Nursing Administration Commons^™

Aligning Theory And Evidence-Based Practices To Enhance Human Flourishing In Nurse Executives, Jim D'Alfonso

Doctor of Nursing Practice (DNP) Projects

Today’s nurse executives lead highly complex and bureaucratic organizations undergoing sweeping reform at an unprecedented rate of change. Change and high levels of stress are the norm in health care, and ineffective stress management can hinder organizational performance and adversely impact personal wellbeing. The risks of nurse executive burnout and unprecedented turnover led to the development of a 4-hour program to teach theory-guided and evidence-based stress management techniques. The program was intended to increase awareness, enhance effective stress management skills, and improve the nurse executive’s ability to flourish in high stress environments. A pre-intervention and 6-month post-intervention assessment (n …

Readiness For Improving Safe Care Delivery Through Web-Based Hospital Nurse Scheduling & Staffing Technology: A Multi-Hospital Approach, Lisa Massarweh

Doctor of Nursing Practice (DNP) Projects

Hospital scheduling and staffing practices are linked to patient safety, nurse satisfaction, and cost outcomes (Steege & Rainbow, 2017). Staffing, while complex, is ultimately central to the overall success of the hospital. Demands to eliminate events that cause death or serious harm, produce high patient satisfaction scores while maximizing workforce productivity, test any administrator’s skillset. Providing qualified staff in the right place at the right time can be challenged by restrictive union contracts, variable patient acuities, staff attendance, and mandated staffing ratios. These demands may lead to overtime utilization. There is a growing understanding of the negative effects of healthcare …

Breast Cancer Patient Preparedness For Transition To Survivorship: Individualized Survivorship Care Plans, Kimberly Beringer

Master's Projects and Capstones

Purpose. For breast cancer survivors, after-effects of surgery, radiation and chemotherapy can be substantial, and recurrence is a concern requiring constant surveillance. National healthcare organizations have promulgated guidelines that include providing individualized survivorship care plans (SCP’s). At a northern California oncology department, SCP’s will be prepared for breast cancer patients and delivered in-person by the oncology nurse navigator (ONN).

Method. The author worked with the ONN to develop the format and content requirements for the SCP’s. The ONN prepared individualized plans for patients and scheduled in-person appointments to deliver the SCP’s. A feedback survey to assess preliminary impact was then …

I’M A Big Kid Now: Enhancing Transition Rn Residents’ Confidence During Pediatric Patient Care, Emily W. Lam

Master's Projects and Capstones

The title of the clinical nurse leader project is “I’m a Big Kid Now: Enhancing Transition RN Residents’ Confidence During Pediatric Patient Care”. The project aims to improve the support components for Transition RN residents during their Transition RN Residency at Children’s Hospital Los Angeles. The clinical leadership theme that correlates to this project is communication. The clinical nurse leader’s role is to act as an educator and a facilitator throughout this project. In examining the clinical nurse leader competencies, competencies “use performance measures to assess and improve the delivery of evidence-based practices and promote outcomes that demonstrate delivery of …

Process Improvement Manual: Front And Back Office, Hafsah Badar

Master's Projects and Capstones

The global aim of this project is to decrease variations and improve efficiency in the tasks assigned to the support staff at an outpatient breast clinic. The breast center has a five-person administrative team who rotate through four positions monthly. The specific aim is by May 1, 2017, 100% of the five employees will have a comprehensive knowledge of their role, and adhere to a standardized way of completing tasks. The CNL Leadership themes used were Educator, Team Leader Manager, and Outcomes Manager. Informative interviews were conducted with the staff to gauge the unique needs of the team. 100% of …

Developing An Electronic Health Record Training Program For New Employees, Crystal D. Figlietti

Doctor of Nursing Practice (DNP) Projects

In May 2015, an electronic health record (EHR) was implemented at an urban, long-term care facility. This facility is part of the county Department of Public Health (DPH) and was one of the last locations to implement the designated EHR system. The unique nature of the facility compared to the smaller, health care centers within the DPH network necessitated development of a customized training and onboarding program for new employees. It was not possible to duplicate an existing training program. The registered nurse (RN) informaticist assigned to the EHR used data from nursing staff surveys and information collected through a …

