DNP Project

State your clinical question draft here. Use the elements of the PICOT sections below to describe each component. Refer to your Melnyk & Fine-Overholt (2015) textbook for PICOT question choices.

What is the gap in practice at your organization that this question seeks to address?

Authors of extant studies have linked nurse-staffing levels with the patient length of stay (Needleman, Buerhaus, Mattke, Stewart, & Zelevinsky, 2002), increased complication rates (Dimick, Swoboda, Pronovost, & Lipsett, 2001; Unruh,2003; Whitman, Kim, Davidson, Wolf, & Wang, 2002), patient mortality and failure to rescue (Tourangeau, Giovannetti, Tu, & Wood, 2002), among other issues.  Minore et al. (2005) conducted a study on nurse turnover rates in Canada, reporting their negative effects on communication, medication management, and continuation of care.  Authors of several studies conducted in the US similarly noted a link between high RN turnover rate and a greater prevalence of wound infections, medication errors, and patient mortality (Aiken et al., 2002; Aiken et al., 2010; McGillis Hall et al., 2004 ).

At UCIMC, nursing shortage/turnover is presently managed by hiring float pool Registered Nurses (FPRN).  The float pool at the UCIMC is a distinct nursing unit that allows this medical facility to utilize FPRNs to fill in for absent unit-specific staff and take on assignments in short-staffed areas, or to assist with unforeseen patient census increases.  Although ensuring that each FPRN is competent to work in numerous departments is viewed as cost-effective for some big organizations like UCIMC, which is a 550-bed trauma center, there are still some concerns and practice dilemmas to consider.  Examples of these practices are:

• FPRNs are not treated like RNs working in other units.  In UCIMC, many FPRNs feel that they are not given the same respect as that afforded to other RNs.
• FPRNs at the UCIMC have different orientation timeline to that offered to other RNs, which is insufficient to prepare them adequately to respond to the needs and challenges of different units to which they may be assigned.
• Because FPRNs do not have a “home” unit, they may not be informed about relevant education and training, the organization’s vision for nursing practice, and organizational strategic plans.  Moreover, they do not have access to the same educational resources and organizational performance improvement opportunities as other RNs have.
• Currently, float pool RNs are not included in most training or practice updates, and rarely receive timely training on new equipment.  As they do not partake in performance improvement projects within the organization, this limits their potential for professional advancement.
• FPRNs frequently report in informal discussions that they are usually assigned either the less challenging patients or the most difficult cases.
• FPRNs are seen as a resource aimed to give regular RNs a break, resulting in their needs not being adequately addressed.
• Owing to the nature of their work and the treatment they receive at the workplace, FPRNs may feel less productive, as their time is spent searching for supplies or seeking help from RNs on the unit.  As a result, these FPRNs feel undervalued and expendable, which may compromise their dedication to patient care and potentially risk patient safety.

Accordingly, the goal of this DNP project is to examine the effect of Appreciative Inquiry Training (AIT) on FPRNs’ intent to stay employed and engaged with organizational activities after attending an AIT event.  AIT is a highly adaptable philosophy and process for engaging RNs in organizational processes and initiatives aimed at instilling changes in their organizations, thus transforming them to a workplace RNs are proud to work in (Bechtold, 2011).  The main aim of AIT is to build a strong core in RNs by giving them confidence they need to complete any job.  Having a strong, positive core increases RNs’ self-respect and confidence in their abilities.  As they are able to recognize the value of personal contribution to the team effort, this generates a positive atmosphere where each RN can work with others (Bechtold, 2011).  However, this can only be achieved if each RN is aware of both his/her strengths and weaknesses and is willing to learn new skills.  Thus, the goal of AIT is to motivate participants to ask questions related to the work of others and discuss positive experiences or successes.  This exchange of knowledge and information promotes collaboration in finding answers, thereby creating shared meaning and providing opportunitiesfor forming new perspectives and experiences.  Given its many benefits, AIT has beenextensively used in practice as an effective tool that can be applied to lead transformational change (Cooperrider & McQuaid, 2012).

AIT is a change management framework that can be used to engage employees in a meaningful way.  As noted above, Appreciative Inquiry Training allows participants to ask questions and partake in discussions about strengths, achievements, values, expectations, and dreams.  AIT technique focuses on positive energy, which is seen as a source of strength that would allow participants to overcome difficulties and achieve improvements.  The AIT instructor acts as a facilitator, whose main goal is to initiate a conversation within the group, which prompts participants to tell their stories and histories that define the organizations they work for (Davis, 2010).  According to Davis (2010), within AIT, conversations serve as a vehicle for reframing individual narratives in a way that promotes transformation.  Thisprocess is based on a four-phase model, referred to the 4-D Cycle, comprising of discovery, dream, design, and destiny.  The aim of the discovery phase is to assist the participants with identifying positive aspects of their prior experiences and the stories shared by others.  Participant stories are crucial to the AIT process, as they foster images of achievement, while the act of sharing them with others promotes the sense of togetherness.  In the dream phase, the participants are encouraged to engage in critical reflection, focusing on the positive aspects of their current situation.  They utilize the insights gained in the design phase, as a part of which the group discusses the positive points each of the participants has identified and draws parallels with the proposed practices.  The stories and statements generated in the discovery, dream, and design phases stimulate imagination, allowing the participants to visualize a desiredfuture.  This marks the start of the fourth phase, destiny, where each participant defines an action plan to achieve the goals defined in the design phase, which should prompt action that can lead to the desired transformation (Davis, 2010).  Accordingly, AIT adoption in this project is expected to improve FPRNs’ retention and increase their organizational engagement (Cooperrider & McQuaid, 2012).

Who is your target population or what problem will be addressed? 

This acute care inpatient setting was chosen for conducting the project because the high FPRN turnover and high level of dissatisfaction result in continuous vacancies, which are costly for the organization, not only because of the need to conduct orientation for new hires, but also due to the RN shortages and compromised patient care.  A recent report from Nursing Solutions, Inc. (2016) revealed some of the costs organizations face due to the nursing staff shortages and therefore compromised bedside care quality.  According to the reported data, the average cost of turnover for a bedside RN ranges from $36,900 to $57,300, resulting in the average hospital losing $4.9M–$7.6M every five years.  Moreover, 1% change in RN turnover was estimated to increase the cost/savings for the average hospital by $379,500 (Nursing Solutions, Inc., 2016).  Nursing Solutions, Inc. (2016) report also cited findings yielded by other healthcare studies that have demonstrated the link between nurse staffing ratios and patient safety.  In many cases, authors of these reports provide evidence linking greater patient to nurse ratios with an increased prevalence of patient safety events, morbidity, and mortality (Nursing Solutions, Inc., 2016).

Accordingly, frequent RN turnover is not aligned with the healthcare aims or the values organizations are striving for.  Specifically, at UCIMC, high RN turnover jeopardizes productivity and staff morale, with the potential to undermine the level of care provided to patients, thereby compromising their safety and wellbeing, therefore, UCIMC is a highly suitable site for the implementation of this project.  In addition, it employs a sufficient number of RNs that could take part in this initiative, as well as provides multiple recourses that can support this project (internal web-based applications, simulation equipment and infrastructure, experienced, and well-trained charge RNs, funding, and leadership support).  Access to these resources would facilitate running reports, allowing assessment of RN improvement and engagement, while also reinforcing shared values and commitment to organizational goals (Buck, 2015).

What is your planned intervention ?

What are you doing that is different than what is currently happening?

If this is a part of a larger project, what is your unique contribution? Be very specific in your description.

After Institutional Review Board approvals, as the DNP project leader, I will start the intervention plan by recruiting the project participants through the following steps:

·           RNs can be identified through an electronic report that is routinely generated by the members of the UCIMC staffing/scheduling team.

·           Six weeks prior to the AIT event, by using work Outlook invitation and emails, initial correspondence will be sent to all eligible FPRNs, informing them of the AIT event, as well as its content, time and date, and inviting them to sign up and participate in the workshop.  In addition, phone calls will be placed to all eligible FPRNs to reinforce the importance of their participation, as well as allow them to allocate time in their work schedule for the workshop attendance.  This direct communication will also ensure that each prospective candidate confirms attendance, as 50−80 RNs are required to reach the desired convenience sample size.

·           Two weeks prior to the workshop, the same email invitation will be sent to the FPRNs reminding them of the workshop, thanking those that have already registered their attendance and inviting those that have not yet responded to the initial invitation to voluntarily sign up.

·           One week prior to the workshop, an email invitation will be sent to all RNs who signed up reminding them of the time, date, and location.  Once again, phone calls will be placed to reiterate pertinent event information.

·           The workshop will be scheduled in a room located on the hospital campus that can accommodate a large number of RNs comfortably.

The AIT event will be evaluated using the following strategies:

·         All FPRNs attending the workshop will be required to complete a survey prior to the workshop and upon its completion, as this will allow RN engagement and involvement in different unit-based improvement projects to be measured and any changes due to workshop attendance identified.  The pre-workshop survey will be administered in paper format, with an assistant facilitating the process, while the post-workshop survey will be administered electronically.  For this purpose, the Gallup Q12 Employee Engagement Survey will be used, as it measures RN engagement effectively, as well as predicts key employment outcomes, such as satisfaction and loyalty (Gallup, 2016).  UCIMC is a Magnet®-Designated Hospital that has been using the Gallup Q12 Employee Engagement Survey for the last 15 years.  As a float pool manager and a DNP student, access to Gallup Q12 Employee Engagement results is accessible, which will be used in the AIT workshop evaluation.

·         A reminder to complete the online survey will be sent to all FPRNs one week following its completion.  A second reminder will be sent after two weeks.  A collection of survey responses will cease four weeks after the workshop (Buck, 2015).

·         At present, FPRNs are not treated like RN working in other units, as many report lack of respect and appreciation for the work they do.

