Nursing Commons^™

Transforming Nursing Preceptors By Developing Emotional Intelligence, Michael Francis

Doctor of Nursing Practice (DNP) Projects

Changing the process of professionally developing nursing preceptors to meet the growing and changing needs of the nursing profession is critical. This evidence-based project leveraged an advanced preceptor education program for inclusion of basic emotional intelligence tenets and transitioning them into preceptor self-awareness, leadership recognition, and return on human capital investment. A large integrated healthcare system in Northern California identified a strategic need for preceptor development and within the system two acute care hospitals and one home health/hospice agency were selected to participate. The intervention included the development of a six-hour curriculum delivered through an interactive and innovative in-person learning …

Frontline Focus: A Nurse Manager's Employee Engagement Toolkit, Christen Straw

Doctor of Nursing Practice (DNP) Projects

Abstract

Average hospital turnover rates in the US reached 18.2% in 2017. Turnover rates for registered nurses (RNs) were also at an all-time high of 16.8%. RN turnover can cost up to $61,100 per nurse resulting in the average hospital loss of $5.7 million per year (NSI, 2018). Employee engagement and job satisfaction levels are predictors of nursing turnover and patient outcomes and should be a top priority for nurse leaders. A disengaged workforce not only affects team morale and organizational spending, but it also impacts the quality of patient care. Multiple studies suggest that employee engagement is the number …

Implementation And Evaluation Of A Nurse-Driven Protocol For Urinary Catheter Management, Analynn Cisneros

Doctor of Nursing Practice (DNP) Projects

Problem Description: Hospitals compromise quality care and the health of its patients by subjecting the patients to risks that are preventable, such as nosocomial infections (IOM, 1999). The most preventable infection is a catheter-associated urinary tract infection (CAUTI) (Tenke, Meizei, Bode, and Koves, 2016). CAUTIs remain prevalent in the acute care setting (CDC, 2016).

Context: Prior to the implementation of this DNP project, the organization of focus did not have a nurse-driven protocol in place to guide urinary catheter management. Joint Commission mock surveyors recommended a protocol be implemented. A nurse-based protocol would benefit this Magnet hospital. Implementing …

School-Based Suicide Prevention Program Implementation: Improving Awareness Among Parents And Faculty, Nicole Neuman

Doctor of Nursing Practice (DNP) Projects

The health development and critical transition period of preteen to adolescence are subject to adverse experiences and prevalent risk behaviors that may negatively influence mental health. Emerging issues of depression and suicide among school-aged youths present a global epidemic. Well-designed interventions, such as school-based programs, align with national strategies and health initiatives to reduce suicide rates and facilitate treatment of concerning symptoms. Database searches for school-based, suicide, depression, prevention, and screening literature from 2012-2017 identified 12 relevant studies selected for review. Mental wellness and suicide prevention curricula must successfully improve wisdom, enhance coping skills/resilience, and foster relationships which support help-seeking …

Nursing Partnership With Patients, Parents And Families For Safety Through Simulation, Courtnay Caufield

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: The importance of communication between nurses, patients, and their family members with respect to treating each other as partners in safety cannot be overstated. It is imperative that families and patients feel empowered to speak up and report clinical errors at any time and be able to communicate effectively to prevent harm and encourage communication.

Context: This is especially important in the acute care setting, where patients may be in contact with multiple people and processes daily. Attention to this safety partnership can be established through improvements in patient satisfaction scores, which are usually collected from patients and …

Caritas Intervention To Reduce Stress And Increase Resilience Among Caregivers, Randy L. Williams Ii

Doctor of Nursing Practice (DNP) Projects

Problem

Workplace stress and burnout consistently rank among the highest concerns in surveys of caregivers. A gap analysis was conducted among a group of patient care coordinators and medical social workers. The gap analysis identified a need for tools to address stress, feelings of being overworked, and irritability.