Patient Care Sitter Reduction And Fall Safety Improvement, Timothy J. Bock

Doctor of Nursing Practice (DNP) Projects

The financial constraints imposed upon operational budgets by the frequent use of patient care sitters is well known among hospital leadership. Despite the high labor costs associated with direct and continuous observation, this intervention is routinely deployed by frontline care teams in an effort to preserve patients from harm, particularly from accidental falls. This reality creates an opportunity where significant budget savings can be achieved by supplanting the use of patient care sitters with more effective fall prevention strategies. This quality improvement (QI) project implemented a non-psychiatric sitter reduction and fall prevention initiative in two high volume adult acute care …

Innovation Through An Academic Practice Partnership: A New Clinical Nurse Leader (Cnl) Implementation Model, Nancy P. Taquino

Doctor of Nursing Practice (DNP) Projects

Problem

The IOM reports (1999, 2001) were catalysts for development of a new nursing role - the Clinical Nurse Leader (CNL). Academic practice partnership models are needed to integrate the CNL role in health care systems.

Context

A large integrated health care system in Northern California and a university Clinical Nurse Leader (CNL) program initiated a formal academic practice partnership, establishing a hospital based MSN CNL program.

Intervention

A CNL implementation model was developed that includes (a) academic practice partnership advisory charter; (b) academic practice partnership roles (MSN CNL program director, MSN CNL faculty liaison, and hospital-based CNL …

Improving Employee Engagement Through The Development Of An Enterprise Performance Management System, Carlton D. Abner

Doctor of Nursing Practice (DNP) Projects

There is ample evidence of our health care delivery system relying heavily on value-based outcomes. The increased focus on outcomes has required health care organizations to adjust how they approach data and how they successfully implement performance management systems. These performance management systems help the organization identify, measure, and report the organization’s performance at an enterprise level using key performance indicators clearly linked to the organization’s overall strategy. As one organization began implementing an enterprise performance management system, the goal of this project was to show how participating in projects with that level of strategic impact can lead to improved …

Nursing Student Work-Study Internship: Partnering To Bridge The Education-To-Practice Gap, Jonalyn M. Wallace

Doctor of Nursing Practice (DNP) Projects

Abstract

Discussed for decades, the need for transitional experiences bridging educational and practice settings gained momentum in the mid-1970s with the release of Kramer’s groundbreaking book Reality Shock: Why Nurses Leave Nursing. Nursing student internship programs were developed in the 1970s as one effort to address this issue. The Northern California Region of Kaiser Permanente partners with five universities to conduct the Nursing Student Work-Study Internship Program (WSP). The program provides senior level nursing students with a paid internship in clinical practice settings, working under the supervision of RN preceptors. The aim of the program is to improve the …

Optimizing Engagement In The Acute Care Setting: A Nurse Driven Staffing Model, Denise D. Fall

Doctor of Nursing Practice (DNP) Projects

Health care is on the threshold of major reform. Central to this reform will be the ability to maximize patient outcomes and resource allocation. The delivery of nursing care is essential to these concepts. Nursing care delivery impacts both patient outcomes and labor costs. Every aspect of care delivery has changed over time: length of stay, acuity, payment methodologies, documentation, technology, and regulatory requirements. Yet the model by which we allocate resources to the bedside is based on an archaic notion and forecasting model around one variable. The development of effective nurse staffing strategies will ensure those delivering care are …

Transforming Self And Systems Through Implementation Of A Caring Coach Leader Program, Priscilla Javed

Doctor of Nursing Practice (DNP) Projects

Assistant nurse managers and nurse managers, often referred to as middle managers, have a direct impact on daily hospital operations, clinical work environments, delivery of high quality safe patient care, and patient outcomes. The stressful demands of this role have caused turnover rates to soar above the national average on some of the inpatient hospital units. Instability of nursing management oversight negatively effects staff job satisfaction and delivery of high quality safe patient care. In reviewing the organizations initial orientation program for transitioning middle managers into their new role, it was missing the supportive guidance of a coach. A Caring …

