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.

The purpose of this project was to identify the standards for the American Association of Critical Care Nurses (AACN). The employees of a 39-bed medical surgical unit within a 697-bed metropolitan medical center were selected through collaboration with the practicum site. Out of 68 allocated positions for this unit, only permanent employees were selected to participate. An employee presented the purpose of the project, the survey process, and inferred consent represented by online login to complete the survey. Following the online assessment, the employee explained the AACN healthy work environment standards in a subsequent presentation. The online healthy work environment assessment measured the AACN healthy work environment standards, which included skilled communication, collaboration, effective decision making, appropriate staffing, meaningful recognition, and authentic leadership. A mean score was generated by the healthy work environment online assessment tool on a scale ranging from 1 (Needs Improvement) to 5 (Excellent). Data from the online assessment were analyzed by comparing mean pre- (3.03) and post- (2.17) project results, which revealed a need for greater understanding of AACN healthy work environment standards. Increased education of the AACN healthy work environment standards and implementation of a formal program would impact nursing turnover rates, improve employee engagement, and ultimately improve the care and outcome of patients, thereby promoting positive social change.

The theme of this thesis is "The Perception of Safety in Nursing Practice". While most of literaure of focused on the psyhisal aspects of safety, this thesis is focused on the psychological ones. This thesis has two goals altogether. Its firt goal is to find out the possibilities of securing patient´s and nurse´s feeling of safety from nurse´s outlook. The second goal is to find out nurses´s perception of their own feeling of safety while at work. The research questions are 1) How do patients perceive their safety during nursing care? 2) What does patient´s safety mean to nurses? 3) How does the personnel perceive their own safety during nursing care? The theoretical part describes safety, needs, communicaton, trust and the possibilities of securing psyhical and psychological safety of patients and nurses alike. The practical part consists of nurses and patient interviews about safety and factors, that may influence it. The data were collected by semi-structured interviews with nurses and patients located in hospitals of south and west Bohemia. The research involved 20 respondents, 10 nurses and 10 patients, of deliberate choosing and by the form of snowball sampling. The data were collected since May through to July 2019 and the collection was concluded at the moment of theoretical saturation. The interviews covered themes like safety, communication, trust, quality of care, EBN, teamwork and what do nurses find lacking while ensuring safety of their patients and their own. The results show that each person perceives their safety differently and it is necessary to fit the care to patient´s specific needs. The respondents agree on the importance of proper communication, of trust between patient and nurse and between personnel alike, and of informedness. Most of the nurses also responded that they miss more time to spend with their patients to build mutual trust and to develop their feeling of safety. Usually the blame lies on their ward being understaffed. This thesis mapped out the perception of safety of nurses and patients including some of the shortcomings involved in the current nursing practice. It can serve as a reference material for studying.

Bedside reporting is one way to improve communication among the health care team. At the study site, at least 50% of bedside reporting was being conducted at the door of the patient's room instead of at the patient's bedside. The project question addressed whether a computer-based education and training video on bedside reporting and a standardized bedside reporting checklist would increase the rate of bedside shift-to-shift reporting among a medical surgical unit (MSU) to 100%. The project addressed the implementation of standardizing bedside reporting through education and training using Agency for Health Care Research and Quality's (AHRQ) Guide to patient and family engagement. The project also promoted use of a standardized tool to conduct bedside reporting and a surveillance tool to ensure bedside reporting was being conducted. Data was collected through surveys and surveillance. The data was tabulated for frequencies displayed in percentages. Post-implementation findings indicated that bedside reporting went from 0% to 86% during the 2-week surveillance period. MSU nursing staff improved their knowledge and skill on how to conduct bedside reporting, but their attitude did not change as they thought the practice of bedside reporting was not an effective use of their time. Findings may be used to increase involvement of patients and families in their inpatient health care.