·         Because FPRNs don’t have a “home” unit, they are usually not informed about relevant education and training, vision for nursing practice and organizational strategic plans.  Moreover, they do not have access to the same educational resources and organizational performance improvement opportunities as other RN do.  Currently, FPRNs are excluded from most training or practice updates, and rarely receive timely training on new equipment and organizational processes.  As they do not partake in performance improvement projects within the organization, this limits their potential for professional advancement.FPRNs report that they are usually assigned either less challenging patients or the most difficult cases, as they are seen as a resource aimed to give regular RN a break.  Owing to the nature of their work and the treatment they receive at the workplace, FPRNs feel less productive, as their time is spent searching for supplies or seeking help from RNs on the unit.  As a result, these RNs feel undervalued and expendable, and this may compromise their effectiveness, potentially jeopardizing patient safety.

Attending AIT would allow FPRNs to ask questions related to the work of others and discuss positive experiences or successes.  This not only promotes collaboration in finding answers, but also allows the FPRNs to create shared meaning while providing opportunities for new experiences.  As AIT is a change management framework that can be used to engage employees in a meaningful way, it is expected to improve FPRNs’ retention and increase their organization engagement (Cooperrider & McQuaid, 2012).

As in any well-established organization, UCIMC executive leadership creates annual organizational goals for the leaders at the next level of hierarchy, which are aligned with the organization’s main direction for continuous improvement and growth.  Increasing RN engagement and job satisfaction is one of the major goals for UCIMC, as they may affect RN performance and thus patient safety. In addition, Nursing leaders in UCIMC embrace the organizational values by selecting a specific goals to enhance overall organizational goals and advance nursing science. UCIMC nurses leaders strive to provide safe, competent, and compassionate patient care. Accordingly, this project is a part of the nursing organizational goals for 2016−2017.  It is a stand-alone project that is supporting other major goals for UCIMC.

My role as a UCIMC leader is to implement the following:

·         Apply a structured cultural change for planned transformation by employing the AIT that matches the UCIMC vision and mission.

·         Formulate a strategy that identifies logistics and risk or impact of this project.

·         Develop communications plan, leadership support roadmap, coaching plan, training plan, and follow up/evaluation plan.

·         Initiate change and demonstrate advocacy for this change.

·         Support employees through their transition stages.

·         Leverage experience and readiness, DNP leader needs help RNs broaden their appreciation of each other’s activities, and sets the stage for creative thinking about roles and collaboration.

·         Share knowledge, DNP leader needs to foster mentoring environment and avail dedicated and qualified mentors and strategies for an optimal sharing environment, and spread confidence and trust, avoid intimidating the sharing process.

·        Provide tools, such as unit-based quality improvement project list that RNs can initiate and maintain, guidelines that RNs can consider when choosing an appropriate project to get involved in within the unit or in a particular specialty, and human and capital resources list that RNs can utilize or share (capital resources refer to money, tools and equipment).

·        Act as a liaison − engage with the project team (Prosci, 2016).

Describe the current state of the problem at your site. What is the desired state? A DNP project many times centers around a process improvement. Be cautious when determining what you will be comparing as this is not a research project.

For a DNP project, the learner will determine the baseline outcomes already present at the organization, implement the project for all participants, and then re-evaluate outcomes post-implementation to determine if there was any change as a result of the implementation.

After Institutional Review Board approvals, as the DNP project leader, I will start  an intervention-based strategy to engage RNs working in the float pool, the aim of which is to provide the participants with an opportunity to change the current culture.  This intervention will consist of Appreciative Inquiry Training (AIT), which is an organizational development tool that engages RNs through innovative thinking and building a strong core, thus ensuring that all involved gain confidence and skills required to complete any job (Bechtold, 2011).  Participation in an AIT workshop would allow FPRNs to collaborate, exchange ideas, and create a future vision for the float pool team.  Pre- and post-workshop surveys will be administered to all attendees, allowing comparisons to be made, which will serve as an indication of the intervention utility and the participants’ progress.  In addition, Gallup’s Q12 metric will be employed to conduct descriptive analyses, aiming to reveal statistically significant differences between pre- and post-workshop scores.  Such findings will determine if workshop attendance resulted in the participating RNs having a greater sense of engagement.  Moreover, as the ultimate goal of this initiative is increasing FPRNs’ workplace satisfaction and thus reducing float pool turnover, the survey results will allow establishing if the goal of increasing RN intent to stay employed in the float pool has been achieved (Buck, 2015).

The retention rate and job satisfaction of FPRNs that attend the AIT will be compared with their pre-workshop levels over a three to six months period usingGallup’s Q12 Employee Engagement Survey, which is administered at UCIMC biannually as a part of the Magnet Recognition Program® (Gallup, 2016).  This will allow ascertaining if any improvements achieved as a result of AIT are retained over a longer term.

What outcomes will be measured?

How do you plan to do this? Will you be using a tool? If so, is it an established tool or one you plan to create? Note that most DNP projects will use an established tool that has published reliability and validity.

Be sure your outcomes link to the identified problem.

How will you know if your intervention resulted in change?

How do you plan to look at your data? Please know that descriptive statistics are appropriate for a DNP project. You will want to consult with a statistician early in this process.

·         After Institutional Review Board approvals, as the DNP project leader, the following tools will be implemented to measure the desired outcome:

·         Human Resources Connect Report (HR Connect Report) web based application will be generated and analyzed to establish the FPRN retention rate eighteen months prior to the AIT workshop delivery date and for six months following the AIT completion

·         Pre- and post-workshop evaluation survey (Gallup’s Q12 Employee Engagement Survey) will be utilized to assess the impact of the workshop on FPRNs’ engagement and workplace satisfaction

·         Number of performance improvement projects that the RNs start after attending the AIT workshop will serve as an indicator of practical application of the knowledge and skills gained at the workshop

In addition, the following indicators will serve as further validation of the AIT workshop utility in meeting the DNP project goals:

·         Compliance with education and training events

·         Increased quality of patient care

·         Decreased contingent RN costs

·         Decreased staffing costs

·         Decreased unit-based RN turnover

·         Decreased accident and absenteeism rates

Following the IRB review and approval, as the DNP project leader, I will collect the pertinent data and store it securely (staff at the UCIMC research center will support the project data collection if needed).  The plan is to collect data over a 12-week period.  Using Gallup’s Q12 Employee Engagement Survey services will allow comparing the project results with the Gallup comparative database, considered one of the most comprehensive databases in the world (Gallup, 2016).

As a leader, you need a project management plan. What is your timeframe? Please be aware that implementation cannot occur until after IRB approval. Consider that your last few quarters should be devoted to data analysis and writing of your final DNP Project paper. Does your timeframe make sense when considering the length of the program?

What data is available from your site or organization to substantiate the identified need?

Citing supporting evidence from the literature is also important; however, be sure that the need fits your organization…. do not try to make your organization fit a need found in the literature.

However, a comprehensive analysis of the HR connects report revealed additional reasons for high FPRNs turnover rate, including unit-specific RNs having the same rate as float RNs do (no differentials), FPRNs being required to work the same number of holidays per year, poor administration support, uncomfortable and unsupportive work environment (no specific home unit or team), and lack of unit-based RN support.

By providing FPRNs with AIT training specifically designed to meet their needs and address their concerns, it is expected that the aforementioned issues will be resolved, as adoption of this framework will motivate all involved to take part in positive changes.  Being proactive in addressing concerns will increase FPRNs’ engagement as well as their commitment to meeting the organizational goals.  In addition, AIT workshop will encourage RNs to ask questions and share positive experiences or successes with others.  This collaborative effort in finding answers will allow them to create shared meaning and act on the responses.  In summary, AIT workshop will serve as a tool that attendees can adopt in the implementation of the designed transformational change.  Cooperrider and McQuaid (2012) demonstrated that AIT attendance and subsequent pursuit of defined goals allowed employees to engage in a meaningful way in any needed unit-based projects or initiatives.  If the same success can be attained at UCIMC, it will improve FPRNs’ organizational engagement, thus increasing their wiliness to remain employed by the organization.

Why would your organization support this project?

What potential benefits exist for the organization as a result of your project findings?

What potential benefits exist for the identified patient population?

If the organization elects to continue what you have started….how will you, as the project leader, transition from the project after completion and allow it to continue on its own?

Therefore, increasing FPRNs satisfaction and retention rate will benefit the organization through:

·         Increased quality of patient care

·         Decreased contingent RN costs

·         Decreased staffing costs

·         Decreased unit-based RNs’ turnover

·         Decreased accident and absenteeism rates (Hunt, 2009).

In the capacity of the float pool manager, as a part of the manager’s annual incentive goals, DNP student is responsible for reducing the float pool turnover and redesigning and improving the format and content of the initial clinical orientation.  DNP student also required to provide on-going support to my subordinates by meeting with all individuals in order to communicate pertinent information and help them be more effective.  DNP student also make sure that DNP student available to attend to their needs and am receptive to their concerns.  By adopting these strategies, DNP student confident that the floating pool can move toward the major UCIMC goal defined as “improve work environment and improve RN satisfaction.”

UCIMC leadership fully supports this project, because high nursing turnover rate is costly and results in a loss of experienced RNs, potentially compromising patient care and safety.  Moreover, registry usage increase that was noted in 2015 indicates that care was, while inconsistent, more costly for the UCIMC patients.

The expected outcomes for RNs are a greater sense of commitment through participation in the AIT workshop and an increased intent to stay employed in the float pool (Buck, 2015).  In addition, it is envisaged that increasing FPRN satisfaction and retention rate will benefit the organization through:

·         Increased quality of patient care

·         Decreased contingent RN costs

·         Decreased staffing costs

·         Decreased unit-based RNs’ turnover

·         Decreased accident and absenteeism rates (Hunt, 2009).

In addition to leadership, what other area of expertise will this project foster for you?

On the other hand, DNP student will develop communications plan, leadership support roadmap, coaching plan, training plan, and follow up/evaluation plan. As described above this project will establish and polish the DNP student skills that are needed to become a transformational leader in times of change. At the end, this project represents several of the Doctoral Education Essentials for advanced nursing practice (AACN, 2006), such as: Essential Scientific Underpinnings for Practice, Essential Organizational and Systems Thinking, and Essential Interprofessional Collaboration for Improving Patient and Population Health Outcomes.

What leadership position(s) do they hold?

The DNP degree from Capella University is leadership focused. Although your project may have a clinical or educational component, please describe how this project demonstrates leadership and a process change for your site or population of interest.

