In an Idaho-based hospital, the registered nurse (RN) turnover rate in the float pool was excessively high. The purpose of this project was to examine the effect of Appreciative Inquiry (AI) on a RN's sense of community (SOC) in a float pool and an RN's intent to stay employed after attending an AI event. Although much had been written about nursing retention, AI, and SOC separately, there was nothing on how AI could be used to increase a RN's SOC or intent to stay employed. AI is a change management framework that has been used to engage employees in a meaningful way. The goal of this project was to engage RN float staff in a 6-hour AI workshop to generate ideas on improving the work environment. The SOC theory by McMillan and Chavis provided the context for measuring RN perception. It was anticipated that participation would lead to an increased SOC and an increased likelihood of staying employed in the float pool. The Sense of Community Index 2 survey was administered pre and postworkshop to a convenience sample of RNs (n = 22) recruited from the float pool. Additionally, RNs were asked before and after the workshop how likely they were to leave their current position in the next 12 months. Data analysis was a paired t test based on a 1-group pretest and posttest design. Demographic data were collected to describe the sample population. The results, although not statistically significant, showed both an increased SOC and an increased intent to leave following the AI workshop. The findings show that AI may be useful for increasing SOC. However, as a tool for nursing retention, both AI and SOC require better understanding. It is hoped this study will provide leaders with a starting point for further investigation into how AI and SOC can be used to improve the nursing work experience.

A significant nursing shortage exists in the United States, which is compounded by high turnover rates. Skilled nurse preceptors are needed to train and assimilate nurses, which would improve retention of nurse preceptors, facilitate transition of nurses to the practice environment, and increase the number of preceptors within the organization. A preceptor preparation program in a 300-bed hospital was developed to promote nurse preceptor success while enhancing learning outcomes and creating a supportive work environment. The organization's leaders are interested in the successes of the program and its long-term role in retaining nurse preceptors who completed the preceptor preparation program. Therefore, the purpose of this doctor of nursing practice (DNP) project was to develop a program evaluation model where the institution could assess the retention rate of preceptors and the overall effectiveness of the program. The evaluation framework consisted of the Benner's model skill acquisition, from novice to expert, which will assist in assessing outcomes of retention of nursing preceptors as they evolved through the program. The project question for this DNP project asked whether a program evaluation to identify methods to capture current rate of retention of preceptors and overall program effectiveness could be developed. A survey tool was successfully developed and the pilot study was accepted by the facility to capture and evaluate the program information. This project provides a model for program evaluation and may increase the nursing literature on preceptor retention programs. Preceptor program outcomes are important to evaluate and can create positive social change regarding the number of quality preceptors available to train new nurses in practice.

Bullying has long been associated with school children. In recent years, however, more attention has been paid to the bullying that has reached beyond the playground and into the workforce. One population facing this problem is staff nurses. To date, no one has found an effective way to address workplace bullying in the healthcare field, nor have effective methods been found for retaining trained nurses affected by this problem. The focus of this dissertation was on understanding nurses' lived experiences and how nurses decided to remain in their current working position despite these problems. Taking a phenomenological approach and using the conceptual framework of resilience, the study included telephone interviews of 2 pilot study participants and 12 main study participants. Recorded and transcribed participant responses to interview questions were coded thematically and analyzed. Three main themes emerged: stories of working with workplace bullying, challenges of the lived experiences of being bullied, and special techniques of nurses being bullied. Three subthemes also emerged: despair, love of being a nurse, and resilience. This study gave a voice to nurses affected by this problem, revealing special challenges they encounter and coping strategies they employ. Hospital administrators can use the findings of this study to create social change within nurses' working environment by implementing policies that will keep their nurses safe and happily employed. Future research should focus on workplace bullying in the nursing field and how it affects patient safety.

The critical and growing shortage of nurses is a global concern. The growth and sustainability of the nursing profession depends on the ability to recruit and retain the upcoming generation of professionals. Understanding the career choice experiences of Millennial nurses is a critical component of recruitment and retention strategies. An interpretive, narrative methodology, was used to understand how Millennial explain, account for, and make sense of their choice of nursing as a career. Individual, face to face interviews were conducted with 12 Millennial Nursing students (born 1980 or after), for whom nursing was their preferred career choice. Participants were interviewed twice and chronicled their career choice experiences within reflective journals. Data was analyzed using Polkinghorne’s method of narrative configuration and emplotment. The participants’ narratives present a shift from understanding career choice within a virtuous plot to one of social positioning. Career choice was initially emplotted around a traditional and stereotypical understanding of nursing as a virtuous profession: altruistic, noble, caring, and compassionate. The narrative scripts evolved from positioning nursing as virtuous towards understanding the meaning of career choice in relation to one’s position in the social world. The narratives position career choice in relation to the participants’ desire for autonomy, respect and quality of life. Pragmatic considerations such as lifestyle, job security, salary and social status were also emphasized. The narratives represent career choice as a complex consideration of social positioning, fraught with hopes, dreams, doubts and tensions. The participants’ perceptions and expectations in relation to their future nursing careers were influenced by a historical and stereotypical understanding of nursing; an image that remains prevalent in society. Insight gained from this inquiry can inform recruitment, education, socialization and retention strategies for the upcoming and future generations of nurses.