Increasing Chlorhexidine (Chg) Daily Bathing Compliance, Jonathan Lee

Master's Projects and Capstones

Chlorhexidine gluconate (CHG) daily bathing in hospitalized patients in the intensive care setting is one of many interventions implemented by institutions to reduce and prevent central line associated bloodstream infections (CLABSIs) and catheter associated urinary tract infections (CAUTIs). These hospital-acquired infections (HAIs) plague and complicate treatments for critically ill patients in the acute care setting. CLABSIs and CAUTIs increase patient morbidity and mortality as well as place a financial burden with increased costs and hospital lengths of stay. The decrease of CHG compliance in our ICU unit can be associated with an elevated CLABSI rates. The focus of this CNL …

Standardization Of Body Imaging Huddle In Radiology, Margaret M. Browne Mcmanus

Master's Projects and Capstones

Mag Browne McManus

Clinical Nurse Leader Abstract

University of San Francisco

Abstract

Communication amongst healthcare providers is critical to reducing errors, and in procedural areas, the huddle can be used to standardized communication amongst the team before the beginning of interventional procedures (Goldenhar, Brady, Sutcliffe, Muething, & Anderson, 2013). Prior to the implementation of the revised huddle, a staff survey indicated none of the staff were satisfied with the current process. The objectives of the standardization of the body imaging huddle in the department of radiology were to increase staff satisfaction by 15% and reduce the time from patient arrival …

Improving Preadmission Testing Nurses' Knowledge Of Aortic Stenosis And Transcatheter Aortic Valve Replacement, Alberta Lynn Canale

Master's Projects and Capstones

Abstract

The purpose of this Clinical Nurse Leader (CNL) project was to reduce gaps in nursing knowledge through staff education. Guided by the CNL theme of educator and information manager, the goals were to increase PreAdmission Testing (PAT) nurses’ knowledge of severe/critical aortic stenosis (AS), transcatheter aortic valve replacement (TAVR) procedure and patient selection, and satisfaction with knowledge by 10%. Rapid growth of the TAVR program has contributed to a gap in nursing knowledge leading to inconsistent patient care and education. An educational program was developed and spread through a series of Plan-Do-Study-Act cycles. Pre- and post- implementation surveys were …

Strategic Community Healthcare Management, Stephanie Penrod

Master's Projects and Capstones

Federally Qualified Health Centers(FQHC) and Community Health Centers are growing with the Affordable Care Act. This paper introduces literature that supports the need for Community Health Centers and management of low income patients with chronic illnesses. This paper also reviews the fieldwork experience at a FQHC. It reviews the goals, project, methods and findings of the fieldwork. This paper also elaborates on the scope of the project and a quality improvement report for the FQHC in observation. It discusses the future potential implementation of the recommendations and the benefits for both employees and patients. This paper concludes with follow up …

Sustainable Cost Models For Mhealth At Scale: Modeling Program Data From M4rh Tanzania, Emily R. Mangone, Smisha Agarwal, Kelly L'Engle, Christine Lasway, Trinity Zan, Hajo Van Beijma, Jennifer Orkis, Robert Karam

Nursing and Health Professions Faculty Research and Publications

BACKGROUND: There is increasing evidence that mobile phone health interventions ("mHealth") can improve health behaviors and outcomes and are critically important in low-resource, low-access settings. However, the majority of mHealth programs in developing countries fail to reach scale. One reason may be the challenge of developing financially sustainable programs. The goal of this paper is to explore strategies for mHealth program sustainability and develop cost-recovery models for program implementers using 2014 operational program data from Mobile for Reproductive Health (m4RH), a national text-message (SMS) based health communication service in Tanzania.