Please describe how the scope of this project is large enough in scale to be a doctoral project. If the project is to be smaller intentionally (due to time limitations, etc.), how might it become generalizable to other populations, other departments, or the entire organization?

Identify the focus of the project; establish the significance; be certain to include at least one or two background studies related to the topic; state the project aims and relationship to your PICOT question; explain how the project is relevant to nursing practice.

*Be sure to include in-text citations and a full reference page (in APA format) following Part II.

The focus of this project is on improving float pool retention rate, increasing FPRN engagement, and consequently improving the overall work environment quality. First, as the DNP project leader, I will meet with the Human Resources representatives to assess the organizational need for this project, and will run all the reports required to establish the FPRN retention rate and engagement rate.  Second, I will meet with the Nursing Education team members to discuss and evaluate the proposed Appreciative Inquiry Training (AIT), as well as determine the availability and accessibility of all required resources, such as material and instructors.  As a part of this meeting, I will evaluate the research process in place at the UCIMC, including data collection and related committees’ approvals.  Third, in my capacity as the DNP project leader, I will meet with the Patient Experience Team to review the employee engagement opportunities currently in place and assess their congruence.  Additionally, I will review the UCIMC annual training records aiming to identify courses that focused on “UCIMC”  employee engagement prospects, this step will help me identifying UCIMC RN engagement vision . Fourth, I will engage with FPRNs through monthly FPRN meetings to assess and observe the current work environment, challenges, and growth opportunities, as well as obtain any suggestions on strategies that could be adopted in order to keep FPRNs employed by UCIMC and/or within the unit.

It is necessary to review the training material, to ensure the content addresses both the advantages and disadvantages of using the float pool at the UCIMC.  While benefits to the FPRNs are numerous and include flexible schedule, variety of clinical experiences, and constant exposure to new patients and different coworkers in every shift, they also suffer disrespect and limited access to training and professional advancement opportunities.  According to Brown (2012), inadequate working conditions and remuneration are cited by licensed RNs as the key factors in their decision to resign from their positions.  In addition to salary and other tangible contractual issues, FPRNs do not feel that they belong to one unit.  Having no “home” unit makes it hard to forge any special connections with coworkers, which often results in FPRNs not having adequate support and being assigned tasks that other RNs do not wish to perform, including caring for the most acute patients in the unit.  Additionally, FPRNs do not have guaranteed shifts when the census is low (Pyati, 2014).

Project Aim

The aim of the project is to assess the float pool work environment and identify the challenges FPRNs are facing in order to provide suggestions for possible improvements.  Based on these findings, Appreciative Inquiry Training (AIT) will be created, focusing on the current work environment and the ways we can improve it as a team.  As a part of the AIT workshop, the RNs will learn how to use appropriate methods to deal with challenges, seek support, and cope with work-related issues.  The AIT curriculum will also include models that FPRNs can emulate in order to be more actively involved in related performance improvement projects.  The goal of the AIT workshop is to help the FPRNs recognize the different opportunities at the UCIMC, so that they can be more engaged in all work-related initiatives, which would improve their workplace satisfaction and likely reduce their intention to leave the organization.  The AIT workshop that will be offered to the FPRNs is designed to include pre- and post-workshop survey, which will yield data pertinent to RN engagement and retention of the curriculum.  Subsequent comparison of the pre- and post-workshop scores will facilitate evaluation of the training against the predefined goals, which should be achieved within three months from the AIT training completion (Buck, 2015).

Relevance to Nursing Practice

According to a report released by Nursing Solutions, Inc. (2014) nursing turnover has been a problem for years. A recently published survey of 113 hospitals showed that the 2013 turnover rate was 16.5%, up from 14.7% in 2012, while bedside RN turnover increased from 13.1% to 14.2%, respectively, indicating that this trend is likely to continue as the economy improves, with significant implications for hospital administrators and patients.  In this context, the changes, related data, associated high cost, and RN morale that arise due to high staff turnover are the primary concern for the nursing leaders.  On the other hand, hospital administrators must focus on implementing a retention strategy that would motivate RNs to stay employed.

Maintaining a float pool can be an effective strategy to supply staff for constantly changing patient census, or to replace staff that is on medical or family leave, calls in sick, or is absent from work at a short notice.  The float pool concept is a true effort to manage patient care by providing trained internal RNs that are not only readily available, but also flexible, skilled, knowledgeable, and orientated to the organization policy, protocol, and culture (Adams, Kaplow, &Dominy, 2015).  However, when adopting this strategy, hospital leaders may unintentionally overlook unit preparedness to deal with FPRNs, or may fail to adequately prepare the FPRNs for the work with different teams/units, which may involve uneven assignments, such as doing admissions or discharges all day (Adams et al., 2015).  Accordingly, the proposed project aims to empower the FPRNs through AIT, by offering them the opportunity to gain new skills as well as discuss the current issues.  The envisaged outcome is a confident and capable team capable of responding to different challenges that may arise in the workplace, while motivating FPRNs to become more actively engaged in performance improvement projects.

In addition, the Institute of Medicine (IOM) (2011) recognized the need for hospitals to rely on float pools as a means of adequately planning for staff shortages, higher acuity, and increased patient census.  The IOM advised hospitals to match the abilities of the float pool nurses with patient needs to optimize patient safety through appropriate training and leadership support.  The IOM further proposed provision of effective communication and education to all FPRNs as a means of promoting patient safety in all units where these nurses may be assigned to fill staff vacancies.

Conduct an exhaustive review of the literature; synthesize the literature on the topic (provide evidence table as an appendix); summarize how the study will contribute to nursing knowledge by filling in gaps, validating, or testing knowledge.

Provide details of your exhaustive search process. Be certain to list all of the keywords or search phrases, each data base used, how many articles were founds, what the inclusion/exclusion criteria were, how many articles were retained and why.

The synthesis should not be an annotated bibliography, but a description of the themes found in the literature which are supported by clusters of evidence. In most cases, a minimum of 20 studies will be needed to support your project.

*Be sure to include in-text citations and a full reference page (in APA format) following Part II
** Build upon your evidence table created in DNP8002, adding all significant references from your continued review of the literature.

To understand the proposed project outcomes, it is necessary to review and assess all related reports, pertinent studies, and current practice gaps.  The project question is: Does the use of Appreciative Inquiry techniques improve the retention and engagement of FPRNs over a three-month period?

In order to answer this question and obtain the pertinent information from the available literature, Capella University database was used to facilitate this search, as it provides access to CINAHL, ProQuest Medical Library, PubMed, and Cochrane Library.  Search terms included float pool concept, needs, history, and challenges; nursing retention, retention strategy; hospital history to manage nursing shortage, Appreciative Inquiry Training (AIT) concept: AIT philosophy; AIT expected outcome, RN engagement strategies; and nursing working environment.  The terms were combined with Boolean operators “AND” and “OR” to facilitate finding relevant articles.  Literature search was further restricted to full text academic journals in the English language that were published between 2010 and 2016.  This strategy ensured that the literature review would focus on recent studies pertaining to RN retention and engagement strategies.  Inclusion criteria included nursing focused research studies in which authors examined obstacles that FPRNs typically encounter, nursing shortage, and RN engagement.

First, abstracts and titles of all identified articles that met the aforementioned criteria were reviewed for relevance to the PICOT question.  In addition, selected journals were manually searched for articles and citations relevant to the systematic review, and the reference lists of many relevant research articles were perused to identify additional sources.  This extensive search resulted in 2,221 articles.  After eliminating repeated articles and those that did not pertain to the PICOT question, 18 research articles remained for detailed analysis, seven research studies, and  eleven systematic reviews.  The work reported in these articles was analyzed, organized, critiqued, and summarized to identify gaps in the existing literature and thus confirm the relevance of this DNP project.

Float Pool History

According to Dziuba-Ellis (2006) the float pool (or resource team) is not a new practice.  The float pool was first introduced in the 1970s as a staffing strategy, though often using different terminology.  In 1980s, hospitals started to redesign their unit staffing practices to manage staffing deficiency issues, whereby reliance on float pools became an effective way to manage staffing shortages.

Many hospitals in the United States have since adopted float pool as a cost-saving and effective strategy to manage RN shortage.  In practice, float pool use eliminated the need for extra RNs, as well as reduced overtime and orientation hours for per diem RNs, or the need for expensive agency to supplement temporary RNs.  According to Dziuba-Ellis (2006) use of float pools, also known as resource teams, is an efficient and cost-effective means for managing fluctuating staffing needs.  Therefore, the major incentive for using float pool stems from the need to deploy RNs to various patient care areas to help in times of increased census or acuity, or address staffing deficiencies.

The float pool at the UCIMC is a distinct nursing unit employing eighty registered RNs and seventy nursing assistants.  The float pool schedule is based on a six-weekly electronic self-scheduling, whereby all full-time employees should make sure that they work three 12-hour shifts every week, as well as work every other weekend (Saturday through Sunday).  These self-determined schedules are balanced by the unit manager every six weeks and the final roster is published on specific web application called API.  Assignments are determined by RN experience and skills, as well as needs of individual units.  As a result, when RNs arrive to work on their scheduled day, they would come to the staffing office to check their assignment prior to proceeding to their allocated unit.  All FPRNs complete comprehensive orientation programs in multiple units to ensure that they possess the competency and capability to work in the designated units.  FPRNs benefit from certain advantages, such as extra pay, ability to maintain a flexible schedule, and working in a preferred unit (if available and applicable).  A survey of FPRNs that had worked at the unit for a minimum of five years revealed that they enjoyed the nature of the work, appreciated being able to gain different skills or experience as well as being given new opportunities to learn, and considered caring for a variety of patients rewarding.

However, reliance on float pools also poses certain challenges for hospitals, such as inability to recruit quality RNs for the pools, high RN turnover, lack of leadership support for FPRNs, and their unfamiliarity with specialty area of units they are assigned to (Dziuba-Ellis, 2006).  According to Larson, Sendlbach, and Missal (2012) although FPRNs provide numerous benefits to other RNs and patients, they tend to be assigned the most difficult patients and are rarely recognized for the work they do.  Thus, both hospitals and the FPRNs experience certain disadvantages due to this work arrangement.