The critical and growing shortage of nurses is a global concern. The growth and sustainability of the nursing profession depends on the ability to recruit and retain the upcoming generation of professionals. Understanding the career choice experiences of Millennial nurses is a critical component of recruitment and retention strategies. An interpretive, narrative methodology, was used to understand how Millennial explain, account for, and make sense of their choice of nursing as a career. Individual, face to face interviews were conducted with 12 Millennial Nursing students (born 1980 or after), for whom nursing was their preferred career choice. Participants were interviewed twice and chronicled their career choice experiences within reflective journals. Data was analyzed using Polkinghorne’s method of narrative configuration and emplotment. The participants’ narratives present a shift from understanding career choice within a virtuous plot to one of social positioning. Career choice was initially emplotted around a traditional and stereotypical understanding of nursing as a virtuous profession: altruistic, noble, caring, and compassionate. The narrative scripts evolved from positioning nursing as virtuous towards understanding the meaning of career choice in relation to one’s position in the social world. The narratives position career choice in relation to the participants’ desire for autonomy, respect and quality of life. Pragmatic considerations such as lifestyle, job security, salary and social status were also emphasized. The narratives represent career choice as a complex consideration of social positioning, fraught with hopes, dreams, doubts and tensions. The participants’ perceptions and expectations in relation to their future nursing careers were influenced by a historical and stereotypical understanding of nursing; an image that remains prevalent in society. Insight gained from this inquiry can inform recruitment, education, socialization and retention strategies for the upcoming and future generations of nurses.

Many healthcare organizations are investigating the reasons for nurse turnover and seeking ways to retain the nurses they already employ. The primary deliverable of the DNP project was a nurse retention plan. In order to devise the plan, the DNP student conducted a literature review, collected qualitative data from representative nursing staff members, and assembled an expert panel of senior leaders to secure permissions to implement the nurse retention plan. The purpose of the project was to develop a nurse retention plan for the emergency department and propose it to an expert panel of nursing administration at the project site. The concepts of nursing satisfaction, theory of human capital, nurse dissatisfaction, and nurse turnover were used for this DNP project. At the practicum site, 36.7% of the emergency department nurses (n =22) participated in the DNP student's focus groups. Coding was used and the themes that emerged from the focus groups were that nurses feel stuck and want the opportunity to advance, there was a lack of communication and pay was a determining factor regarding whether nurses plan to stay employed in the project site's emergency department. Recommendations to decrease voluntary nursing turnover included more flexible scheduling, forming a scheduling committee in the department, providing for more nursing autonomy, and the sharing of emergency department staff throughout the health system all of which were accepted by the expert panel for evaluation and implementation. This project contributes to positive social change, as nurse satisfaction and decreased nursing turnover has been linked to increased patient satisfaction and better patient outcomes.

The purpose of this research is to determine the degree to which a positive experience with nursing leadership increases nurse's job satisfaction. The different values and norms of the generational cohorts result in each cohort perceiving leadership characteristics differently. Factors such as length of exposure to leadership, location, shift worked, clinical versus non-clinical positions and the presence or absence of Servant-Leadership, all have the potential to impact nursing satisfaction. Nursing satisfaction, or dissatisfaction impacts retention, further modifying nursing leadership practices. Conflict, Cohort, Servant-Leadership, and Self-Discrepancy theories were utilized to identify the relationships of generations to each other and to the leadership characteristics existing in their organizations. Two Central Florida healthcare organizations were utilized to obtain data regarding leadership characteristics, generational cohort and nursing satisfaction indicators. A total of 440 survey questionnaires were distributed, 182 were returned, a response rate of 41%. Factor Analysis utilizing principal component analysis was performed to reduce the 57 variables contained within questionnaires to one construct that represented a leadership characteristics variable. This variable was utilized to test 3 of the hypotheses. Principal component analysis was utilized to reduce 10 characteristics of Servant-Leadership, to a construct that represented a Servant-Leadership variable. Qualitative data was collected from 25 interviewees and was used to enrich and supplement the quantitative data from the survey questionnaires. Nursing leadership characteristics affect nursing satisfaction as demonstrated by this research. The more positive the perception or experience of nurses in relation to nursing leadership, the more job satisfaction increases. Even though literature states that Generation X employees exhibit less job satisfaction, due to generational specific values and norms, generational cohort did not demonstrate significance in this study. A positive perception of nursing leadership characteristics demonstrated a positive impact on nursing retention within an organization. Nurses who are satisfied with leadership characteristics tend to stay with that organization. The presence of Servant-Leadership characteristics also demonstrated a positive impact on nursing job satisfaction and retention. Leaders that demonstrate Servant-Leadership characteristics engender increased job satisfaction for their employees and increased retention of nurses for their organizations.

The problem addressed in this project is the high attrition rate among English as Second Language (ESL) students in a local community college associate degree nursing program. If the retention problem is addressed, the increase in the number of ESL nursing student graduates could result in a more diverse nursing workforce, reflecting the diversity of the community. The purpose of this study was to examine student and faculty views regarding factors that contribute to the academic success and retention of ESL students. To that end, a qualitative case study approach was used, guided by the theoretical frameworks of Cummins's contextual interaction theory and Freire's and Mezirow's transformational learning theory. By using purposeful sampling, 8 ESL students and 5 faculty members were interviewed in both structured and unstructured interviews. The data were decoded using Nvivo computer software to establish themes and categories for analysis. The themes pointed to faculty lacking: (a) cultural awareness and sensitivity, (b) knowledge of the academic needs of ESL students, (c) knowledge of teaching strategies to accommodate the learning of ESL students, and (d) skills to prepare ESL students for what to expect. The findings led to creating a professional development workshop for faculty and led to recommending that the director and dean of the nursing program make it mandatory for faculty to continue their education on skills to improve academic success of ESL students. The findings suggest administrators should make cultural awareness competency compulsory. These efforts and faculty training may result in broader positive social change for ESL students and faculty, administrators, and the community, improving the number of graduating nurses to serve a diverse patient population.