.

This quality improvement project examined nurse leaders’ interventions that address CBO, promote healthy work environments, and promote joy in work. From June through August 2021, an 8-week resilience program …

Decreasing Patient Fall Rates In The Microsystem, Kevin Dwayne Sanchez Camaya

Master's Projects and Capstones

Abstract

Problem: Falls are considered never events, yet continuously occur in the inpatient setting. Falls,

especially falls with injuries, impact the patients, the staff, and the hospital. Falls cause extended lengths of stay, affect the morale of the patients and the staff, and are non-reimbursable events.

Context: There have been an increased rate of falls within a medical/surgical/telemetry unit

microsystem at a Northern California hospital despite standardized screening and prevention tools. The unit can house up to 52 patients and is the designated Covid unit of the hospital at the time of this project.

Interventions: The interventions include optimizing the …

Enhanced Recovery After Surgery: Necessity Of Real Time Tracking In Quality Measures And Outcomes, Emily Owens

Master's Projects and Capstones

Abstract

A High Reliability Organization (HRO), such as this Northern California Medical Center, holds itself to high standards of performance in the areas of recognition, ranking, and accreditation. The commonality between these high-scored and valuable acknowledgements is the pillars of Quality Outcomes. As benchmarking and reporting allow this facility to measure outcomes against self and other plans, it greatly strengthens the internal focus for continual improvement and goal setting in direct patient care and outcomes. A deeper layer of the Quality Department includes the bundle “ERAS – Enhanced Recovery After Surgery”, which is compiled of principles aiming to minimize opioid …

Creating A Pipeline To Increase Diversity In Executive Leadership Positions, Trarina Harris

Doctor of Nursing Practice (DNP) Projects

Background: Minority nurse leader presence at the executive leadership level is suboptimal, with insufficient pathways to increase representation. The lack of diversity in executive leadership threatens efforts to improve patient care and reduce disparities (Jerome Harris, 2021).

Local Problem: Practices to increase the diversity of executive nurse leaders at a pediatric medical center have had very little to no impact. Frontline nurses and nurse executives are not racially or ethnically representative of the increasingly minority patient populations served.

Context: As a commitment to increasing workforce diversity, the medical center developed an executive-level Racial Equity Taskforce, which aligned with the …

Manager Onboarding To Improve Knowledge And Confidence To Lead, Christine (Tina) K. Asiimwe

Doctor of Nursing Practice (DNP) Projects

Background: Primary care (PC) is increasingly the setting for affordable, coordinated, end-to-end patient care, with PC managers in charge of organizational performance. While PC managers are central to high-functioning teams, they often receive inadequate onboarding.

Local Problem: Primary care onboarding competes with other operational priorities and faces time constraints, lack of mentorship, and cost.

Context: At an integrated healthcare system, a need was identified to develop structured, role-specific onboarding for newly hired PC managers to improve knowledge and confidence to lead.

Interventions: Bauer’s Four Cs framework for onboarding guided the development of a manager onboarding program for 12 new PC …

Nurse Practitioner-Led Care Pods: A Team Communication Enhancement Model, Miranda Saint-Louis, Miranda Saint Louis

Doctor of Nursing Practice (DNP) Projects

Background: Communication has become a key performance measure in the shift to value-based healthcare. Given the impact of communication failures on patient harm, length of stay, and dissatisfaction with care, new models of care with better communication through structured teamwork and interdisciplinary collaboration are needed.

Problem: In a 16-bed geriatric medical/surgical unit of a New York City multispecialty community hospital, the workflow structure unintentionally created inconsistent handoff communication, gaps in continuity of care, missed care events, and inattention to the patient’s priorities in the care plan. A gap analysis identified communication deficiencies that impacted team effectiveness and patient care …

Patient Coordinated Care Response Team, Joshua Fox

Master's Projects and Capstones

Section I: Abstract

Problem: Communication between medical professionals and patients is a critical element to patient satisfaction and safety. The 2020 patient overall satisfaction scores for the local Roseville hospital were 73%. These data demonstrated an opportunity to enhance processes and the culture at the local Roseville hospital to meet the communication needs of its patient population.

Context: A patient coordinated care response team was developed to improve communication for newly diagnosed cancer patients or other life-altering diagnosis patients.

Interventions: A survey was completed to establish the current state of patient satisfaction with communication practices with healthcare providers in the …

Nurse Manager Communication Associated With Staff Nurse Satisfaction Or Retention, Svetlana Periut

Master of Science in Nursing Final Projects

Background: Nursing communication is a significant part of a nurse's job, especially when communicating with their patients, patient's families, and the healthcare team. Communication is the center of attention of many studies, and the way nurse leaders relate massages can influence an organization’s outcomes, including nurse satisfaction and retention. This integrative review aims to analyze communication styles, behaviors, and instruments used by hospital unit nurse managers to increase staff nurse satisfaction and retention.

Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis were used in the literature search and review. The Johns Hopkins Evidence-Based Practice Model and Guidelines were …

Development And Implementation Of An Evidence-Based Practice Mentor Fellowship, Stacy L. Alves

Doctor of Nursing Practice (DNP) Projects

Background: The Institute of Medicine (2008) set a goal that 90% of healthcare decisions would be based on the best evidence possible by 2020, yet many challenges remain. Common barriers include clinicians’ beliefs about the value of evidence-based practices, their competency to implement it, and systems issues such as time, resources, and organizational value and preparedness (Melnyk et al., 2017).

Local Problem: A hospital within an integrated health care system sought to increase the use of EBP for clinical decision making. A gap analysis revealed a lack of sufficient EBP mentors to lead efforts to promote system-wide EBP implementation.

Context: …

Nursing Management To Reduce Hospital Readmissions After Percutaneous Coronary Interventions- Integrative Review, Jeena S. Daniel, Doreen Wagner

Master of Science in Nursing Final Projects

Abstract

Percutaneous coronary interventions (PCIs) are considered life-saving techniques in the event of myocardial infarction and remain the standard of care for managing acute heart attack. Given the success of the procedures, decreased complications, and the economic advantage over open-heart surgery, coronary interventions continue to be the preferred treatment choice. However, amidst the growth and success of these procedures, readmissions after percutaneous coronary interventions have been identified and still prevail among hospitals. Hence, the goal was to conduct an integrative review to identify and synthesize literature on the interventions that help reduce readmissions after percutaneous coronary interventions and illuminate nurses' …

Manager Onboarding To Improve Retention, Knowledge, And Confidence To Lead, Christine Asiimwe

Doctor of Nursing Practice (DNP) Projects

Objective: The purpose of this paper is to review the literature on manager onboarding best practices and their impact on turnover intention, knowledge, and confidence to lead teams in primary healthcare settings.

Background: Primary care onboarding is often insufficient due to competing operational priorities, time constraints, lack of mentorship, and cost. With primary care increasingly the setting for affordable, coordinated, end-to-end patient care, primary care managers must be well-prepared to lead the care team.

Methods: A review of the literature identified best onboarding practices associated with job satisfaction and turnover, reduced time to proficiency, increased knowledge, and confidence to lead. …

Bullying In The C-Suite: A Nurse Leader Perspective, Kimberly Ann Colonnelli

Doctor of Nursing Practice (DNP) Projects

An estimated 35% of American workers have experienced bullying, and in 80% of those situations, the perpetrator was a supervisor or boss. 1 However, the reality is that bullying can come from anyone in the workplace, including subordinates. Victims are generally well liked and good performers, making them feel like threats to a bully’s power base. Bullying, unlike harassment, is not a legally defined behavior, so no laws currently exist to punish it. Victims are, therefore, at the mercy of their bosses, supervisors, co-workers, and human resource departments for protection or relief. Bullying is not a singular event, but rather …

The Relationship Between Collective Nursing Knowledge And Nurse Turnover: An Application Of Nursing Intellectual Capital Theory, Pamela Russman-Chambers

Doctorate of Nursing Science Dissertations

The value of a healthcare organization is vested in the expertise, intellect, and wisdom of employees. Nursing knowledge resides both within the individual nurse and the collective knowledge embedded in organizational structures and practice environments. Healthcare organizations rely on their ability to utilize this knowledge to deliver high-quality care to patients. Hospitals wanting to gain a competitive advantage and achieve financial stability must be adept at acquiring, cultivating, and using the nursing knowledge stocks of the organization. When this knowledge can be utilized to mitigate healthcare issues and improve patients' health, this collective knowledge or intellectual capital is often the …

A Performance Improvement Project To Improve Hand-Off Communication Documentation Within The Surgical Services Department, Bobbie J. Wich, Millie Escalona, Judy E. Bowling, Ana L. Santos

Nursing & Health Sciences Research Journal

Over 80% of adverse events in healthcare are due to miscommunication. To improve patient safety, The Joint Commission recommended the use of standardized hand-off communication tools in 2012. One acute care hospital in Southeast Florida implemented standardized handoff reports in 2014 with few revisions since that time. The COVID-19 pandemic brought to light additional critical information was needed to keep patients and staff safe, such as laboratory results indicating the need for isolation precautions. The nurses within the surgical services noticed this critical information was not sufficiently included in the handoff report. The lack of this information led to unnecessary …