Nurse Retention Issues and Float Pool Retention Strategies

In most healthcare settings, float pool turnover is high, as RNs tend to move to a specific specialty.  In addition, unit managers often recruit the FPRNs that possess unique set of skills and inclusive perspective gained through working in different units and caring for a variety of patients.

It is of particular concern that RNs working in float pool leave the organization due to insufficient support, lack of opportunities, or a negative work environment that leads to the loss of autonomy.  Tummers and Groeneveld (2013) examined the reasons contributing to the RNs’ intent to leave their organization, focusing on career growth opportunities, destructive working atmosphere, loss of autonomy, and workplace safety.  The authors highlighted the need to address these issues as, when RNs leave their organization, this can negatively affect organizational performance, given that high turnover contributes to the nursing shortage and staffing issues, potentially compromising patient care and safety.

Nurse turnover, in general, is related to economic and non-economic factors.  The non-economic factors include concerns about the professional practice, standards of care, inadequate staffing for providing safe patient care, and RN burnout due to increased workload and greater demands placed on individual RNs.  Among the economic factors, the most notable are high turnover cost, loss of human capital and work process continuity, and their potential to adversely affect patient care quality (Jones & Gates, 2007).

Recently, Mazurenko and Gupte (2015) reviewed the RN turnover in the United States, aiming to elucidate why RNs leave specific jobs or the profession itself.  The study results revealed that RNs who reported work-related disability or illness, or experienced high physical demands or burnout, and were displeased with schedule arrangement, were more likely to leave the profession.  However, RNs who reported high level of stress, were unhappy with organization’s leadership, felt disappointed with their opportunities to grow, and were not compensated, were more likely to leave the organization.  In highlighting these differences, Mazurenko and Gupte (2015) cautioned healthcare managers to be vigilant of the different factors that are associated with RN attrition, as some would result in not only RNs leaving the organization, but the entire profession.  This would lead to greater RN shortages at the national level.  These findings are also valuable for the policy makers, who should consider allocating additional resources to ensure that workforce assigned to each nursing unit is of adequate size and sufficiently qualified, and thus able to provide high quality care.

Accordingly, Robert Wood Johnson Foundation (RWJF) (2009) supported a study aiming to identify strategies that can be adopted in order to retain experienced RNs.  The findings indicated that such strategies must address both economic and non-economic factors that lead to RN attrition.  The proposed non-economic nursing retention strategies included new staffing initiatives, innovative employee health and wellness programs, and organizational culture that values senior RN experience.  The strategies focusing on the economic factors included compensation packages that reward more senior workers by offering benefit options and flexible work schedules.  According to the RWJF (2009) turnover rates among experienced RNs can be reduced by implementing strategies aimed at improving RN morale, job satisfaction, and productivity.

Appreciative Inquiry Training (AIT) Concept and Expected Outcomes

Appreciative Inquiry Training (AIT) is an approach to change management that requires coevolutionary search for the best in people and motivating them to offer their maximum to their organization and the world around them.  This is achieved by focusing on what is working well and what each RN is engaged in, before reviewing the results and proposing the way forward.  The goal is to convey the message that an organization can only grow when each RN is engaged in shared governance foundation and organizational activities  (Bechtold, 2011).  According to Stratton-Berkessel (2015) AIT prompts the participants to adopt a positive perspective on life and recognize positive traits in themselves and others.  AIT, as a training format, aims to explore the best in all RN members and the organization as a whole, and identify the ways this can benefit all involved.  It focuses on positivity, innovation, and discovery, allowing RNs to design their own destiny (Stratton-Berkessel, 2015).

According to Buck (2015), low RN morale and loss of autonomy in the work environment are the main reasons for turnover.  Bechtold (2011) examined how using AIT training as an organizational development approach that addresses employee morale can improve RN attitudes, engagement, and collaboration.  As a result of this training, Bechtold reported that the AIT workshop attendees developed a stronger sense of belonging and had a greater commitment to the organization.  In this study, the data was gathered through participant feedback and increased number of RNs engaged with projects aimed at improving the workplace, which led to a positive affirmation of what means to stay employed for life in one organization.  In addition, one of the outcomes was that using AIT workshop strengthened the core values at the company, such as Accountability, Respect, Integrity, Innovation, Service and Excellence.

On the other hand, according to Jones, (2004) and Minore et al. (2005), they highlighted how poor perception of the profession is another reason behind high nursing turnover.  Chauk (2015) explored the potential of using AIT workshop as an approach to transform student RNs’ image of nursing.  Chauk conducted an explorative-descriptive study, including a pretest, appreciative inquiry as the study-specific intervention, and a posttest.  The analysis of the pretest results revealed a mix of positive and negative perceptions of nursing image, whereby the negative perceptions mostly pertained to improving nursing work environment and low respect for the profession.  The posttest results showed a significant positive change in the student RNs’ perceptions of the nursing image as respected and appreciated profession following the AIT workshop.  In addition, Chauk’s (2015) study demonstrated the real potential for using AIT as a teaching strategy to produce a positive nursing image change.

In the same vein, Richer (2007) examined the effect of AIT training on the changes in healthcare professionals’ and particularly RNs’ job satisfaction and intent to stay employed in their organizations.  In this work, Richer considered many factors that affect RN satisfaction, such as shortage of RNs, ageing of the RNs, evolution of medical technologies, and increased complexity of nursing duties, all of which added pressure, while also degrading the work environment and thus reducing the RN satisfaction level.  The author employed case study design to assess multiple aspects relating to retention and examine the changes in healthcare technologies.  In conclusion, Richer (2007) highlighted the need to implement innovative ideas to improve work environment, stating that AIT workshop was the way to tap into innovative potential of RNs within the organization.  The author further explained that upper and middle management support and involvement is required throughout the change processes.

Stakeholders for the Project

            Richer (2007) highlighted the significance of management involvement in improving work environment and providing opportunities for RNs to be engaged and grow within the organization.  Thus, it is essential to identify types of stakeholders in this context.  Wallis and Kennedy (2013) identified stakeholders at:

·         The organizational level, which includes hospital RN leaders, and hospital management team

·         The public level, which includes public health department, and federal qualified organizations

Their study design combined participant observations, group interviews, and the use of standardized tests measuring individual emotional intelligence and team dynamics.  The results pertinent to the organizational level revealed that organizational environment or culture appears to be a strong contributing factor in team success and RN retention.  In addition, RN leaders that received training equipping them with the skills needed to address challenges associated with retention of RNs were able to show better commitment to supporting innovative plans aimed at retaining RNs within the organization.  At the public and federal level, the study results confirmed the importance of increasing leadership collaboration and teamwork dynamics to create a complex system that support RNs’ work environment and overcomes the resistance to change within the organization (Wallis & Kennedy, 2013).

Describe the theoretical framework or conceptual model to be used in the study, connect the study aims and PICOT question to the framework or model, operationally define study variables, provide any study assumptions.

*Be sure to include in-text citations and a full reference page (in APA format) following Part II.

Since, nurses learn their major skills from clinical rotations and simulation labs, grounding the AIT in experiential learning theory is highly applicable, as it allows the workshop to focus on active learning experience, as a part of which the participants can discuss real-life topics and engage in hands-on situations.  When Kolb and Kolb’s (2005) theory is effectively applied in the AIT workshop, students can work together to assist each other in developing their goals, which would translate to greater organizational commitment and improved job satisfaction.  The AIT workshop also provides RNs with a safe environment in which they can share with their peers their feelings, thoughts, actions, and priorities and discuss these in the context of different patient/family/work related scenarios.  This collaborative approach to problem solving allows students to reflect on their experiences, as well as learn from others, motivating them to think deeply about the AIT subject matter as it relates to their own understanding (Kolb & Kolb, 2005; Lisko & O’Dell, 2010).

Similarly, Malcolm Knowles (1988) defined this method of teaching adult learners as a combination of art and science, as adults need to relate new content or skill to practice in order to master it successfully.  Knowles’ method is based on the premise that adults learn best in collaborative environments that provide them with ample opportunities to relate the taught content to real-life problems.  According to Queensland Occupational Therapy Fieldwork Collaborative [QOTFC] (2007) they emphasized that collaborative learning environments are highly interactive, rather than instructional, as the trainer acts as a facilitator of learning, it supports open-mindedness and equality between the trainer and learners

In the development of this theory, Knowles recognized six traits that are unique to adult learners, namely (a) adults are self-directed and internally motivated; (b) adults prefer to relate content to be learned to their life experiences and prior knowledge; (c) adults focus on the goal or learning; (d) for adults, the content or skill to be learned must have personal relevance; (e) adults learn best by doing; (f) to engage adult learners, they must feel respected (QOTFC, 2007).

Knowles (1988) also acknowledged the importance of readiness to learn, stating that most individuals recognize the need to learn something new when faced with a specific problem or situation that the new skill or knowledge would help to address.  For this reason, Knowles’ theory is highly relevant to the AIT workshop, as nurses primarily learn from hands-on practices.  Accordingly, nurse trainer/educator/administrator needs to create a learning environment that fosters the learners’ readiness to learn and focuses on their life goals, as this will facilitate not only learning, but would also promote adoption of the desired organizational goals (Knowles, 1988).

Knowles (1988), when discussing the importance of readiness to learn, further noted significance of practice, recommending that teachers focus on teachable moments, which should ideally arise in the context of meaningful experiences.  Second, Knowles (1988) recommended grouping adult learners according to their shared interests and preferences, as this would provide optimal learning experience for nurses that have different learning styles and goals, while also fostering commitment to the shared objectives.

As shown above, training groups of adult learners that share similar interests fosters RN engagement, allowing them to refocus their attention on organizational values and opportunities.  Wood (2015) studied the relationship between the AIT workshop and employee engagement.  The author highlighted that many studies reviewed in his work demonstrated positive correlation between employee engagement and organizational performance.  In recent years, many organizations started to diverge from traditional problem-solving methods to take a more positive stance focused on improving external and internal performance.  One of these methods is AIT training, as it is aimed at active RN engagement by understanding how individuals make sense of their lives and their experiences.  Cooperrider and McQuaid (2012) explained that AIT workshop is an intervention theory that focuses on positive aspects of an organization to stimulate a desired change.  Adoption of the AIT allows the participants to investigate what is good in an organization, motivating the RN to be actively engaged in this positivity to enrich organizational performance.  In sum, it is a technique aimed at transforming an organization by perpetuating its strengths.

