Medicine and Health Sciences Commons^™

Frontline Nurse Leader Orientation Programs: A Review Of Literature, Shanelle Renee House

DNP Qualifying Manuscripts

Abstract

Aim This manuscript aims to synthesize the literature on the skills and knowledge needed by frontline nurse leaders and effective orientation or training programs developed to meet those needs.

Background Frontline nurse leaders are often promoted to positions of leadership due to their strong clinical skills; they often do not receive formal training.

Evaluation A literature search was conducted to identify and critically appraise journal articles that discuss orientation and training programs offered to frontline nurse leaders.

Key Issues The literature review revealed that frontline nurse leaders require a variety of skills and knowledge to be successful. Orientation and …

Implementing A Fall Prevention Program: A Quality Improvement Project To Promote Patient Mobility On The Medical-Surgical Unit, Alba Araiza

Master's Projects and Capstones

Implementing a fall prevention program is imperative in acute healthcare settings. Falls are one of the top reported events that occur in hospitals and it is a patient safety concern that requires the implementation of evidence-based practices to reduce falls. This quality improvement project will be developed by a master’s prepared clinical nurse leader (CNL) on a medical-surgical unit to improve patient safety.

Problem

Maintaining patient safety is the most important priority in health care. Health care organizations implement protocols, policies and procedures to ensure that care is provided in a safe manner to minimize preventable harms. However, falls are …

Implementing A Fall Prevention Program: A Quality Improvement Project To Promote Patient Mobility On The Medical-Surgical Unit, Alba Araiza

Master's Projects and Capstones

Abstract

Implementing a fall prevention program is imperative in acute healthcare settings. Falls are one of the top reported events that occur in hospitals and it is a patient safety concern that requires the implementation of evidence-based practices to reduce falls. This quality improvement project will be developed by a master’s prepared clinical nurse leader (CNL) on a medical-surgical unit to improve patient safety.

Problem

Maintaining patient safety is the most important priority in health care. Health care organizations implement protocols, policies and procedures to ensure that care is provided in a safe manner to minimize preventable harms. However, falls …

A Literature Review On The Benefits For An Interprofessional Educational Program To Increase Novice Nurse Awareness Of Case Management In Heart Failure, Emily Trefethen

DNP Qualifying Manuscripts

Abstract

Purpose/Objectives: The purpose of this literature review is to examine the potential value for an interprofessional education program to increase novice nurse awareness of case management in heart failure.

Primary Practice Setting: Acute care healthcare settings involving novice nurses.

Findings/Conclusions: Evidence demonstrates that interprofessional collaboration on transitional care interventions for HF patients reduces 30-day readmissions. Implementation of an interprofessional education program for novice nurses can be an effective intervention to decrease readmissions by increasing knowledge of the nurse case manager role and development of interprofessional relationships.

Implications for Case Management Practice: Increased awareness of heart failure case management is …

Nurse-Driven Protocol To Reduce Urinary Catheter Infections: A Quality Improvement Project, Sara Burrington

Master's Projects and Capstones

Costs of healthcare are astronomical, not only in the financial sense, but in many aspects of life for both patients and healthcare providers. Costs include those accompanying healthcare associated infections (HAI), where as a result of environmental factors, a patient acquires an infection during their admission. Since 2008, Medicare and Medicaid no longer reimburse hospitals for infections deemed ‘reasonably preventable.’ The biggest offender of this type of HAI is overwhelmingly, catheter associated urinary tract infections (CAUTI) (Kennedy, Greene & Saint, 2013). With approximately 31% of the inpatient population requiring an indwelling catheter at some point throughout their stay, risk of …

Compounding Effects Of Reducing Nurse Burnout And How It Can Produce An Increase In Patient Safety And Satisfaction, Alexander Mua

Master's Projects and Capstones

The reduction of nurse burnout has shown to have an increase in patient satisfaction and quality of care. It also has shown a decrease in patient-related or sentinel events. Accordingly, with the reduction of nurse burnout, there has also been a reduction of compassion fatigue. This project has illuminated the benefits of acuity-based caseload at the micro-level, including the cost-effective nature of overtime pay, including HCHAPS benefit score. The method of obtaining, planning, and implementing was based on the Plan, Do, Study, Act (PDSA), which required collaboration amongst multiple disciplines, groups, departments, and executives. The process and goals concluded to …

