Nursing Administration Commons^™

Implementation Of A Nurse-Driven Early Mobility Algorithm In Critically Ill Adults, Andrea Saito

Doctoral Projects

Background: Early mobilization of critically ill patients is recommended in clinical practice guidelines to mitigate ICU-acquired weakness, delirium, and improve recovery. This intervention is inconsistently implemented in many health systems due to a variety of barriers. One frequent barrier is uncertainty regarding whether patients meet safety criteria for mobilization. Purpose: The purpose of this quality improvement project was to implement a nurse-driven early-mobility algorithm with a clinical safety screen in an adult medical-surgical ICU and evaluate its impact on patient mobility scores, delirium rates, and ICU length of stay.​ Methods: The intervention was evaluated using a quasi-experimental before and after …

Exploring Virtual Nurse Perceptions Of Caring Through Acute Care Teleconferencing, Monika Lu

Doctoral Projects

Virtual nursing programs have emerged as innovative solutions to address hospital operational challenges and workforce shortages. However, concerns remain about the potential for decreased human connection in telehealth environments. Limited evidence exists regarding virtual nurses’ perceptions of caring behaviors and their ability to develop therapeutic relationships through teleconferencing technology. Purpose: This exploratory study examined virtual nurses’ (ViRNs) perceptions of caring and identified strategies for fostering patient relationships in telehealth settings. Methods: A mixed-methods custom survey was distributed to 25 eligible ViRNs at Stanford Health Care, with 19 respondents (76% response rate). ViRN caring perceptions were measured quantitatively using a 5-point …

Patient Reported Outcome Measure Use In Heart Transplant Care, Nichole Côté

Doctoral Projects

Despite growing evidence supporting Patient-Reported Outcome Measures (PROMs) in chronic disease management, no consistent application exists within the international heart transplant community. This Doctor of Nursing Practice project implemented the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) as a PROM within the a large volume heart transplant clinic, evaluating workflow feasibility, the association between Overall Summary Scores (OSS) and visit length, and clinician perceptions of PROM use. The KCCQ-12 was administered via a mobile health application with automated distribution. Workflow integration was assessed by calculating the percentage of scheduled visits with completed PROM documentation. Visit length was measured using electronic medical record …

Building Nurse Managers’ Knowledge And Confidence To Lead Clinical Ladder Success: A Theoretically Informed Educational Framework, Michelle Joann Chlebinski

Doctoral Projects

Background: Clinical Ladder Programs (CLPs) offer a structured pathway for nursing professional growth, fostering clinical excellence while improving nurse satisfaction and longterm retention. Although nurse managers play a pivotal role in facilitating the CLP, there is currently no comprehensive educational framework to enhance their knowledge and confidence in supporting clinical ladder advancement. Purpose: The aim of this DNP project is to develop implement, and evaluate an educational framework grounded in Benner’s Novice-to-Expert framework and Watson Caring Science® to enhance nurse managers' knowledge and confidence in leading nurses towards clinical ladder success. Methods: In a quasi-experimental study using a single-group, pre-post …

Advancing Equitable Nurse Assignments Through Nursing Workload Score Categorization In An Adaptable Acuity Unit At An Academic Health Center, Moses Albaniel

Doctoral Projects

Inpatient nursing shift assignments often rely on clinical judgment, which can lead to inequitable workload distribution on mixed‑acuity units. This quality improvement project evaluated assignment equity using the coefficient of variation (CV) of nursing workload acuity scores and examined the relationship between workload balance and perceived assignment burden. A single‑group pretest–posttest design was implemented on a cardiac adaptable acuity unit at Stanford Health Care over a 12‑week period, encompassing 168 shifts from December 14, 2025, to March 7, 2026. The intervention, implemented with 11 charge nurses, combined structured charge nurse education with an optimized Epic Reporting Workbench tool incorporating dynamic …

Ai Literacy In The Nursing Informatics Community: A Needs Assessment, Jerri Westphal