Context

The setting is an acute care trauma facility providing care to general medical–surgical adult patients, cardiac care, pediatrics, and maternal child care. This facility exists within a larger integrated health care system, consisting of more than 20 acute care facilities in Northern California. The participants were patient care coordinators and medical …

Implementing A Surgical Infection Prevention Practice In An Integrated Healthcare System, Tammy Peacock

Doctor of Nursing Practice (DNP) Projects

Problem: One of the most preventable health care associated infections (HAI) is surgical site infection (SSI). Approximately sixty percent of SSI’s could be prevented. The devastation of an SSI to the patient can be catastrophic. The cost to the health care system for treating SSI’s can be substantial (Ban et al., 2017).

Context: The rate of surgical site infections has been on the increase over the past three years. The concern for the amount of harm affecting our patients was worrisome. The cost of reputation and the bottom line to the organization was recognized by senior leadership. The support from …

Teamstepps: A Foundation For Shared Governance In A High-Risk Obstetrical/Neonatal Service Line, Genevieve Wright

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: Declining registered nurse (RN) engagement in the maternal child health (MCH) department, despite improvements in RN staffing, some reductions in nurse-patient ratios, the addition of support staff resources, and a focus on quality and safety.

Context: The project setting is an MCH department of a 184-bed community hospital, part of a large national organization, serving a diverse population in Northern California. The initial stakeholders included RNs, managers, and assistant managers; the team was later expanded as the project developed (see Appendix A).

Intervention: The original aim of this project was to improve nurse engagement among frontline nurses through …

Improving Management Of Obstetrical Emergencies: Using Simulation-Based Training, Amira Amatullah

Doctor of Nursing Practice (DNP) Projects

The aim of this Executive Leadership Doctorate in Nursing Practice project was to assess the effectiveness of simulation-based training as a strategy to ensure patient safety and quality care by improving the knowledge and confidence of obstetric nursing staff. Collateral goals included the development of a simulation-based interactive training program to improve staff response to obstetric emergencies and the establishment of an Interprofessional Simulation Training Center.

The use of simulation-based training is widely accepted ans used in healthcare education. Several benefits of simulation-based training include a learner-centered approach, safe acquisition of technical skills training and development of effective communication skills. …

Implementing A Nursing Professional Model To Improve Staff Nurse Engagement And Teamwork, Lakhbir Sohal

Doctor of Nursing Practice (DNP) Projects

Problem: Several studies have examined the role of the nurse and reveal that job-related stress, defined as an overload of high acuity patients, physical and emotional demands of the job, and lack of autonomy, may impact engagement and teamwork (Garrosa et al., 2010). Evidence suggests a direct correlation between high levels of staff engagement and teamwork improves quality outcomes for the organization. Therefore, it is imperative that we measure staff engagement and teamwork on our nursing units to ensure that quality indicators are met and that as an organization we provide safe patient care.

Context: The purpose of this Doctor …

Colorectal Cancer Screening In Veterans Affairs, Neda Afshar

Doctor of Nursing Practice (DNP) Projects

Each year, eligible veterans are referred to the gastroenterology department for colorectal cancer screening, primarily for colonoscopy. Once the colonoscopy is completed and is found to be unremarkable, the patient is asked to return in 10 years for a follow-up colonoscopy. However, if problems are found on the original colonoscopy, such as polyps, the patient enters a surveillance period where more frequent colonoscopy monitoring occurs. While primary care providers are aware of the monitoring guidelines, many providers unnecessarily order fecal immunochemical tests (FITs) during this period of surveillance. Unnecessary costs to the Veterans Affairs Health System (VAHS) include cost of …

Improving Pediatric Oral-Systemic Health Through Motivational Interviewing: An Interprofessional Training Intervention, Oksana Prodan

Doctor of Nursing Practice (DNP) Projects

Introduction: In response to the prevalence of early childhood carries (ECC) in the United States, recommendations were established for pediatric primary care providers to routinely incorporate oral-systemic health promotion services into clinical practice. An interprofessional education project was developed between Advanced Practice Registered Nurses (APRNs) and dentistry students in San Francisco to assist trainees in the effective delivery of oral systemic health promotion services. Improving health promotion communication skills was identified as an area of need for both sets of learners. Therefore, the IPE activity was designed to incorporate Motivational Interviewing (MI) into the training along with pediatric oral …