Improving Handoff To Decrease Sepsis Mortality: A Quality Improvement Project, Macdana Selecon, Macdana Selecon

Master's Projects and Capstones

A sepsis handoff tool utilized between Emergency Department nurses and unit nurses at a 554-bed acute care hospital were investigated. A survey assessing general knowledge of the facilities sepsis protocol was given to ED nurses, and unit nurses. The electronic health records (EHR) were evaluated for feasibility to transfer the facilities current paper format sepsis handoff tool into the EHR with time sensitive alerts. Three literature reviews supported utilization of standardized handoff tools for improved patient outcomes.

Improving Discharge Medication Education On A Sepsis Unit: A Quality Improvement Project, Maria Noguez

Master's Projects and Capstones

Ineffective discharge education plays a role in increased readmission rates, adverse drug events, and worsened patient outcomes post-hospitalization. When combined, the resulting financial burden on America’s healthcare system is exorbitant, as is the physical and mental toll on unsuspecting patients. To close the current gaps in discharge teaching, this project is incorporating the teach-back method and utilizing updated medication handouts.

Starting on the sepsis unit of a large, local medical center – the Clinical Nurse Leader (CNL) interns employed assessment tools to identify areas for improvement. The data revealed rushed, incomprehensive discharge medication education and reflected in low HCAHPS scores …

An Approach To Increase Education In The Flu Vaccination Clinic Process, Koki Guangxi Inlow, Lucy Dale, Devante Lindsey, Nancy Tran Manalo, Elena Teresa Cleary

Master's Projects and Capstones

The Health Ministries Program, located in Orange County, is supported by a large faith-based community hospital and provides community resources such as flu vaccinations that are overseen by the Faith Community Nurse (FCN). In collaboration with the program, University of San Francisco (USF) nursing students researched and developed an implementation of a multi-purpose educational flyer to increase education and better streamline the process at flu vaccination clinics throughout Orange County faith-based organizations. Research shows that many individuals still do not get vaccinated due to misconceptions, misinformation, and lack of knowledge on the importance of flu vaccinations. The cost of flu-related …

Reducing Vascular Access Complications Through Precise Cannulation Plan Implementation, Rosemarie Quicho

Master's Projects and Capstones

Abstract

Aneurysm, which is the dilatation of the arteriovenous fistula (AVF), and pseudo-aneurysm, which is caused by leaking of blood outside the arteriovenous graft (AVG), pose a threat to the vascular access (VA) and the patient (Mudoni et al., 2015). Uneven vein penetration by dialysis needles and subsequent skin scarring lead to the development of inflammatory changes in the VA area. Scab formation masks the signs of ongoing inflammation. Damage to and tearing of the scab can then lead to lethal exsanguination from the VA (Handlos, Marecová, Smatanová, Dvořáček, & Dobiáš, 2018). Dialysis staff members are trained to use the …

Increasing Utilization Of Motivational Interviewing To Promote Pediatric Oral Health, Ulyses Reamico

Doctor of Nursing Practice (DNP) Projects

Prevalence of early childhood caries (ECC) remains high even in developed countries such as the United States. An interprofessional education (IPE) project between University of San Francisco (USF) School of Nursing and Health Professions and the University of the Pacific (UoP), Arthur A. Dugoni School of Dentistry was initiated four years ago to enhance nurse practitioner (NP) and dental students’ pediatric oral-systemic health assessment and health promotion communication skills. Since then, USF NP students received pediatric oral health assessment training and spent clinical rotations at UoP to provide pediatric oral care alongside dental students. This doctor of nursing (DNP) project …

Caring Science Education: The Essence Of Professional Practice For The Registered Nurse, Linda C. Ackerman

Doctor of Nursing Practice (DNP) Projects

Problem: Hospitals have moved from caring, healing environments to business or economic models of caring institutions that focus on census instead of on patients and on technology instead of on touch or human connection (Watson, 2006).