As has been noted, the purpose of conducting AIT workshop at the UCIMC is to engage FPRNs in a review of their current work environment, which would result in identifying areas that need improvement, motivating them to work collaboratively on developing innovative ideas that can address these shortcomings and thus create a better work setting.  It is, however, important to recognize that, employee engagement requires motivation and open communication, which must exist prior to instigating any changes.

As noted above, individuals must need to feel motivated in order to ensure their engagement in any effort, including training.  Thus, while employees will strive for higher salary and other tangible rewards that can help meet their more immediate needs, they also need to feel valued and appreciated, which can serve as a powerful motivation to succeed in the workplace and will in turn enhance their engagement.  Consequently, motivation is one of the important factors that can help the employer improve employee commitment and performance.  Sandhya and Kumar (2011) conducted a study aiming identify factors that influence employee motivation and engagement.  Their findings allowed them to summarize employee motivators, which comprised of offering recognition through remuneration and promotion, putting adequate safety measures in place, improving and maintaining positive morale, providing specialty-related incentives, conducting performance appraisals, and ensuring open communication and shared governance foundation.  In addition, the authors reported several motivators that are specific to RNs, such as enhancing RN skills to match market requirements, supporting RN growth, respecting RN opinions, treating RNs with respect, and valuing their knowledge.

In a much earlier work, Herzberg (1968) proposed a two-factor theory of motivation, comprising of work environment (factors that “surround the job” rather than the job itself), and democratic approach to management.  According to the author, job enrichment can be achieved by providing employees with a variety of challenging and interesting tasks, as well as a degree of autonomy in how they approach them, as this promotes a greater sense of achievement.  Herzberg was of the view that, when employees are allowed to make their own decisions in certain areas of their working life, their level of commitment increases, ensuring their loyalty.

As a result, motivation and engagement are important factors that can help any organization improve RN and organizational performance.  According to Sandhya and Kumar (2011) employees can be motivated through open communication, career development programs, and performance-related remuneration, which would increase job satisfaction, and thereby retention.  When designed well, AIT workshop can facilitate open communication and RN engagement.  In particular, as the aim of the AIT workshop offered to the FPRNs as a part of the current DNP project is improving their relationship with the management, the FPRN participants will be able to develop the requisite skills and knowledge that can facilitate positive workplace change in a structured setting.  As a result of AIT workshop attendance, FPRN participants will create a future vision that can be translated into practice with the goal of reducing the floating pool turnover rate.

Describe the project design, including detailed intervention information: describe the setting; describe what data needs to collected, how data will be collected (include the validity and reliability of any instruments to be used), describe the statistical analysis to be used (as appropriate to your project); how data will be measured, state anticipated findings, state the limitations of the study.

*Please provide your data collection tool as an appendix.  Remember that use of established tools will require evidence of permission by the author prior to IRB submission.

**Most, if not all, projects will require some level of statistical analysis.  Consultation with a statistician is recommended prior to completing this section.

The aim of the project is to examine the effect of Appreciative Inquiry Training (AIT) on FPRNs’ intent to stay employed after attending an AIT workshop.  Appreciative Inquiry Training is a highly adaptable philosophy and process for engaging RNs in building their organization and transforming it into a workplace they can be proud to work in.  By encouraging a broad range of stakeholders to get involved into this initiative, both within and outside the system, and motivating them to ask positive questions and share their beneficial experiences and success stories, this AIT workshop will assist the FPRNs working at UCIMC in creating a shared meaning of the answers and act on the responses.  A well designed and correctly implemented AIT workshop serves as a wellspring for transformational change (Bechtold, 2011).  Accordingly, AIT is a change management framework that will be used to engage FPRNs in a meaningful way in order to increase their organizational engagement and thus improve their retention.  The research method adopted in the present investigation will be discussed next, along with the data collection and analysis methods.  This will be followed by the strategies used to deliver the workshop, as well as the means of conducting ongoing project evaluation against its predefined objectives.

Design and Methods

The problem this project aims to address is the failure of the FPRNs in UCIMC to engage with organizational transformation or growth.  This fact is supported by HR Connect Report that highlight high levels of job dissatisfaction among FPRNs, which has resulted in a high float pool turnover rate.  In order to address these issues and thus increase FPRN engagement and retention, an AIT workshop will be offered to all RNs working full or part time in the float pool medical/surgical division, with the exception of the per diem FPRNs.

The participants will be recruited by adopting the following strategy:

• Eligible FPRNs will be identified through an electronic report that is routinely generated through staffing/scheduling office in UCIMC.

• Six weeks prior to the AIT workshop, by using work email, an invitation will be sent to the selected FPRNs, informing them of the AIT workshop, as well as its content, time and date, and inviting them to sign up and participate in the workshop.  In addition, phone calls will be placed to the eligible FPRNs to reinforce the importance of their participation in the event, and allow them to plan time in their schedule for attendance.

• Two weeks prior to the workshop, the same email invitation will be sent to the FPRNs reminding them of the workshop and inviting those that have not already confirmed their participation to voluntarily sign up.

• One week prior to the workshop, an email invitation will be sent to all RNs who have signed up for the workshop, reminding them of the time, date, and location.  Once again, phone calls will be placed to reinforce related event information.

• The workshop will be scheduled in a room located on the hospital campus that can accommodate a large number of RNs comfortably.

Project Design

A quantitative method is chosen to achieve the purpose of this project.  A quasi-experimental pretest/posttest design is considered appropriate for this project, as outcomes may only be measured after the intervention (AIT training) has taken place.  In addition, observation time will be needed before and after the indicated intervention, and there is no control group (participants will not be assigned to the control and treatment groups).  More specifically, because all FPRNs will be invited to participate (with the exception of per diem RNs) those that volunteer to attend the workshop will form a convenience sample.

Experimental design involves selecting groups (non-randomized group), upon which a variable is tested (engagement level and retention rate), without any random preselection processes (Allison, 2015).

A quasi-experimental pretest/posttest design has been chosen for this project since AIT as an intervention will be administered to the selected FPRNs in the UCIMC as an education program.  In addition, the posttest assessment will be conducted electronically for all workshop attendees six weeks upon AIT workshop completion.  Furthermore, since there will be no control group, an experimental, single group pretest/posttest design will remain the most appropriate.  In a selected one-group pretest/posttest study, the intervention is administered to the selected FPRNs that form the study sample, and data is collected before the intervention (pretest) and after the intervention (posttest).

The pretest results will demonstrate current RN understanding of organizational changes, and will define what kind of transformations can be expected at the posttest.  The AIT workshop will commence with a pretest that will be administered to the attending RN to determine the RNs’ understanding of the recent organizational changes, as well as currently used engagement behaviors or approaches.  The pretest will be followed by a four-hour AIT workshop offered to all participants.  A posttest will be conducted six weeks after completing the AIT to determine whether there are any changes in the RNs’ engagement level and the retention rate within the float pool.  The Gallup Q12 Employee Engagement Survey will be utilized to measure staff engagement, as it predicts key employment outcomes, such as satisfaction and loyalty.

Data Collection

The data collection will start with requesting a current HR Connect Report (web-based application) that will be used to determine the FPRN retention rate and clarify the reasons for high attrition.  At UCIMC, the terms “retention rate” and “turnover rate” are used interchangeably, even though other health organizations consider one as the inverse of the other.  However, the retention rate, referred to as the “stability index,” can be utilized to measure the retention of a particular group of employees over a specified period of time, thus complementing the turnover rate metric.  At UCIMC, retention rate (expressed as a percentage) is calculated as a ratio of the number of individual employees who remained employed for the entire measurement period and the number of employees at start of that measurement period multiplied by 100.

When HR Connect Report in UCIMC define how many employees remained employed for the entire measurement period, only those employees who were employed on both the first and the last day of the period are considered.  Thus, workers hired within the measurement period are excluded from this metric.  The same principle will be applied when administering the pretest survey at the start of the AIT workshop.  This pre-evaluation survey will be designed using Gallup Q12 Employee Engagement Survey (Figure 1) and will be administered in paper format.  Six weeks upon the workshop completion, the same survey will be administered electronically to the FPRNs that have attended the workshop in order to measure their engagement and note any changes relative to their initial scores (Gallup, 2016).  In addition, the survey responses will be analyzed to determine the FPRN participants’ involvement in different unit-based quality improvement projects, as this is also indicative of the changes in the FPRN participants’ empowerment level as a result of workshop attendance.  Finally, their ability and readiness to generate innovative new ideas for improving practice and sense of job purpose in the organization will also be evaluated.

As the float pool manager at the time of conducting the AIT workshop, in order to avoid any conflict of interest and protect the participants’ rights, DNP student will clearly state my role as a student and project coordinator at the beginning of the event, as well as in all communication emails and phone calls.  FPRNs will be informed that participation is voluntary and their decision to take part in the project or decline participation would not affect their job status or annual evaluation.  Of course, FPRN participants will be paid their hourly wages for attending the AIT workshop, since the benefits they will obtain have long-term benefits to the unit and the organization.  The first communication email will reinforce that all survey results will be shared with all FPRNs.  Moreover, the FPRN participants will also be reassured that if they experience any discomfort or distress as a result of involvement in the project, they reserve the right to withdraw from the training and their information and any pertinent data will be excluded from analyses and any subsequent reports.