Building The Foundation Of A Mentoring Program For Chief Nurse Executives, Patricia Gooch

Doctor of Nursing Practice (DNP) Projects

The chief nurse executive (CNE) is the senior leader whose primary responsibility is to assure quality of care and patient experience in acute care hospitals. Uncertainty in the political arena and further changes to the Affordable Care Act (ACA) highlight the need for hospitals to maintain continuity of leadership for the executive closest to patient care – the CNE. In a large and complex health system, the role of the CNE can be an overwhelming responsibility for seasoned professionals – and especially daunting if you are new to the role of CNE or new to an organization as an experienced …

Creating A Healthy Work Environment Using Communication And Recognition, Rachel A. Coicou

Doctor of Nursing Practice (DNP) Projects

Working in a healthy environment is of interest to nurses at every level of employment. Whether a frontline nurse or a nurse executive, it just feels better to wake up each morning and go to work in a place that respects clear communication and recognizes the great work that is being done. Working in such an environment is engaging and encourages employees to thrive (Shirey, 2006). Teamwork, camaraderie, and work satisfaction will increase in a healthy environment (Hall, Doran, & Pink, 2008). Thus, nurse leaders’ imperative is to meet the obligation of creating a healthy work environment (HWE) for the …

Development Of An Advanced Practice Provider Onboarding Structure, Amy Ziegler

Doctor of Nursing Practice (DNP) Projects

Advanced practice providers, also referred to as nurse practitioners and physician assistants, are increasingly being employed to function in a variety of healthcare settings. As organizations grow their advanced practice provider staff, they must develop a distinct advanced practice provider orientation and onboarding program. Finding the right staff is only half the battle; if you do not orient and onboard staff properly the will not stay (National Systems Contractors Associations [NSCA], 2017). Administrators, certainly directors of advanced practice providers, are pursuing unique and dynamic ways to facilitate credentialing, privileging, orientation and onboarding of these individuals. The director for advanced practice …

Building The Business Case For Clinical Nurse Leader Integration Into A Hospital Staffing Model, Shelley Johnson

Doctor of Nursing Practice (DNP) Projects

The Clinical Nurse Leader (CNL) is a newer role in the nursing profession. This generalist Registered Nurse (RN) role was designed to help address fragmented healthcare delivery and care coordination, emphasize and facilitate evidence-based practice, and improve patient quality outcomes at the microsystem level (AACN, 2011). This paper describes a Doctor of Nursing Practice (DNP) project that took place from January through December 2017 focused on making the business case to incorporate CNLs into a hospital staffing model. The CNLs focused on reducing hospital acquired infections (HAIs). The CNLs’ work reduced HAIs by 48% in 2017 as compared to 2016 …

On-Line Simulation In Clinical End User Training, Genoveffa Devers

Doctor of Nursing Practice (DNP) Projects

Abstract

In today’s ever-changing, do more with less environment, nurses and clinicians must be thought of as adult learners who are self-motivated with a need to know and master the technology they are using. In busy hospital and clinical environments, training nurses and clinicians in the traditional classroom setting can be both difficult and costly. On-line simulation training provides access to all staff to gain hands on end-user experience before new equipment is implemented. As hospitals look to embrace new technologies in this complex healthcare environment, assuring staff training is a required part of the vendor selection process and incorporated …

Ethics Education To Empower Nurses To Effectively Consult The Hospital Ethics Committee, Elaine L. Ware

Doctor of Nursing Practice (DNP) Projects

Nurses interacting with patients and family members need support when the course of the patient’s care becomes uncertain or conflicted leading to ethical concerns. Educating nurses about the purpose of the Hospital Ethics Committees (HEC) may support nurses with ethical concerns, alleviate moral distress and improve job satisfaction. Utilizing the HEC for ethically challenging care situations enhances the professional practice and supports the code of ethics for nurses. HECs which are often underutilized can provide valuable resources for nurses. This DNP project sought to increase the number of nurses’ ethics consultations to the HEC after providing ethics education using a …