METHODS: We delineated 2014 m4RH program costs and considered three …

Using A Strategic Model For Professional Development: The Importance Of Evidence-Based Competencies As A Foundation For Professional Practice., Peggi B. Winter

Doctor of Nursing Practice (DNP) Projects

Abstract

A nursing professional practice model (PPM) is designed to provide a framework for how nursing practices, communicates, leads, collaborates, and provides the highest quality of care as we navigate the complex healthcare system. An infrastructure for learning, competency, and performance needs to be integrated into this model as a foundation for accelerating business and clinical initiatives, promoting standardization, and sharing successful practices. It is now, more than ever, a necessity to have a well-trained, highly competent nursing workforce. Simply having the knowledge and the skill to do a job is insufficient; rather, it is implied that a competency has …

Building A Framework For Professional Nursing Practice Across The Continuum Of Care, Elizabeth S. Bigby

Doctor of Nursing Practice (DNP) Projects

Nursing professional practice models are designed to unite and align nurses under one vision, set of values, and a professional practice model. The goal of this project was to implement and enculturate a professional practice model of nursing with assistant nurse managers and leaders across the continuum of care at an urban medical center and associated ambulatory medical offices. Staff engagement has been shown to improve satisfaction and decrease turnover and implementation and enculturation of a professional practice model improves engagement. The target population was nurse managers and leaders as they needed to embrace professional practice before the project was …

Improving The Patient Experience By Implementing Patient-Centered Care In A Community Hospital, Richard A. Billingsley Dnp, Mha, Rn

Doctor of Nursing Practice (DNP) Projects

Health care is a complex business currently undergoing extensive reform. These changes require new methods of care deliver and ways in which health care organizations are operating. At the forefront of this change effort is the 2010 Patient Protection and Affordable Care Act, which is transforming health care from a volume-based, fee-for-service process to the delivery of services that have value, improve quality outcomes, increase satisfaction, elicit greater efficiency, demonstrate improved safety outcomes, show cost-effectiveness, promote better access to services, and result in high reliability between providers and organizations. The goal of providing a more positive health care experience is …

Caution: Line-Of-Sight In Icu Designs, Diane C. Bartos

Doctor of Nursing Practice (DNP) Projects

It has been estimated that by the end of 2015, the U.S. will spend approximately $200 billion in new healthcare facilities construction. Infection prevention, patient and family satisfaction, and technologies influence contemporary designs of critical care units. All of these impacts have created larger patient care units, with a majority of single patient rooms. These larger spaces have created challenges for the clinicians to maintain the line-of-sight. The line-of-sight is one tool clinicians often use to maintain patient safety.

Since the seminal publication by the Institute of Medicine in 1999, patient safety concerns have escalated after revealing numerous deaths in …

Preventing 30-Day Readmissions Of Clostridium Difficile Patients Utilizing Targeted Discharge Instructions, Keith A. Howard

Doctor of Nursing Practice (DNP) Projects

The Patient Protection and Affordable Care Act of 2010 ushered in a new era of fiscal accountability for healthcare organizations. Healthcare organizations and providers are now jointly held responsible for the improved quality of patient care and sustained reductions in patient care events termed healthcare-acquired conditions. To ensure compliance with this newly enacted legislation, the Centers for Medicare and Medicaid Services (CMS) began penalizing hospitals for targeted conditions leading to 30-day readmissions beginning in October 2012. Annually, CMS has focused attention on conditions that endanger patient health and welfare while secondarily attempting to reduce the excessive financial expenditures in …

Improving Patient Satisfaction Through Reducing Nurse Overtime And Redesigning Nurse Staffing And Scheduling, Abby Romme

Master's Projects and Capstones

Increasing cardiac device patient demands within a large Midwest healthcare institution resulted in significant increases in staff shift requirements and corresponding patient complaints. The quality improvement project aimed to decrease patient complaints by executing a standard baseline daily full time equivalent (FTE) staffing strategy for future schedules, increasing nursing FTE, and maintaining institutional staffing standards. Standard calculated daily nursing requirements targeted 17.0 FTE. Implementation occurred over a three month period including schedule reprocessing, a pending incremental nursing FTE request, and a restructuring of unit based scheduling and paid time off guidelines. The completed schedule accurately captured staffing requirements for 100% …

Process Change At An All-Volunteer Run Clinic With Pcmh Level 1 Recognition, Erin Flynn

Master's Projects and Capstones

This project directly involves the Clinical Nurse Leader (CNL) essential Informatics and Healthcare Technologies, and the CNL role function will be to act as a Team Manager. (AACN, 2013). The global aim of this process improvement is to improve the clinic workflow to increase patient and provider satisfaction in a Patient-Centered Medical Home (PCMH). The need for this project was discovered during the process of applying for PCMH recognition (of which the clinic has now earned level 1), and successful implementation of this project will meet PCMH guidelines. While applying for PCMH recognition, a clinic workflow document had to be …