Doctoral Projects

Nursing informatics professionals are required to lead AI integration in healthcare, yet their baseline AI literacy, competency, and educational needs have not been formally assessed. This descriptive needs assessment examined AI literacy, competency, adoption readiness, and engagement among nursing informatics professionals, concurrently identifying educational priorities and preferred learning modalities. A cross-sectional survey was administered to members of the American Nursing Informatics Association (ANIA) and the broader community (N = 194). The N.U.R.S.E.S. framework (Hoelscher & Pugh, 2025) informed the survey instrument's domain structure. Five composite indices were developed: AI Familiarity, Knowledge, Attitude, Competency, and Use. Descriptive statistics and Pearson correlation …

Cross Cultural Mentoring: Including Diversity Awareness Strategies Into Healthcare Leadership Mentor Curriculum To Support Career Advancement Of Underrepresented Racial And Ethnic Groups, Deidra R. Burris

Doctoral Projects

Background: Mentoring programs in healthcare organizations can establish clear pathways for advancement through various management and leadership levels to senior-level positions. While mentoring develops leaders, many healthcare organizations do not offer mentoring programs that address unique issues experienced by members of racially and ethnically underrepresented groups. A study was conducted using a single-group, repeated-measures design to assess the impact of an intervention aimed at improving mentor attitudes, behaviors, and confidence regarding cultural awareness in the mentoring relationships of healthcare leaders. Methods: The study was conducted in a large California healthcare organization. The Cultural Diversity Awareness related to Race/Ethnicity (CDA-R/E) subscales …

Healthcare Provider Comfort Surrounding Adverse Childhood Events (Aces), Cameo Culcasi

Doctoral Projects

Adverse Childhood Experiences (ACEs) are strongly linked to long-term health outcomes, yet discussions around ACEs in clinical settings remain inconsistent. This study investigates the comfort levels of healthcare providers in addressing ACEs with their patients, identifying barriers and facilitators to such conversations. Using a Quasi-experimental, single group, pretest-post test experimental design, we surveyed a diverse group of physicians, nurse practitioners, and physician assistants working in a primary care setting, providing ACE training, and an opportunity for learning reflection. Preliminary results indicate that while most providers acknowledge the importance of discussing ACEs, many report discomfort due to time constraints, lack of …

Patient Perception Of Nurse Practitioner Care, Nurse Practitioner Scope Of Practice And How That Influences Provider Choice, Naomi Hemp

Doctoral Projects

This project investigates patients' perceptions of nurse practitioner (NP) care versus physician (MD) care, the factors influencing these perceptions, and patients' understanding of NP scope of practice. A cross-sectional design was used, gathering quantitative data through an anonymous one-time survey distributed via Qualtrics, open for three months. Questions were based on The Watson Caritas Patient Score (WCPS) and the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS). Data were analyzed using Intellectus Statistics software™, with descriptive statistics summarizing the findings. A two-tailed paired samples t-test revealed statistically significant differences in favor of patients' perceptions of NP care versus …

A Four-Year Longitudinal Study Of Effectiveness Of Evidence-Based Bundle Practices For Preventing Catheter-Associated Urinary Tract Infections In An Academic Health Care Center, May Mei-Sheng Riley

Doctoral Projects

Catheter-associated urinary tract infections (CAUTIs) significantly contribute to morbidity, prolonged hospitalization, and elevated healthcare costs, underscoring the crucial need for prevention to ensure patient safety. Despite ongoing mitigation efforts, CAUTI prevalence remained a concern in our facility at the time of this study. Catheter insertion and maintenance bundles, a recognized framework utilizing teamwork, collaboration, and focused interventions, were implemented to reduce CAUTIs and improve patient safety. This study evaluated the effectiveness of these bundles in reducing CAUTIs and catheter utilization to identify best practices for enhanced catheter management and care quality.

Improving Communication And Job Satisfaction: Utilizing Team Strategies And Tools To Enhance Performance And Patient Safety (Teamstepps) For Interventional Service Areas, Sukhbinder Kaur Sangha

Doctoral Projects

Purpose: Improved communication and job satisfaction among staff are essential for those working in high-stress critical care environments like the cardiac catheterization laboratory (Cath Lab). The purpose of this investigation was to utilize the quality improvement initiative Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) to improve attitudes and job satisfaction in the Cath Lab. Method: A total of 30 subjects participated in a TeamSTEPPS educational intervention. After obtaining informed consent, a demographic survey, a pre- and post-test TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ) and Job Satisfaction Survey (JSS) were administered. The post-test included open-ended questions for feedback …