Implementation Of The Win Workforce Stability Tool Kit, Ellen Katherine Kuhnert

Doctor of Nursing Practice (DNP) Projects

Precise and accurate staffing is vital to healthcare organizations. Comprehensive workforce planning is the foundation for successful staffing. Healthcare leaders need workforce data and tools that provide visibility and actionable intelligence to drive the best possible resource decisions. A workforce tool kit that nurse leaders can use to maintain visibility into their overall workforce picture can drive cost savings and provide operational wins. Lack of visibility into workforce metrics and tools drove the development of a tool kit that would aid in addressing some of these issues. The tools included provided real-time, market-specific data that was used to drive decisions …

Promoting Transgender Cultural Awareness And Sensitivity Through Education: It Starts With A Pronoun, Jacob Adkison

Doctor of Nursing Practice (DNP) Projects

Background: Health and social disparities affect the quality of life of transgender and gender nonconforming people in a negative manner as opposed to that of their cisgender counterparts (James et al., 2016). Gender discrimination, the lack of medical insurance, and a shortage of culturally competent providers contribute to some of the healthcare barriers in this population. The absence of supportive education for healthcare practitioners for providing culturally sensitive care impacts the transgender and gender nonconforming persons’ desire to seek routine health maintenance due to stigma, which can result in poor health outcomes (Bauer et al., 2009).

Methods: To help fill …

Enhancing Health Literacy Using Teach Back Method To Increase Patient Adherence, Tram Mendoza

Doctor of Nursing Practice (DNP) Projects

Health literacy is an important component of successful health care delivery and relies on both individual and systemic factors to achieve. For individuals not trained in the medical field, health literacy can be a complicated and perplexing web of information to navigate. Patients can have varying degrees of health literacy affecting their understanding of health conditions, especially the elderly, immigrants, minorities, and the low-income populations. Limited health literacy can pose risks on a patient’s well-being, interfere with their self-care and health maintenance, and possibly create obstacles for the patient if health instructions are not clearly understood. One proven model of …

An Assistant Nurse Manager Leadership Laboratory Program And Its Effect On Nursing Outcomes, Alexandra Wiggins

Doctor of Nursing Practice (DNP) Projects

Aim: This paper summarizes the project development, implementation and outcomes of an Assistant Nurse Manager leadership laboratory program and elements involved in the coursework. Through lecture, simulation, and mentoring components, noted change in leadership ability of novice/advanced beginner Assistant Nurse Managers were assessed over a six-month period and monitored the effects on quality and financial metrics, as well as the self-confidence of the Assistant Nurse Managers. Evaluation conducted included both quantitative and qualitative outcome assessment.

Background: The literature shows that quality leadership produces quality nursing outcomes (Houser, 2003). Leadership style (Wong & Cummings, 2007), communication skills (Vogus & Sutcliffe, 2011), …

Manager Leadership: Beginning At Novice, Kathy Bay

Doctor of Nursing Practice (DNP) Projects

To meet the current and anticipated nursing leadership gaps, there is a critical need for tools and programs to develop of future leaders. Unfortunately, there is a deficiency related to the preparation and readiness of novice nurse managers which impacts turnover, burnout, and the quality, safety and cost of care for patients. The aim of this Doctor of Nursing evidence-based change in practice project was to create an online training program that integrated two national nursing leadership competencies to assist the development of novice nurse managers as they transition to a formal leadership role.