Stroke Education Program To Reduce Readmission, Karnesha Dominguez

MSN Capstone Projects

Stroke is a major cause of long-term disability and mortality in the United States, exemplifying a complex chronic disease with high co-morbidity, associated healthcare costs, and readmission rates. Unfortunately, patients diagnosed with strokes often present to acute care settings with stroke events after they have had been previously diagnosed. Readmission rates among stroke patients are as high as 13% with most readmissions being unplanned and many avoidable (Brom et al., 2021). An estimated 6.6 million Americans aged 20 years and older have had a stroke, and each year approximately 795,000 people experience a new or recurrent stroke (Duncan et al., …

Bedside Handoff In The Emergency Department, Sheila Pochron

MSN Capstone Projects

Background

A standardized approach to bedside handoff improves nurse and patient satisfaction as well as quality outcomes.

Objectives

To compare the preference for bedside handoff in the emergency department post implementation by analyzing nursing surveys and Press Ganey data.

Design

A mixed method pilot study.

Settings

A not-for-profit community-based safety net hospital which is Magnet designated. ED is a level 3 trauma center with 60,000 visits annually.

Participants

ED nurses (n=52) and adult patients (n=86)

Methods

A pre and post implementation survey that utilized the 5-point Likert scale was given to nursing staff in the emergency department. Questions were asked …

Bedside Shift Reporting: A Benchmark Project, Clydea C. Hale

MSN Capstone Projects

Patient care is forever changing to improve satisfaction, safety, and overall treatment. Over the past few years, patients and their families are more invested in their overall care in the hospital and expect to be informed every step of the way. A common complaint from patients or their families is that one nurse or staff did not know the individuals care or treatment plan, there were no shift goals to work toward discharge, and the nurse did not update the patient/family with changes in care. All of these complaints along with the patient satisfaction scores and communication between the treatment …

Hourly Rounding To Reduce Patient Falls - A Quality Improvement Project, Shelley L. Lloyd

MSN Capstone Projects

Patient falls are devastating. They can result in injury and even death. They also result in extra costs for the patient as well as they facility. Hourly rounding is a simple process that can help reduce the number of patient falls within an acute care facility. Purposeful hourly rounding will help meet the needs of the patient as well as allow the staff member to asses the environment for safety issues. Rounding should happen every hour during the day and every two hours at night. During these rounds, staff will ask the patient about pain, bathroom needs, comfort, peacefulness of …

Impact Of Central Line Bundle Care On Reduction Of Central Line Associated-Infections: A Scoping Review, Alisha James-Scott Msn, Fnp-C, Rachel Savoy Msn, Fnp-Bc, Donna Lynch-Smith Dnp, Acnp-Bc, Apn, Ne-Bc, Cnl, Tracy Mcclinton Dnp, Ag-Acnp-Bc, Apn

Doctor of Nursing Practice Projects

Purpose/Background Central venous catheters (CVC) are typical for critically ill patients in the intensive care unit (ICU). Due to the invasiveness of this procedure, there is a high risk for central line-associated bloodstream infection (CLABSI). These infections have been known to increase mortality and morbidity, medical costs, and reduce hospital reimbursements. Evidenced-based interventions were grouped to assemble a central line bundle to decrease the number of CLABSIs and improve patient outcomes. This scoping review will evaluate the literature and examine the association between reduced CLABSI rates and central line bundle care implementation or current use.

Methods A literature review was …

Leadership Rounding To Improve Patient Satisfaction In Pediatric Ambulatory Care, Tara J. Haskell

Student Scholarly Projects

Practice Problem: Low patient satisfaction has been linked to poor treatment compliance, patients leaving the practice, staff decreased job satisfaction, and high staff turnover (Haskard Zolnierek & DiMatteo, 2009; Prakash, 2010). Magnet reporting has identified wide discrepancies in ambulatory clinics, with some clinics reporting below benchmark patient satisfaction ratings.

PICOT: In pediatric ambulatory and primary care services, how will the implementation of leader-led customer service rounding, compared to current practice, increase family and/or patient satisfaction over 4 weeks?

Evidence: Key findings are that the rounding needs to be population-specific, intentional, and swiftly followed up when problems are identified. The body …

Medicated-Assisted Treatment And 12-Step Programs: Evaluating The Referral Process, Candace S. Brown, Chudney Williams, Ryan E. Stephens, Jacqueline Sharp, Bobby Bellflower, Martinus T. Zeeman

Doctor of Nursing Practice Projects

Purpose/Background Overdose deaths in the U.S. from opioids have dramatically increased since the COVID-19 pandemic. Although medicated-assisted treatment (MAT) programs are widely available for sufferers of opiate addiction, many drop out of treatment prematurely. Twelve-step programs are considered a valuable part of treatment, but few studies have examined the effect of combining these approaches. We aimed to compare abstinence rates among patients receiving MAT who were referred to 12-step programs to those only receiving MAT.