Validity and Reliability of Chosen Instruments

After carefully considering the main project objectives, Subject-completed instruments were chosen as a category.  As previously noted, the Gallup Q12 Employee Engagement Survey will serve as the data collection instrument (Appendix A), which will be used to measure RN engagement (Gallup, 2016).  Q12 Employee Engagement Survey benefits from simplicity and conciseness, along with a strong correlation to engagement and performance.  According to Gallup (2016), the company preserves the biggest comprehensive database of employee engagement.  Additionally, the Gallup organization conducted hundreds of focus groups and many thousands of employee interviews in different types of facilities, at all levels, in most industries.  From these resources, researchers identified hundreds of variables that could be of interest to both researchers and practitioners.  The Gallup organization utilized these comprehensive findings to summarize the main variables of interest in twelve key employee expectations (Thackray, 2001).  Another benefit of utilizing the Gallup Q12 Employee Engagement Survey in this project is that it has a Cronbach’s alpha reliability of 0.91 at the business unit level of analysis Appendix B.

As noted above, Q12 Employee Engagement Survey was conducted in various contexts, and at different workplaces, including military and religious institutions.  In addition, participants of diverse ages took part in the surveys, thus providing perspectives of those as young as 18 as well as those of 95-year-olds. The sample sizes of the studies that informed the final version of the survey instrument ranged from as small as 22 to as large as 12,000 participants.  Despite these many benefits, it is important to consider the following factors when using the Gallup instrument:

·         How long will it take to administer?  According to Gallup (2016), participants need 15−30 minutes to complete this tool effectively.

·         Are the directions clear?  According to Gallup (2016), the Q12 Employee Engagement Survey is well known for its ease and clear message; it is simple to understand, and simple to modify to match research purposes.

·         How easy is it to score?  According to Gallup (2016), Q12 Employee Engagement Survey has a 12-item scale; it was developed to better reflect the major engagement and performance elements with concise scores that can be reflected in the results.  Q12 Employee Engagement Survey has a Cronbach’s alpha reliability of 0.91 at the business unit level of analysis (Appendix B).

·         Do equivalent forms exist?  Yes, there are other tools, but according to Gallup (2016), this system will enable survey users to compare their results with those of others using this instrument globally.  This will also help strengthen the validity of the instrument.  This information will be made available to users of the Gallup institution worldwide.

·         Have any problems been reported by others who used it?  According to the results of different reviews, Q12 Employee Engagement Survey has strong characteristics and easy technique to validate findings.

Data Analysis

The data collection using Gallup Q12 Employee Engagement Survey (Appendix A) will be straightforward due to the simplicity of the survey instrument itself and the relatively small sample size.

Demographic information that will be collected manually includes (a) gender, (b) nursing education level, (c) number of years employed as a FPRN in UCIMC, and (d) total years of RN experience (Appendix A).

The attending RNs will be informed at the AIT workshop that they will receive anonymous post-AIT workshop survey that they will be required to complete electronically.  This survey will be identical to the pre-workshop Gallup Q12 Employee Engagement Survey, but will exclude the demographic data and will be sent six weeks following AIT workshop completion.

As the manger for the float pool at the time of the AIT workshop, to avoid a conflict of interest and protect the FPRNs’ rights, DNP student will inform them that participation or non-participation would not affect their standing in the float pool or on their annual evaluation.  In addition, any RN that feels discomfort or distress during the workshop will be allowed to leave and his/her data will be excluded from the survey analyses.  As previously noted, all FPRNs attending the AIT workshop will be paid their hourly wage, since their participation benefits the department.

Project Evaluation Plan

As explained previously, the project results will be presented at the bimonthly RN meeting (30-60 minutes will be projected for the project topic as a point of discussion).  These meetings will allow the FPRN workshop participants to reflect on their experience and elaborate on how it helped them to engage in the organizational activities constructively.  The FPRNs who did not participate in the workshop will be encouraged to take part in the anticipated discussion about the project results, as well as actively contribute to the efforts to build the future UCIMC vision.

Project Strengths and Limitations

Strengths

AIT training has been extensively studied and is currently widely applied as an organizational development approach aimed at increasing employee morale and level of collaboration.  As a result of participating in the AIT workshop specifically designed for the FPRNs at the UCIMC, these RNs are expected to develop a stronger sense of belonging and commitment to the organization, as measured through participant feedback and increased number of RNs engaged in projects aimed at improving the organization.  These beneficial changes are anticipated to result in a positive affirmation of what it means to stay employed in one institution until retirement, thus reducing float pool turnover rate.  In addition, using AIT training is expected to strengthen the core values at the company.

Limitations

The key limitation to this project is the small sample size (50−80 RN).  In addition, as the purpose of AIT workshop is increasing employee engagement in the long term, one post-intervention survey administered six weeks following the workshop completion may not allow time for the participating RNs to engage in some leading organizational projects that can be identified in the AIT workshop.  Increasing the float pool retention rate is another long-term goal; hence, it would be more informative to measure the FPRN retention rate one year after the workshop completion, at least for this specific group.  Lastly, as UCIMC is one of many healthcare organizations serving the population of southern California, the findings yielded by this project will pertain to the UCIMC float pool and cannot be generalized to FPRNs working at other institutions.

While some DNP Projects will not include a sample, most will.  So, as appropriate, address the following:

Describe the sample for the project, including inclusion and exclusion criteria, sample recruitment process, and human subjects protection methods.

The project sample will be drawn from the entire population of male and female FPRNs working at the UCIMC (with the exception of per diem RN) and will include the FPRNs that participate in the AIT workshop.  This, non-random convenience sample will be recruited from the float pool through email communication, and an electronic consent form will be also sent with the email (Appendix C).  While the AIT workshop will be offered to all RNs working in the float pool, it is expected that 50−80 RNs will participate in the AIT workshop.

The process of recruiting project participants will start with identifying the FPRNs through an electronic report that is routinely generated by the staffing/scheduling office in UCIMC.  Then, six weeks prior to the AIT workshop, by using work email, an invitation will be sent to all selected FPRNs, informing them of the AIT workshop, as well as its content, time, and date, and inviting them to sign up and participate in the workshop.  In addition, phone calls will be placed to reinforce the importance of participation in the event, and plan ahead of time for this event.  Next, two weeks prior to the workshop, the same email invitation will be sent to the FPRNs, reminding them of the workshop and inviting those that have not yet registered to voluntarily sign up.  One week prior to the workshop, an email invitation will be sent to all RNs who confirmed their attendance, reminding them of the time, date, and location.  Once again, phone calls will be placed to reiterate the pertinent event information.  The workshop will be held in a classroom located on the hospital campus that can accommodate a large number of RNs comfortably.  Clinical charge RNs/supervisors and interested nursing management will also be invited to participate in the workshop.

The first communication email will reinforce that all survey results will be shared with all FPRNs and will remind the participants of their right to withdraw from the project at any time, for any reason.  Specifically, should any FPRN experience any discomfort or distress and decide to cease participation, all pertinent information and data will be excluded from the subsequent analyses and reports.

Describe the time it will take to complete the project. Provide a quarter-by-quarter listing of activities from start to finish, using the following model under which most project should fit:

Quarter 1 – Approval of SMART Form Part I/II and Conference Call

Quarter 2 – IRB Approval and Beginning of Project Implementation

Quarter 3 – Continued Project Implementation and Data Collection

Quarter 4 –Data Analysis, Writing Final Product, Committee Approval

Quarter 5 – All Final Milestones

Quarter 1 – Approval of SMART Form Part I

 Collaborate with UCIMC as the practice site to develop the project idea.

 Submit SMART Form Part 1 & Part 2 draft to the mentor.

 Mentor approval of SMART Form draft Part 1 & Part 2.

Quarter 2 – Approval of SMART Form Part II, Conference Call, and IRB Approval

 Collaborate with the mentor via phone conference to discuss SMART Form update and        recommendations.

 Summarize any phone conferences and post to the Capella assignment board.

 Revise SMART Form and resubmit within two weeks of the phone conference with the mentor.

 Collaborate with the mentor via phone conference if additional revision of theSMART Form is necessary.

 Summarize any phone conferences and post to the Capella assignment board.

 Submit the entire SMART Form for Committee review.

 Collaborate with the Committee members via phone conference if additional revision of the SMART Form is necessary.

 Summarize any phone conferences and post to the Capella assignment board.

 Submit the entire SMART Form for School review.

 Summarize any phone conferences and post to the Capella assignment board.

 Collaborate with the Committee members via phone conference to discuss the project plan.

 Complete IRB paperwork for UCIMC and submit.

 Once the IRB for UCIMC approves the project, complete and submit the IRB application to

Capella University.

 Collaborate with the mentor via phone conference regarding the IRB response.

 Summarize any phone conferences and post to the Capella assignment board.

 Meet with the stakeholders at UCIMC to discuss the project and the anticipated timeline for its implementation.

 Collect and appraise FPRN retention rates/ engagement level utilizing the data compiled by the Human Resources department.

Quarter 3 – Project Implementation and Data Collection

 The DNP project leader starts observations over a two-week period to obtain baseline reports from HR and Education Department.

 All selected FPRNs will be invited to attend the AIT workshop via FPRN meetings and email.  FPRNs will be informed that participation or non-participation would not affect their job status or annual evaluation.  Of course, RN participants will be paid their hourly wage for attending the AIT workshop, since their participation has long-term benefits to the unit and the organization.  In addition, through the initial email, all FPRNs will be informed that, if any participant experiences any discomfort or distress, he/she reserves the right to withdraw from the project, whereby all pertinent data will be removed from the records and will be excluded from subsequent analyses.

 The DNP project leader will collaborate with the Education Department to arrange and prepare the AIT material and agenda.  AIT workshop will be presented to address all quality activities in UCIMC, and UCIMC position with respect to other comparable medical centers.

 The DNP project leader will continue working on the AIT materials and related activities, and will include all other float pool assistant managers interested in providing the training to the FPRNs that voluntarily agree to take part in the project.

 To reduce observer bias, all assistant managers interested in acting as peer auditors will be trained to observe practice in a neutral and non-judgmental manner, and AIT workshop will be offered to the peer auditors before presenting it to the eligible RN.

 A reminder email will be sent and phone calls made to all RNs that agree to take part in the workshop, in order to reiterate the date, time, and location of the AIT workshop.

 The AIT workshop will take place twice in the same month, allowing both night and day shift FPRNs to attend.

 Pretest will be given at the beginning of the AIT workshop, and will take about thirty minutes to complete.  All survey papers will be collected in one envelope, and all surveys will be completed anonymously.