A video-based module system with active …

Advanced Access: Creating An Infrastructure For Success In Primary Care, Kimberly D. Perris

Doctor of Nursing Practice (DNP) Projects

The Humboldt Independent Practice Association (IPA) has sought to improve the health of Humboldt County through practice transformation efforts. To date, Humboldt IPA’s primary care practice, the Priority Care Center, is building a foundation toward an Advanced Access model of care with an overarching aim of effectively improving access to quality care in Humboldt County. The 10 Building Blocks of High Performing Primary Care Practices framework set the stage for the intervention and was used as a roadmap to build an infrastructure for success. Team-based care was highlighted as the project relied on having systems and processes that empower the …

Decreasing Environmental Health Risks In The Philippines: Implementation Of A Culturally Appropriate Screening Tool, Alyssa Samson

Doctor of Nursing Practice (DNP) Projects

Objectives: The purpose of this DNP project was to increase the knowledge of environmental health risk factors in the Philippines among nurses and doctors located within that healthcare system. The overall goal was to educate providers on local environmental health risks, provide training for the use of a screening tool (Tagalog Environmental Health and Safety Assessment Tool [TEHSAT]), and provide resources aimed at increasing screening of at risk populations and provide opportunities for education and health promotion.

Methods: This project included a two-part educational training session. The first part included a preliminary presentation on environmental health and the use of …

Ethics Education To Empower Nurses To Effectively Consult The Hospital Ethics Committee, Elaine L. Ware

Doctor of Nursing Practice (DNP) Projects

Nurses interacting with patients and family members need support when the course of the patient’s care becomes uncertain or conflicted leading to ethical concerns. Educating nurses about the purpose of the Hospital Ethics Committees (HEC) may support nurses with ethical concerns, alleviate moral distress and improve job satisfaction. Utilizing the HEC for ethically challenging care situations enhances the professional practice and supports the code of ethics for nurses. HECs which are often underutilized can provide valuable resources for nurses. This DNP project sought to increase the number of nurses’ ethics consultations to the HEC after providing ethics education using a …

Standardizing And Magnetizing Improvement Projects, Brittany Kyle

Doctor of Nursing Practice (DNP) Projects

Abstract

Recent changes to healthcare reimbursement models have forced hospitals to improve their quality of care while reducing costs. John Muir Health has adopted the Performance Improvement philosophy to address these challenges. However, the current state for improvement project design is not standardized and does not guarantee that Magnet© standards will be followed. This design has caused confusion, inability to achieve project goals, and dissatisfaction among team members. The inability to achieve project goals has resulted in an ineffective use of resources and redundant work.

The objectives of this project were to standardize the way improvement projects are reviewed …

Improving Communication Competency In Perioperative Nurse Managers, Philomena Whelan

Doctor of Nursing Practice (DNP) Projects

Abstract

Aim: This paper outlines the project planning, implementation and evaluation of a project aimed at improving the communication competency of perioperative nurse managers. Leadership development consisted of providing education and simulation practice to managers of the operating room (OR), pre and post anesthesia recovery (PACU) area and sterile processing (SPD). The goal was to improve the OR turnover time, cost per OR hour, patient access and the perception of the participants in their ability and willingness to speak up.

Background: The literature shows that training is needed to improve the ability of teams to understand the factors influencing the …

An Informatics Solution For Operating Room Efficiency, Richard A. Barrow

Doctor of Nursing Practice (DNP) Projects

Problem: For most hospitals, a major cost is the operating room. Inefficiency increases costs and risks for adverse events. An efficient operating room can also be a major revenue generator.

Context: This evidence-based performance improvement project was conducted in a small rural Veteran’s Hospital, which belongs to an integrated health network in Central California. The facility has four operating rooms and is expanding services provided to their patients.

Intervention: The intervention was the use of analytics and evaluations to improve the operating room efficiency by five percent. The use of 3 separate queries which were combined to generate reports and …

Leadership Development, Succession Planning And Simulation: A Succession Plan For Organizational Success, Beth Eichenberger

Doctor of Nursing Practice (DNP) Projects

Future executive nurse leaders must be identified and prepared for the challenges of 21st century health care. The literature suggests a lack of existing standardized succession plans for these leaders. Senior leaders are often faced with the complex issue of how to develop and validate the competencies required for these leadership roles (Dyess, Sherman, Pratt, & Chiang- Hanisko, 2016). Therefore, in the absence of a succession plan, creating a leadership development program, which provides a pipeline of new executive leaders, would alleviate this gap. The motivating force is an effort to promote current talent and provide a higher level of …