Improving Nurse Confidence Around Communication With Physician Partners Through The Caritas Processes, Deborah M. Yracheta

Doctoral Projects

Nurses are the eyes and ears at the bedside during a patient’s hospital stay. They are responsible for communicating significant changes in a patient’s health status, mainly to their physician partners. Unfortunately, good communication between nurses and doctors is a shortcoming of the nursing profession. Seven thousand reviewed malpractice lawsuits were directly related to poor provider communication, resulting in $1.7 billion in malpractice cases and 2,000 preventable deaths. These communication errors also lead to prolonged hospital delays in care, underscoring the need for improved communication. These poor outcomes compromise patients’ lives, safety, and well-being and decrease patient satisfaction scores, ultimately …

Unlocking Icu Barriers: Investigating The Challenges Of Early Progressive Mobility, Leslie S. Bigler

Doctoral Projects

Approximately 800,000 patients in the United States annually are admitted to the Intensive Care Unit (ICU) due to critical illnesses and prolonged immobility contributes to poor patient outcomes. While existing data demonstrates early and progressive mobility helps improve outcomes, adherence remains inconsistent for a variety of reasons such as safety concerns, staffing, and lack of knowledge and confidence of mobilization techniques. This quality improvement project, conducted in a 20-bed Medical Intensive Care Unit, asked staff to identify barriers to adherence to mobility protocols. Nurse managers and clinical educators play a crucial role in addressing these issues using strategies such as …

Experiences Of Transitioning Medics And Hospital Corpsman, David Renfro

Doctoral Projects

Approximately 2,000 medics transition from military service to civilian jobs annually, and the civilian workforce currently does not have a mechanism to utilize the skills of these transitioning veterans. Medics and Hospital Corpsmen are not licensed or certified, making transferring into employment in the community difficult. The Veterans Affairs (VA) has an intermediate care technician (ICT) program that provides employment for previous active-duty medics and hospital corpsmen. Understanding the transition of medics and hospital corpsmen better positions the Department of Defense and the VA leadership to support the transitioning veteran.
This DNP project used a quality improvement framework, and a …

Creating Rural Nurse Retention Strategies For Nursing Administrators, Susan Lesser

Doctoral Projects

Rural area nurse retention has been referred to as a crisis for decades; this crisis has been exacerbated by several factors including the COVID-19 pandemic, resources being directed towards larger hospitals, the inability to recruit and retain healthcare providers to rural areas, and the aging workforce (Rossetter, 2020). The researcher in this Doctor of Nursing Practice (DNP) Project investigated the elements that encourage rural nurse retention and sought to develop retention strategies that are rooted in the literature and anchored in the concerns of rural nurses. Retention strategy recommendations were drawn from results from the Revised Casey Fink Nurse Retention …

How Implementing A Digital Competency Management System Reduced Nurse Training Cost And Improved Npd Practitioner Satisfaction In A Pediatric Hospital, Dionne Margallo

Doctoral Projects

Healthcare organizations must have high-quality nursing staff to deliver optimal patient care. Educators and managers evaluate nurses by their performance through nursing competencies, or “knowledge, skills, [and] abilities” (KSA) (American Nurses Association, 2015, p. 86). Traditional competency evaluations and manual tracking posed a problem within one pediatric hospital. Leaders did not have a transparent way to see the knowledge and skills of their nursing staff. This resulted in increased organizational costs due to retraining and increased workload and job dissatisfaction among educators. The purpose of this quality improvement (QI) project was to evaluate how implementing a digital competency management system …

Tiered Centralized Education In The Transition-To-Practice Program To Improve Nurses' Level Of Confidence On Nursing Sensitive Indicators Outcomes, Froiland Agana Ascaño

Doctoral Projects

A tiered Centralized Education in the Transition-to-Practice (TTP) Program is crucial to improving nurses' Level of Confidence on nursing-sensitive quality indicators. The benefits of a structured orientation program taught by trained content experts are evident in the literature. In addition, training transition-to-practice RNs during onboarding with training and assessment sessions throughout the orientation program to increase frequency provides skills acquisition. This study examined the impact of a house-wide education program on the nurses' confidence levels of CLABSI prevention, a measured nursing-sensitive quality indicator. This quasi-experimental quality improvement study measured the confidence and comfort levels of transition-to-practice RNs and identified that …

Full Practice Authority: Determining Readiness Among Nurse Practitioner Students In Mississippi, Betty Hoffman

Doctoral Projects

Full practice authority has been granted to nurse practitioners by many states. These practitioners are educated and trained as full primary providers of health care. Full practice authority for nurse practitioners is not granted in Mississippi, which currently ranks in the lowest positions for health care in the United States. The low ranking can be attributed to a lack of providers and access to services.