Context: As nurse leaders, we have an obligation to create an environment of authentic, professional, human caring practices within our organizations. Caring science empowers nurses to balance the art and science of clinical judgment by engaging and collaborating with the patient and their family, focusing on the needs of the whole person, honoring the unique perception of health and healing, and engaging them to …

The Impact Of A Nurse Engagement Model Implementation On Patient Outcomes, Karen Strauman

Doctor of Nursing Practice (DNP) Projects

As key figures in health care today, nurses contribute greatly to the provision of safe, quality care delivery in the acute care setting. Increasing evidence indicates that patient outcomes are better in hospitals with good nurse work environments, including those with a professional practice model of care delivery. With health care organizations currently facing demanding competitive markets, multiple governmental regulations, various accreditations, financial stability, patient safety concerns, patient and family satisfaction, sustainable quality metrics, resource stewardship, and workforce issues such as turnover and shortages, it is imperative that organizations look to assuring they have a strong nursing workforce. Professional practice …

Implementation Of A Mentor Program To Support Nurse Retention: A Pilot Project, Lucy Camarena

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: Primary factors affecting nurses’ decisions to stay at an organization include nurse self-concept, job satisfaction, and professional growth. A high turnover rate of nurses poses a risk to patients’ safety and healthcare outcomes. The implementation of mentor programs in institutions that employ new nurses has been shown to reduce turnover rates, increase the quality of patient care, and empower nurses in professional development. The existing literature supports the use of mentor programs and encourages their implementation in healthcare institutions.

Interventions: The DNP project’s goal was to identify effective methods of promoting positive nurse self-concept and increasing job satisfaction …

Coaching Nurse Leaders In Conflict Management And Team Building To Improve Retention, Jeanette Black

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: Retention of assistant nurse managers (ANMs) was identified as a concern from interviews with executive leadership and ANMs employed at a large hospital within a Northern California integrated health system. The nurse leader orientation training was reviewed, with gaps identified in conflict management and team building.

Context: The attrition rate of U.S. nurse managers in 2010 was 8.3%, higher than executive nurse leaders, with replacement costs equal to 75% - 125% of a nurse manager’s salary (Loveridge, 2017). Employee turnover and dissatisfaction due to conflict can have detrimental effects on retention, productivity, morale, and quality of patient care. …

Expanding Magnetic Resonance Imaging Access For Patients With Cardiovascular Implantable Electronic Devices, Rosalie Geronimo

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem. Patients with non-conditional cardiovascular implantable electronic devices (CIEDs), which lack magnetic resonance imaging (MRI) components, are unable to undergo MRI.

Context. The Heart Rhythm Society guidelines for patient device management and Centers for Medicare and Medicaid Services requirements for persons with specific expertise in implanted permanent devices to manage CIEDs during MRI spurred policy, procedure and staffing changes.

Interventions. The evidence-based change-of-practice project comprised of workflow development, policy and procedure changes, implementation of required staffing support to manage the CIED during an MRI.

Measures: The outcome measure was to improve access to MRI for patients with CIEDs, measured …

Nurse Manager Succession Planning: Building A Leadership Pipeline For The Future, Katie Stephens

Doctor of Nursing Practice (DNP) Projects

Problem. This academic medical center was increasing bed-capacity and needed to hire 12 additional nurse managers (NM) to meet these new requirements. Promoting assistant nurse managers (ANM) to the NM role saves time and money, supports leadership and cultural continuity, and demonstrates a strong organizational commitment to internal human capital.

Context. Formal nurse manager succession planning (NMSP) programs have been shown to increase nurse manager competency and retention rates, while also helping to identify and develop new generations of nurse leaders. To mitigate the recent loss of ANMs and strengthen the remaining leadership bench strength, the organization is developing, implementing, …

Dnp Project: Development Of A Nurse-Led Pop-Up Clinic Model In San Diego, Jennifer King

Doctor of Nursing Practice (DNP) Projects

Baccalaureate nursing programs across California (CA) are required by the state board of nursing to provide theory of public health and applied clinical learning to meet the requirements of the state’s public health nurse (PHN) certification. Students in Bachelor of Science in Nursing (BSN) programs are expected to enter the workforce prepared to address population health needs that synthesize community-based assessment and understand epidemiologic approaches to strategize interventions in diverse populations at the local, state and national levels. To adequately prepare nurses for true population health practice, clinical experiences need to be in appropriate settings where they can apply theory …

Larc Method Appropriateness In Substance Use Treatment: A Quality Improvement Project For Integrated Care, Malia Johnson Dnp, Fnp, Alexa Curtis Phd, Fnp-Bc, Neda Afshar Dnp, Fnp-C, Msn, Cgrn

Doctor of Nursing Practice (DNP) Projects

Problem: Individuals with substance use disorder (SUD) have disproportionately higher rates of unintended pregnancy when compared to the general population, estimated to be 85% (Heil et al., 2011). Not only are poor maternal and fetal outcomes associated with unplanned pregnancies, but pregnancies in women with SUD are further complicated by additional risks and adverse outcomes (Black & Day, 2016).