Methods In this prospective study, a cohort of participants from a MAT clinic agreeing to attend a 12-step program was compared to 15 controls selected …

Aspects Of The Physical Work Environment And Nursing Work, Yolanda Keys

Nursing Theses and Dissertations

Objective: The purpose of this body of work is to inform nurse leaders and design professionals of opportunities to leverage the physical environment to enhance the overall work environment for nurses.

Background: The environments in which nursing work takes place need to support the staff who work within them. Healthy work environments have been shown to improve outcomes for patients, nurses, and organizations; however, the contribution of the built environment to the overall work environment for nurses is not fully understood.

Methods: Included in this portfolio are three studies: 1) a descriptive study exploring the experiences of …

New Graduate Nurses’ Experiences Of Engaging In A Leadership Role In Hospital Settings During The Covid-19 Pandemic, Justine Jeanelle Ting

Electronic Thesis and Dissertation Repository

New graduate registered nurses are often expected to assume leadership roles and responsibilities quickly upon entering practice. Since the emergence of the COVID-19 pandemic, new nurses may find their leadership capabilities tested even further as the demands of leadership have been made increasingly complex in the context of an infectious disease outbreak. The purpose of this interpretive descriptive study was to explore new graduate registered nurses’ experiences of engaging in frontline leadership roles in hospital settings during the COVID-19 pandemic. In-depth interviews were conducted with 14 participants across Ontario. Content analysis revealed four main themes: nominated and necessitated into leadership …

Reddit And Nursing During Covid-19: A Summative Content Analysis, Julia C. Savin

Electronic Thesis and Dissertation Repository

Purpose: The purpose of this thesis was to explore what self-identified nurses discussed on the nursing SubReddit during the Covid-19 pandemic between March 2020 to May 2020.

Methods: The Hsieh and Shannon (2005) summative content analysis with emergent categorical development was used to categorize the naturalistic data.

Findings: Through analysis, six content categories were identified from the nursing SubReddit: (a) employers’ approaches to the pandemic; (b) emergency preparedness in response to the pandemic; (c) shared experiences; (d) nursing students and new graduate nurses; (e) coping; and, (f) gratitude to nurses.

Implications: (a) Leadership that is communication-focused will improve the quality …

"More Accessible And Easier To Deal With": A Qualitative Inquiry Of Leaders' Perceptions Of The Evolving Roles And Responsibilities Of Advanced Practice Providers At Texas Medical Center, Athena Krasnosky Msn, Aprn, Cpnp, Jessie Marcet-Gonzalez Msn, Aprn, Cpnp, Jordan Rodriguez Bs, Natalie Cormier Smith Msn, Aprn, Np-C, Brenda Chesley Msn, Aprn, Cpnp-Ac/Pc, Linda Brock Msn, Aprn, Cpnp, Heena Narsi Prasla Msn, Aprn, Cpnp, Geran Barton

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Background. With over 10 million patient encounters a year at Texas Medical Center (TMC), Advanced Practice Providers (APPs) are being incorporated into health care delivery models. Moving beyond the narrow “scope of practice” debates that frequently surface when talking about APPs, this inquiry instead seeks to broaden the discussion and take a more comprehensive view of how APPs are being incorporated into health care delivery models that span across several TMC institutions.

Methods. This study uses a thematic analysis study design to analyze structured interviews collected from a small convenience sample of Advance Practice Provider Program Directors at Texas Medical …

Outcomes Of A Positive Patient Id Campaign At A Pediatric Quaternary Care Center, Taylor Kim Md, Arjun M. Dangre Bds Mph, Andrea L. Davis Mph Cic, Betty J. Reeves Mha, Mt (Ascp), Omobola T. Durojaiye Msn, Rn-Bc

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Introduction. Positive patient identification (PPID) is critical to safe and accurate labeling of patient lab specimens. Accurate PPID is also an important priority of The Joint Commission’s National Safety Goals. Inadequate PPID compromises may lead to waste of time and resources, and in the worst-case scenario can lead to significant patient morbidity and mortality. With a focus on PPID, this initiative examined the occurrence of mislabeled and unlabeled lab specimens as well as compliance with wearing ID bands in a cohort of hematology/oncology and bone marrow transplant inpatients at a large pediatric quaternary care center.

Methods. Using the Plan-Do-Study-Act Model, …