 Electronic post-survey will be sent to the AIT workshop attendees six weeks later, and a reminder email will be sent three times to remind the FPRNs to complete the survey on time.

 The DNP project leader will also analyze the pre- and post-workshop survey data.

 The DNP project leader will share the data and evaluate the data collection efforts at the one- and two-month mark with the unit.

Quarter 4 – Data Analysis, Writing Final Product, Committee Approval

 Write and submit the project abstract to the mentor for review.

 Collaborate with the mentor via phone conference about the abstract.

 Summarize any phone conferences and post to the Capella University assignment board.

 Revise the abstract if needed and resubmit.  Collaborate with the mentor as needed via phone.  . Summarize any phone conferences and post to the Capella University assignment board.

 Research and submit the abstract for Conference or Presentation to Stakeholder Organization.

 Communicate the engagement and retention rates results to hospital stakeholders through organizational meetings and newsletters.

 Collaborate with the mentor via phone conference about abstract submissions.

 Summarize any phone conferences and post to the Capella University assignment board.

 Submit the final project to the mentor for approval.

 Revise the final project if needed and resubmit.

 Submit the final project to the Committee for approval.

 Submit the final mentor and committee approved DNP project for approval by the Nursing

Director.

 Complete format editing.

 Collaborate with the mentor via phone conference.

 Prepare for a final conference call by preparing PPT.

 Create a recorded presentation using Adobe Connect.

 Complete practice hours.

 Submit the final practice immersion log.

Name:

Name:

Name:

(if needed)

Framework

Method

Setting

Analysis

This paper provides a conceptual framework and language that scholars might use to provide insight and support for using AI as an organizational development approach that complement existing Arab cultural factors for practicality and benefit.

Literature review that establishes AI’s foundational theories and links with Arab cultural factors. An overview of the AI 4D model is then followed by critiques of the AI approach. The paper presents an application of AI to address the issue of low employee morale.

A brief literature review establishes the theoretical basis of AI, and the 4D model of AI is presented. Critiques to the AI approach are shared, followed by a brief review of an AI application in a large organization.

>AI foundational theories:

-AI is rooted in social constructionist theory. In postmodern management theory, organizations are viewed as social constructions, continuously being created by the conversations that take place between people, which in turn affect the relationships, identities, and emotions of organizational members

– AI is rooted in positive psychology theory. Research suggests that those who are considered psychologically and socially functional demonstrate a higher frequency of positive images than negative images, and that such underlying images heavily influence the fate of cultures and civilizations.

– AI is rooted in narrative communication; and a strong emphasis on the importance of relationships.

>The 4D model of AI:  this model include four phases of the AI approach: Discovery, Dream, Design, and Delivery.

>Critiques of AI center on appropriateness, repression of negative images, and unexpressed resentment suggests that other alternatives may be equally effective, that groups may reach agreement for fear of rejection and exclusion, and that groups may find utility in voicing neutral or negative points.

-AI presents has a promising alternative to traditional problem solving and its inherent, often negative effects.

-Practical implications – The sharing of stories as part of the AI approach served to bond employees to each other and served to instill a shared sense of ownership for the past and future success of the organization.

-Originality/value – This paper provides insight and support for using AI as an organizational development approach those complements existing Arab cultural factors for practicality and benefit

Weakness: Research limitations/implications – Critiques of appreciative inquiry (AI) center on appropriateness, repression of negative images, and unexpressed resentment. Despite critiques, a lack of dialogic discourse, and support from scientific research for this relatively new approach, AI presents a promising alternative to traditional problem solving and its inherent, often negative effects.

Ranking:

Level V

Valid -no

Reliable- no

Applicable- yes

Overall rank- moderate

This paper provides a conceptual framework and language that scholars might use to assesses the differences in patient assignments between float pool nurses versus scheduled unit staff nurses

A Pilot comparative study

Aim was to assesses the differences in patient assignments between float pool nurses versus scheduled unit staff nurses

Aimed to statistically determine whether float pool nurses to receive more difficult patient assignments than the scheduled unit staff nurses

Float pool nurses as a group of nurses who accommodate unit staffing in response to variability in-patient care needs.

Patient acuity: which mean the level of difficulty of patient assignment.  And lastly compared to  scheduled unit staff nurses.

At the time of data collection, not all patient care units in the hospital were using the same acuity system developed for the organization. Because of this, a consistent data collection tool needed to be created. By using this tool, researchers could compare data from multiple units more accurately. The data collection tool was developed specifically for the purposes of this study and was used to assign a composite level of difficulty to each patient assignment.

Terms clearly defined –Prospective

Methods adequately described

Measurement was accurate –Timeframe clear.

Weaknesses: The medical-surgical and critical care results were analyzed together, affecting the measurement of patient flow and patient volume in data collection.

The volume of patients and patient flow varies from shift to shift. A day shift medical-surgical nurse may have three to five patients, including new admissions, while a night medical-surgical nurse may have six patients with no patient flow. By analyzing all shift data together, the researchers may not have represented accurately the measure of patient flow difference between medical-surgical and critical care units.

Two RAs were used to collect data for this research study. The tool was created by the RAs and informal conversations were held regarding how data were to be collected. However, prior to starting the data collection, no test of inter-rater reliability was conducted.

Ranking: Level- I

Evidence from experimental study (randomized controlled trial)

Ranking:

Level- I

Valid- yes

Reliable- yes

Applicable- no

Overall rank-high

Framework

Method

Setting

Analysis

in management literature. Price’s causal model

of turnover has been widely applied to examine organizational

turnover among RNs. This model suggests that

a number of individual, organizational and environmental

factors may be associated with an RN’s decision to leave an

organization. Given that this model has been widely applied

and validated in the RN workforce this study adopted this

model as a framework for examining factors associated with

organizational turnover among RNs To our knowledge, there is no unified conceptual framework

of professional turnover that could be easily adapted to the

RN workforce. Therefore, we have relied on organizational

behavior literature and scarce evidence from previous studies

on RN professional turnover to identify potential factors

for this study

Cross-sectional design

Aim was to examine and compare factors associated with making the decision to vacate a job (organizational turnover) versus

Leaving the profession (professional turnover) among registered nurses (RN) in the United States (U.S.).

Consisted of 8,796 RNs who held an active RN license as of March 10, 2008, but changed a place of work or left the profession entirely.

The data collection design was based on the stratified systematic sampling in each state with stratification by age level, dual license and employment commuting effects. Data were collected through postal surveys, internet-based surveys and direct interviews

-Second dependent variable, i.e. professional turnover, is derived by comparing the respondents’ principal nursing position in 2008, at the time of the survey, to the principal nursing position in 2007, a year before the survey.

Independent variables were derived from a single question that asked RNs to mark their primary reason(s) for employment change from a list of options. The question was: “Were any of the following the primary reason(s) for your employment change?” The following response options were provided: burnout, stress, physical demands, disability, illness, lack of good leadership, lack of collaboration, scheduling, issues, inadequate staffing, lack of advancement opportunities, better pay benefits, or other.

The overall survey response rate was 62.4 percent. The descriptive

characteristics of the study sample are presented

in Table 2. Approximately 14 percent (4,682) of RNs left

the profession and 14 percent left their organization

from a total sample size of 36,646. Both groups were more

likely to be White (88.7% and 82.9% respectively) and reside

in urban areas (81.6% and 83.7%). Nurses who left the

profession were more likely to have bachelors in nursing (34.7%), whereas the highest proportion of nurses who left

the organization had an associate in nursing as their highest

educational level (38.6%)

Approximately 14 percent (4,682) of RNs left the profession and 14 percent left their organization (4,114)

from a total sample size of 36,646. Both groups were more likely to be White (88.7% and 82.9% respectively) and reside

in urban areas (81.6% and 83.7%). Nurses who left the profession were more likely to have bachelors in nursing (34.7%), whereas the highest proportion of nurses who left

the organization had an associate in nursing as their highest

educational level (38.6%).

Policy makers and health care managers should be aware of the different factors that are associated with RNs’ decision to leave the profession or an organization. Health care managers involved in the development of nurse retention strategies should address organizational leadership and consider development of comprehensive career-development programs. Policy makers should consider allocating additional resources to ensure that RN workforce is of adequate size, is qualified, and is able to provide high quality care in the U.S.

-Descriptive statistics were used to describe trends, patterns, and factors of patient assignment of float and unit nurses.

Terms clearly defined

Methods adequately described

Measurement was accurate

–Timeframe clear.

This study was presented with a big population sample.

– The data were collected simultaneously on exposures and outcomes, specific inclusion and exclusion criteria were established at the design stage.

– Results were enough to measure prevalence for all factors under investigation.

– This study was able to examine predictors of turnover among RNs who already left an organization or profession rather than simply stating their intention to leave.

Weakness:

-Although this study is based on a representative dataset, the information about reasons for turnover was obtained from subjective self-reported data by RNs who had left the organization or the profession. Therefore, our results may suffer from “memorability” bias

– Given the analytical approach of this study, e.g. focusing only on “leavers”, it is not possible to directly compare our findings with previous research that is based on data from nurses still working in the profession and those who left it

– the dataset limits our ability to consider other factors that may influence RN’s decision to leave the profession including unemployment rate, recession, availability of other jobs in the market, and government policies, e.g. Affordable Care Act,[47] that may affect the job market

-Due to the cross-sectional nature of the data, the identified relationships can be interpreted as associations only. Thus, subsequent studies should consider adopting longitudinal designs to shed a light on “causal” relationships between predictors of organizational and professional turnover and actual turnover among RNs.

Ranking: level II

Quantitative research,

Cross-sectional design

Cross-sectional (consecutive)

Ranking:

Level- II

Valid-yes

Reliable- yes

Applicable-no

Overall rank-high

Framework

Method

Setting

Analysis

Content analysis’: term is used

in different ways (sometimes as equivalent to thematic analysis), but in qualitative synthesis

refers to a systematic, manner of coding themes, which is stable across raters; 28

‘Content analysis’: term is used
in different ways (sometimes as equivalent to thematic analysis), but in qualitative synthesis
refers to a systematic, manner of coding themes, which is stable across raters; the themes

can then be presented as ‘counts’7

The protocols were developed by the research team, which included two senior nurse administrators of Aboriginal heritage, in collaboration with members of the Health Program staff. Data collection involved two complementary methods: a systematic review of 135 client charts, and in-depth, semi-structured interviews with 30 health-care providers serving the three communities.