Perinatal Patient Management, Natalie Whitten

Master's Projects and Capstones

The medical center has lacked the bed capacity and nursing staff to accommodate the needs of maternity patients. Patients are redirected to other network and non-network medical centers due to lack of bed availability, inadequate nurse staffing, and poorly managed patient movement. This project aims to improve patient management in the perinatal departments, including the discharge process. We will have 100% staff participation to facilitate bed management. The patient management project was conducted in a 200-bed hospital serving the residents of an urban area. The perinatal areas of labor & delivery (L&D), antepartum, and postpartum (OB) are highly productive units …

Improving Patient Safety: Reducing Medication Errors In The Microsystem, Erica M. Dent

Master's Projects and Capstones

In a 72-bed for-profit long-term acute care hospital located in an urban setting, there has been a fifteen percent increase of medication errors that the pharmacy department has detected across nursing, and pharmacy departments, as well as with physicians from both day and night shifts. Over the last month there has been a total of twenty-eight medication errors including the transcription, administration, evaluation, and documentation processes. The microsystem consists of a telemetry/medical-surgical unit as well as a small intensive care unit consisting of ten beds.

The prospectus details a project implemented to reduce medication errors within the microsystem. The steps …

Outpatient Medication Error Improvement, Savannah M. Klinginsmith

Master's Projects and Capstones

Patient Safety Initiative -Improving Medication Administration (Outpatient Care)

SPECIFIC AIM: We aim to Improve the medication administration process and involve all staff within 6 months

In the microsystem consisting of 14 family practice and urgent care clinics, there is not a standard process based on evidence based practices for medication administration. With and estimated of 400-600 medications (immunizations included) being administered per day, without a standard of care protocol, the risk for medication errors is evident.

Objectives and changes anticipated based on implementation of the project is to engage staff in support for improving medication administration standard of care based …

Specimen Labeling Improvement Project: Slip, Traci Hoiting

Doctor of Nursing Practice (DNP) Projects

Blood specimens are labeled at the time of acquisition in order to identify and match the specimen, label, and order to the patient. While the labeling process is not new, it is frequently laden with errors (Brown, Smith, & Sherfy, 2011). Wrong blood in tube (WBIT) poses significant risk. Multiple factors contribute to mislabeling errors, including lax policies, limited technological solutions, decentralized labeling processes, multi-tasking, distraction from the clinician, and insufficient education and training of staff. To reduce blood specimen labeling errors, a large academic medical center implemented an innovative technological solution for specimen labeling that integrates patient identification, physician …

Implementing And Evaluating A Clinical Information Interface Between An Electronic Medical Record And A Patient Classification System, Tanya Osborne-Mckenzie

Doctor of Nursing Practice (DNP) Projects

As a result of the Affordable Care Act and the Institute of Medicine’s initiatives, hospitals are challenged to improve outcomes as efficiently as possible. How does the national initiative of RNs partnering with other healthcare professionals to improve the quality of patient care at a lower cost, cascade down to individual organizations? One answer may come by focusing on nurse staffing in acute care hospitals. Considering the impact RNs have on patient quality outcomes and the bottom line of hospitals, appropriate management of the RN workforce is one of the most important areas hospitals can focus on in order to …

Avoiding 30-Day Readmissions Of Acute Mi Patients Utilizing Cardiac Rehabilitation, Patricia T. Forsberg

Doctor of Nursing Practice (DNP) Projects

A significant number of Acute Myocardial Infarction (AMI) patients were readmitted to an urban San Francisco Medical Center within 5-7 days post discharge this year. Two of the main identified causes were symptom management issues and medication instructions, both of which are part of the discharge instructions. It’s not surprising that 80% of all discharge teaching is forgotten by patients by the time they hit the parking lot. With the recommended timeframe for post discharge follow up appointments at 48 to 72 hours post discharge and as those appointments are not typically available within the recommended timeframe, patients are more …