Context: Addiction treatment centers and programs are primed with opportunity to offer family planning services, when contact with medical providers is increased for substance use treatment. In response to the opioid crisis and unprecedented rates of unintended pregnancy, this project …

Improving Chronic Hepatitis B Virus Screening At A Safety-Net Primary Care Clinic, Uwaezu J. Umeh

Doctor of Nursing Practice (DNP) Projects

Hepatitis B Virus (HBV) is a type of virus that affects the liver. Chronic hepatitis B is usually asymptomatic and many HBV carriers remain unaware of their viral status, thereby may unknowingly transmit the disease. If left untreated or undetected, it could lead to cirrhosis, hepatocellular carcinoma or mortality. Although this virus is endemic in some parts of the world such as Asia and Africa, it is important to note that HBV has become a global problem. The Centers for Disease Control and Prevention (CDC) in conjunction with the United States Preventive Services Task Force (USPSTF) estimates that about 700,000 …

Adopting Complex Case Management Competencies, Phyllis Stark

Doctor of Nursing Practice (DNP) Projects

Improving disposition management of complex hospitalized patients is crucial to the success of acute care facilities. Most hospital patients discharge in less than 5 days, but there is a cohort of complex patients whose length of stay far-exceeds the norm (Centers for Medicare and Medicaid Service Website, n.d.). Today’s case managers are focused on patients who are discharging today or tomorrow in order to keep hospital census cycling through. This phenomenon known as “throughput” drives daily operations and is a measure of success. When case managers are faced with complex patients whose length of stay measured in weeks, months, or …

A Quality Improvement Project To Implement Shared Medical Appointments For The Management Of Type 2 Diabetes In Latino Patients, Denisse Maldonado

Doctor of Nursing Practice (DNP) Projects

Problem: Santa Rosa Community Health (SRCH) is one of the largest federally qualified health centers in Northern California, providing health care to more than 30,000 patients. More than half of the patients receiving care at the SRCH Lombardi site are Latino patients. Patients self-identify as Latino or other ethnicity on the initial health center registration form. SRCH serves 964 patients with diabetes. Due to limited access to appointments and resources, seeing a healthcare provider regularly can be difficult, posing a barrier to diabetes management. Patients with diabetes would greatly benefit from regular appointments with their primary care provider and resource …

A Formal Hcahps Teaching Program Targeting Communication Improves Hcahps Scores, Bobbie Davis

Master's Projects and Capstones

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey given to patients after discharge from an inpatient unit is a validate tool used to determine the level of patient experience. Organizations across the country, including the Northern California Academic Medical Center, have implemented many initiatives aimed at improving these scores. HCAHPS scores for the hematology/oncology unit at this medical center remain low even after previous education efforts. The aim of this quality improvement project was to improve the patient experience, as evidenced by HCAHPS scores, with the implementation of an HCAHPS teaching program for nursing staff, focusing on …

Use Of A Prevention Bundle To Reduce Colon Surgical Site Infections, Stephanie Kimberly Leong

Master's Projects and Capstones

Site Infections (SSIs) are the second highest amongst healthcare-associated infections (HAIs). SSI rates are disproportionally higher among colon surgeries, resulting in significant complications with adverse clinical and economic impacts (Keenan et al., 2014). The overall upward trend in SSI rates, including the increase colon SSI rates in 2018 called for immediate action in a 120-bed community medical center. A multidisciplinary team was assembled to implement an improvement initiative using evidence-based guidelines. An evidence-based care bundle was designed and implemented to prevent and reduce colon SSI rates. There are seven process measures: the use of chlorhexidine wipes preoperatively, hair clipping outside …