This project seeks to explore attitudes and understanding of nurse practitioner students in the State of Mississippi regarding full practice authority. A survey will be electronically distributed to determine what is already known and understood …

Evidence-Based Policy And Procedure Review System, Meredith A. Stokes

Doctoral Projects

Policies and procedures guide practice and the care of patients in every field of healthcare. Incorporating best practice evidence into clinical practice is a critical step towards providing safer patient care and improved patient outcomes. The challenge has been finding a way to incorporate best practice evidence into policies and procedures. Accordingly, an evidence-based project to answer the following clinical practice question was proposed: What is an evidence-based strategy for reviewing, updating, and disseminating policies and procedures for office staff at a cancer treatment organization? Through the use of Donabedian’s Model for Quality Improvement, student created tools, and an evidence-based …

A Quality Improvement Project To Improve Financial Sustainability Of Home-Based Palliative Care Program, Andrea L. Giffel

Doctoral Projects

Background and Objectives: Home palliative care services are challenging to bill due to the complexity of services and competing time demands. Objectives and protocol were developed to guide coding and billing to increase Relative Value Unit generation and improve financial sustainability.

Design: A quality improvement project.

Setting: A home-based palliative care program in one health system in the Midwest.

Participants: Participants included 7 nurse practitioners.

Intervention: Coding protocol were developed, providers were educated, electronic health record audits were conducted to collect data on improvement, and feedback provided to prompt improvement.

Measurement and Analysis: Documentation of advanced care planning and billing, …

Learning Lean To Lead, Krystle Irene Guenther

Doctoral Projects

This project sought to see if training frontline nurses and physicians together in Lean methodology improved collaboration between the two disciplines while giving them the tools they need to lead change at the bedside and in their practice. A quasi-experimental pre- and post-intervention methodology was used. The intervention was six, four-hour in-person modules on performance improvement (PI). Respondents completed two surveys, the performance improvement instrument and the Professional Practice Environment Assessment Scale (PPEAS). Surveys were paired for analysis. There was a statistically significant median increase in participants confidence for all questions on the PI instrument post-intervention. Results for the PPEAS …

Implementation Strategies To Reduce Hospital Readmission Rates In Adults With Sepsis: A Quality Improvement Project, Erin Kucharek

Doctoral Projects

Background: Sepsis is a concern in healthcare, as patients are 2 to 3 times more likely to be readmitted to the hospital than those with other illnesses. Readmitted patient with sepsis costs the healthcare system $3.5 billion dollars per year. Effective care coordination is a tool that decreases readmission rates in other illnesses and is likely applicable to those with sepsis. The purpose of this quality improvement project was to determine if primary care provider follow-up appointments, increased home care utilization, and patient education would reduce sepsis readmissions.

Methods: The Transitional Care Model guided project design and The Kotter Model …

Utilization Of Patient Toolkit And Discharge Algorithm For Providers To Reduce Readmission Due To Repeat Ground Level Fall, Sara Karl

Doctoral Projects

Introduction. Falls are the leading cause of injury and injury death in adults over the age of 65. A retrospective examination at Level 1 trauma center in the Midwest found that 19.4% (118/605) of older adults admitted with a ground level fall were readmitted with a subsequent fall and injury. The aim of this quality improvement initiative is to determine if the implementation of an evidenced based patient toolkit and a discharge algorithm for providers will reduce outpatient falls. The objective was to reduce hospital readmission due to repeat fall.