1^st resource of data: Clients’ charts are a key source of information on the process of care. Pathology-specific tools, designed to give a holistic assessment of the health system’s response to clients, were developed by the research team to capture information along several dimensions: time sequence; actions taken by provider category in assessing, diagnosing, developing, and implementing treatment plans; and evaluation.

The second source of data was in-depth individual interviews with 30 members of the interdisciplinary health-care teams serving the communities, both resident and visiting professionals and local paraprofessionals. All those providing services during the period of data collection were invited to participate; as a result, the respondents included short- and every discipline present

Structure: the core elements of a health system’s structure — material resources, human resources, and organization — create amenities of care that influence variable degrees of access and variable degrees in the quality of care received.

Process:process considers what is actually done in the delivery of care by both providers and recipients

Outcomes: are the effects of care on clients, their families, and their communities. Obviously, such

outcomes can derive from various sources; for example, specific courses of treatment can be measured in changed health status for clients.

certain strategies could reduce its impact. First, in instances where short-term placements are necessary to ensure coverage, a system allowing the same group of nurses to rotate in and out of a given com- munity would be ideal. Second, no matter how brief their assignment, all nurses who go north must be properly oriented to the practice, culture, and particular community. Third, system-level accommodations should be made to maximize the contribution of paraprofessional staff from the communities; usually they are knowledgeable, competent, and the most stable component of the health-care team

Weakness: there are no empirical data validating any of these methods. The assessment of study quality is limited by the need to rely on author-supplied information and an understanding that there is no true reference standard for quality.

Ranking:

Level III

Valid -yes

Reliable- no

Applicable- yes

Overall rank- moderate

Framework

Method

Setting

Analysis

organizational change in professional settings such as health care requires the

understanding that organizations are socially constructed. Organizations are in essence

contexts in which people act and interact to create new realities through learning and

innovation. The second premise is that, in order to initiate

Change, particular attention should be paid to the process in which change takes place.

This process, described as complex and non-linear often focuses on specific problems to be solved.

Methods: Multiple sources of evidence were used. They consisted of participant observation, questionnaires providing quantitative and qualitative evidence, interviews, direct observation and documentation.

Intent to stay rate

Conclusion: This study makes a contribution to micro-systems examination of change processes and reveals how ideas evolve and are developed in a multidisciplinary context. AI represents a way to tap into the innovative potential of individuals within an organization. The findings suggest that upper and middle management support is required throughout change processes and that multilevel interventions need to be pursued to facilitate the implementation of innovative ideas and subsequently improve work environments.

AI was reported to promote a united approach to change, foster collaboration, and build trust among workers

AI worked very well in a multi-agency setting where there was a tendency for groups to blame each other for organizational shortcomings

The main precept of AI is that individuals who are in relationships with one another can co-create an effective future that generates new meaning and inspires new possibilities

The diversity of AI applications in health care will grow as managers and researchers continue to use this approach in a wide variety of situations.

Weakness: Limitations in using AI, and these are important to address:

Lack of time and resources for an AI process.

The complexity of health care organizations makes it difficult to track changes attributable to AI.

The relationship of the individual to the group is particularly important to address in health care where professionals are often depicted as functioning in disciplinary silos

The difficulties and challenges encountered in keeping the discussions focused on the positive

Ranking:

Level I

Valid -yes

Reliable- yes

Applicable- yes

Overall rank- high

Framework

Method

Setting

Analysis

& provides a conceptual framework and language that scholars might use to guide the conduct Strategies to Retain Experienced Nurses As Nursing Shortage grow.

New study from The Robert Wood Johnson Foundation funds a wide array of programs that are working to help build a national Culture of Health.

The new study includes seven in-depth case studies examining strategies used by health care and non-health care institutions that have received recognition for their success in retaining experienced workers, as well as findings from 13 separate research projects conducted from January 2007 to December 2008 to explore the impact of interventions aimed at retaining experienced nurses in hospitals. It is a follow-up to the groundbreaking white paper, Wisdom at Work: The Importance of the Older and Experienced Nurses in the Workplace, commissioned by RWJF in 2006.

-Innovative approaches to

-Staffing: Allocating the resources needed to deliver quality care

-Employee health and wellness programs: include activities such as company-sponsored exercise, weight-loss competitions, educational seminars, tobacco-cessation programs and health screenings that are designed to help employees eat better, lose weight and improve their overall physical health

-Training and development opportunities: an educational process which involves the sharpening of skills, concepts, changing of attitude and gaining more knowledge to enhance the performance of employees.

A sustained commitment by company leaders to retain older workers;

Corporate cultures that value the experience of older employees; ongoing data collection and analysis to address concerns of senior employees; opportunities for older employees to transfer to less demanding roles; compensation packages that reward longevity; and benefits catering to older employees such as phased retirement options, flexible work arrangements and opportunities to receive in-home care for parents and spouses.

Building a “culture of aging” at Bon Secours health system in Richmond, Va., with flexible work and retirement arrangements, mentoring, and ergonomic programs;

a “snow bird” program at Carondelet Health Network in Tucson, Ariz., that makes it easier for Carondelet to offer temporary R.N. assignments to licensed nurses from other Nurse Licensure Compact states; and

comprehensive retention programs at Scripps Health in San Diego that include interactions with employees through trainings, orientations and communication that aim to consistently engage employees and provide them with relevant information.

Weakness;

Ranking:

Level V

Non research evidence, organization that review the quality improvements studies and reports

Ranking:

Level- V

Valid-no

Reliable- yes

Applicable-yes

Overall rank-moderate

Framework

Method

Setting

Analysis

Appreciative Inquiry Principle reminds us that, when we envision a positive future, we are more likely to act positively and live ourselves into that positive future.  Cultures are shaped in the images we hold.

Strength-based, transformational, positive change concept.

Weakness: individual expert opinion is not infallible. Potential biases acknowledged, as this article published in author business website.

Ranking:

Level V

Valid -no

Reliable- no

Applicable- yes

Overall rank- low

Framework

Method

Setting

Analysis

Design: Survey.
Method. Survey of 9982 nurses in 156 Dutch organizations in 2010–2011, 6321 nurses in nursing and care homes and 3661 nurses working in home care, based on the ActiZ Benchmark in Healthcare.

Aim: To analyze the impact of six job characteristics on the intention of nurses to leave their organization, specifically focusing on long-term care settings: nursing homes, care homes and home care.

-Job characteristics
-Work pressure
-Leadership
-Autonomy
-Development and

-Career opportunities

-Working atmosphere

-Organizational vision

Control variables

Gender (0 = female. 1 = male)
Age (in groups)
Years at employer
Supervisory position

Intention to leave

(Intention to leave the organization) means staff will state: ‘If I could, I would resign from this organization today’ and ‘At the moment, I am actively searching for a job outside the healthcare sector’

Work pressure

Work pressure (workload, physical and mental strain)

Leadership

Leadership (an active and motivating leadership style)

Autonomy

The indicator autonomy (empowerment and independency)

Development and career opportunities

that the organization offers to develop skills and to foster career progress

Work atmosphere

Work atmosphere (pleasure at work, a good team spirit and collegiality)

Organizational vision

We measure the organizational vision (the acknowledgement of ambitious goals as part of the mission of the organization)

– Descriptive statistics were used to describe trends, patterns.

– A theoretical model was constructed linking six job characteristics to intention to leave. This model was tested in a survey of 9982 nurses from 156 Dutch organizations.

– The regression model explained 30% of the variance in intention to leave. The high internal consistency values and the satisfaction of regression criteria strengthen the reliability and the validity of the statistical conclusions drawn. As such, we can conclude that the model worked satisfactorily.

Weaknesses:

First, the scales used were not validated in earlier studies. Future studies should further test the model of intention to leave in long-term care using validated scales.

Second, the analysis makes assumptions about the direction of causality, moving from job characteristics to intention to leave the organization. A longitudinal design could be helpful to establish causality, which was impossible given the cross-sectional design of this survey. Furthermore, objective data on actual turnover would improve the validity of studies.

Third, the survey results provide insight into the importance of several job characteristics for nurses’ intention to leave their organizations, but not into the meaning of these factors in specific work contexts.

Ranking: Level I

Evidence from experimental study (randomized controlled trial)

Ranking:

Level-I

Valid- yes

Reliable-yes

Applicable-yes

Overall rank-high

Framework

Method

Setting

Analysis

• Collaborative leadership: improving leadership skills, especially those involved in collaborative problem solving among people from across different parts of an organization.

• Teamwork: understanding the factors that contrib- ute to building effective clinical care teams that generate collective energy internally and for the organization in which they operate.

• Systems change: understanding the dynamics of complex systems and sources of resistance to change in organizations

Personal reflections on growth

Self-assessment of teams ability to function effectively

Personal reflections team dynamics and effectiveness

Personal reflections on growth and success

Self-assessment of project effectiveness and potential

360 assessment of project effectiveness and potential

Team dynamics are significantly affected by the behaviors and attitudes of key individuals. On both of the successful teams (red and yellow), individual members experienced a significant increase in their scores on the social competency subscale of the emotional intel- ligence test. However, there were no changes on the personal competency subscale, which was already fairly high. It appears that being a member of an effective team helps build social competency rather than simply relying on people bringing that strength with them to the team. Participants on successful teams were also the only ones to show an increase on their Life Orientation Scale that is a measure of optimism. Both of these findings suggest that successful teams experienced res- onance, a state in which all members feel that they are one and that their collective strength is greater than their individual capacities (Goleman et al. 2004).

Apart from the effects of individual behaviors on team dynamics, organizational environment or culture appear to have been a strong factor contributing to team success.

Implications for nursing management Team approaches to retention hold promise but require careful development and are most likely to work where organizations have a collaborative problem-solving environment.

Weakness:

Ranking:

Level III

Valid -no

Reliable- no

Applicable- yes

Overall rank- moderate