Improving The Rate Of Hand Hygiene Immediately Before And After Wound Care In The Street Nurse Microsystem, Amanda Ramos Sandoval

Master's Projects and Capstones

The street nurse team of Sacramento, CA provides many services to patients who are experiencing homelessness, including a substantial amount of wound care. While the street nurses were performing hand hygiene (HH) prior to and after wound care, they would often not be performing it immediately prior and post-wound care. Because the nurses hike to their patients (who are living on the streets or in out of the way camps) the street nurses would often perform hand hygiene while at their cars prior to going to the patient and again when they returned to their cars after performing wound care. …

Burnout, Depression And Suicide Prevention For Nursing Staff In High-Intensity Settings, April Ritchie

Doctor of Nursing Practice (DNP) Projects

Nurses working in high-intensity settings experience burnout at higher rates than in other nursing areas. Burnout in healthcare is a problem estimated as high as 70% by the Agency for Healthcare Research and Quality. Burnout can lead to depressive symptoms, which can lead to suicidal ideation in affected healthcare providers, which makes early identification and treatment of utmost importance to the mental and physical wellbeing of these nurses.

The purpose of this project is to examine burnout in nursing staff working in high-intensity areas of the hospital in order to help identify burnout and/or depressive symptoms before they lead to …

Implementation Of A Simulation-Based Interprofessional Patient Safety Program, Mariko Nowicki

Doctor of Nursing Practice (DNP) Projects

Problem: Despite mandatory biannual patient-safety training at hospitals in Japan, medical adverse events continue to increase. However, many such events are preventable through adherence to standard practices of safe patient care.

Context: A lecture-based educational approach is inadequate to develop patient-safety competency in clinical educators or clinicians. Participation in simulation-based interprofessional patient-safety training programs can enhance knowledge, skills, and attitudes to promote patient safety culture and enhance patient outcomes.

Interventions: An evidence-based train-the trainer-patient safety program was conducted using simulation for interprofessional healthcare educators to serve as safety champions.

Measures: Three outcome and three process measures geared toward self-evaluation and …

Applying The Model Of Interrelationship Environments And Outcomes To Simulation For Nurse Leaders To Enhance The Professional Practice Work Environment: Creating A Mile One Nurse Leadership Simulation Toolkit, Alicia Garcia-Cisneros

Doctor of Nursing Practice (DNP) Projects

In nursing leadership, defining a culture of accountability is pivotal to ensure patient safety and achieve optimal patient outcomes. Nurse leaders play a significant role in transforming the professional environment, work culture, and professional behavior to deliver the highest-quality patient care. Often, nurse leaders are challenged in developing workplace environments and structures that encourage professional autonomy, advocacy, and culture climates as well as in motivating nursing staff to feel engaged. Despite an abundance of evidence underscoring the importance of staff engagement, a Gallup study revealed that only 30% of U.S. employees and 13% of employees worldwide are engaged in their …

Strengthening The Advanced Practice Clinician Workforce Pipeline Through Preceptor Education And Support, Tarina Levitt-Trujillo

Doctor of Nursing Practice (DNP) Projects

Problem: The Advanced Practice Clinician (APC) workforce pipeline is dependent on clinical training opportunities. Clinician providers are encouraged to precept students but rarely are offered support tools to ensure a successful process. Lack of adequate support can result in a suboptimal outcome for the APC students.

Context: Clinician preceptors in a large healthcare organization looking to build a robust APC pipeline to support future patient populations.

Interventions: Preceptor materials were developed and delivered to clinical preceptors to help them successfully precept advanced practice clinician students during their clinical rotations. This material consisted of 20 microlearning modules to help clinicians …

Nursing Practice Meets Theory, Debra J. Morton

Doctor of Nursing Practice (DNP) Projects

These are challenging times for nurse leaders. Over the last decade, debates on healthcare reform have focused on the cost of care in the United States. This discussion has placed increasing pressure on nurse leaders to operate organizations that are more efficient, while improving quality and patient outcomes.

The practice of commanding and directive leadership has never been effective long term. Nurses want leaders to make sense of a situation and explain the why. With the growing trend toward hospital reimbursement for performance measures that are nurse-driven and informed consumers with higher expectations than ever before, it is vital …