Methods: The design of this project was mixed methods, observational, …

Increasing Annual Retinal Exams Among Patients With Type 2 Diabetes, Afokoghene H. Odhu

Doctoral Projects

The Center for Disease Control and Prevention (CDC, 2017) reports that approximately 30 million people in the United States (US) have diabetes. Approximately 8 million have diabetes retinopathy (DR) (CDC, 2018). DR is the leading cause of vision impairment in type 2 diabetes patients. Left untreated, DR can result in loss of vision and blindness (Hernández, Simó-Servat, Bogdanov, & Simó, 2017). The US spends approximately $500 million dollars annually in the treatment of diabetes-related blindness (CDC, n.d.). Early detection and management of DR through tight glycemic control, aggressive blood pressure and lipid management is essential to preventing complications of the …

Increasing Patient Satisfaction Survey Response Rate At An Ambulatory Surgery Center, Carlee Nicholson

Doctoral Projects

In an effort to increase distribution rate and response rate of the patient satisfaction survey at this ASC, adjustments were made to current processes. These interventions included accentuating the option of a paper or emailed survey, providing pre-operative and post-operative response prompts, as well as adding a cover letter to the existing survey. The purpose of these interventions was to ensure a 100% distribution rate of the survey as well as to increase the response rate by 20%.

Results were obtained by collecting forms to monitor distribution of the survey. The response rate was calculated by the number of responses …

Optimizing Clinical Processes Using The Electronic Health Record To Improve Patient Outcomes In Primary Care, Alex Jubril

Doctoral Projects

Background: The EHR has been used to leverage clinical processes for the improvement of patient outcomes. The average users of EHR limit its uses to the minimum level required to complete the daily tasks needed, regardless of the existence of features within the EHR that are readily available to optimize clinical processes for efficiency and effectiveness.

Objectives: The objective of this project was to improve the documentation in a nurse-managed health clinic related to the patient-centered medical home (PCMH) core criteria through enhancing the EHR to foster the quality improvement metrics and reporting.

Methods: This was a quality improvement project …

Nurse Managers: An Association Between Empowerment And Burnout, Sonja Lynn Avery

Doctoral Projects

The purpose of the study is to ascertain the presence of an inverse relationship between nurse managers’ feelings of structural empowerment and self-perception of burnout. Although research is available studying the effects of staff nurse empowerment and burnout, literature is sparse relative to evaluation of nurse manager empowerment and burnout. Of the studies available, there is supportive evidence pertaining to the negative implications associated with nurse manager burnout such as reduced staff nurse retention and morale, decrease in quality of patient care, and financial impact on organizational success. With such negative implications associated with a lack of empowerment and burnout, …

Improving Patient Handover From The Pediatric Emergency Department To The Pediatric Intensive Care Unit, Kathryn Devinney

Doctoral Projects

Patient safety can be at risk during registered nurse handover, particularly when transitioning between high risk areas. According to The Joint Commission (2017), a standardized transition process should be implemented during patient handover. The purpose of this paper was to evaluate the effect of a standardized process with a cognitive aid on handover between a pediatric emergency department and an intensive care unit. Objectives of the project were to decrease conversion time in the emergency department, increase standardized process utilization, and improve patient outcomes, registered nurse perception and satisfaction, and patient proxy satisfaction. This evidence-based quality improvement project took place …

Interprofessional Collaboration To Improve Discharge Planning, Erica L. Spalding

Doctoral Projects

Historically, health care professionals collaborated solely with other professionals within the same discipline. However, evidence shows collaboration between all disciplines involved in patient care leads to improved patient outcomes. Interprofessional collaboration can reduce costs and improve patient care, yet is used inconsistently in health care systems. Interprofessional collaboration was not fully used on two medical-surgical units in a large health system in the Midwest, particularly during the discharge planning process. This project aimed to standardize rounds on two units as part of a larger initiative to standardize rounds across all units within the system. The clinical question to be answered …

Development Of A Process For Adoption And Attainment Of Pcmh Recognition Requirements For An Urban Primary Care Clinic, Jamie L. Hendricks

Doctoral Projects

The Centers for Disease Control and Prevention (2017) reported that in 2016, healthcare expenditures in the United States totaled 17.9% of the gross domestic product. Unfortunately, care quality is not reflective of the high costs of care. Models of care delivery like the patient centered medical home (PCMH) have shown promise in addressing these concerns.

This project focused on program development for PCMH adoption at an urban clinic in an effort to improve financial stability and remain competitive. The purpose was to propose a plan for adoption and attainment of PCMH recognition requirements for an urban primary care office.

The …