The role of the nurse manager is important in organizations and influences outcomes such as the safety and quality of care provided on a unit, satisfaction, turnover of nursing staff, and overall health of the work environment. Stressors for managing nurses can impair physical and emotional health and lead to poor patient and staff satisfaction, safety, and outcomes. The evidence-based practice project will explore nurse managers' well-being and self-care activities. The theoretical framework of the project is the Relationship-Based Care Model as well as Kotter's change theory. The literature suggests that self-care activities can reduce stress and improve well-being. A group of nurse managers who have accountability for inpatient hospital units will be recruited to participate in the project through public discussion boards and email groups of organizations that support nurse leaders. They will be educated through a self-guided learning module about stress and self-care and then will be asked to participate in self-care activities 3 times weekly for 4 weeks. Following the education, the nurse managers will complete a researcher-crafted posteducational assessment to evaluate whether the education and activities met their needs, whether they learned new information, and the helpfulness of the project. Nurse managers participating in regular self-care are able influence positive social change by role modeling healthy coping skills to nurses providing direct care to patients. Self-care promotes effective stress management and contributes a healthier work environment.

High-stakes licensure or certification examinations are required for many health professions disciplines to ensure safe entry-level practice. Accrediting agencies set a benchmark for graduates' first-time licensure or certification success as a measure of program effectiveness. Failures of graduates on licensure or certification examinations may directly affect the school's recruitment and retention of qualified students and faculty, as well as institutional financial viability. A health science university has added Health Education System, Inc. (HESI) standardized examinations using computer adaptive testing into the family nurse practitioner (FNP) master's program to support certification success, although research on these advanced practice examinations as related to certification outcomes was lacking. Guided by classical test theory, this study was an investigation of whether a relationship existed between students' performance on 4 HESI standardized examinations (Advanced Pathophysiology, Advanced Pharmacotherapeutics, Advanced Health Assessment, and the APRN/FNP Exit exam) and first-time FNP certification success. Binary logistic regression analysis of data from 117 students who graduated between 2013-2016 indicated that none of the 4 standardized HESI examinations significantly predicted FNP certification success, perhaps due to the examinations not carrying any evaluative weight within the program. The results of this project study may be used to promote positive social change by providing a means to improve first-time certification success and increasing the availability of primary care providers in the role of FNP.

The nursing profession is facing a potentially devastating shortage of nurses by the year 2020. Contributing to the shortage is the retirement of experienced nurses who are over the age of 45, and an aging baby boomer population. The loss will place a considerable strain on the overloaded health systems. As a result, it is important to identify successful strategies for addressing the problem of experienced nurse retention. Therefore, the purpose of this project was to conduct a systematic review of literature to answer the question of what retention strategies have been used to prevent the loss of the experienced nurse who is approaching retirement age. The systematic review, guided by Benner's theory of novice to expert and Kanter's empowerment theory, included quantitative, qualitative and mixed methods studies published between 2007 and 2017. Studies published in the United States and Canada were 8studies selected for detailed review, were graded using the Joanna Briggs Institute grading criteria. The themes identified in this study included five key indicators: nurse autonomy and empowerment (75%), stress and burnout (62%), workplace engagement (68%), leadership commitment (56%), and training/career development action plans (56%). The key indicators may provide the basis for recommendations for managers and leaders in promoting experienced nurse retention in their work settings. Positive social change is possible when management takes into consideration the value of the key indicators above in experienced nurse retention efforts. By retaining experienced nurses, the nursing profession can promote positive patient outcomes and a mentoring plan for nurses approaching retirement age.

Nurse practitioners (NPs) are significant members of the health care team. Variation and lack of standardization in the practicum preparation of the NP has been identified as problematic. There is a need to improve NPs preparation to efficiently and independently impact health care. This project presented the 1-minute-preceptor (OMP) model as a standard tool in the practicum preparation of the NP through a preceptor-focused continuing education session. The aim of the OMP is to help ensure that students are exposed to the level of critical thinking and problem solving needed in the role of an independent, efficient NP. Knowles's adult learning theory and the educational design process model provided the theoretical framework and guided the development, implementation, and evaluation of the continuing education program. Participation in the continuing education program was voluntary. Pretests, posttests, and evaluations of the continuing education session were collected and analyzed. Ten preceptors participated in the educational session and evaluation. Based on pretest and posttest results, knowledge of the OMP model improved from 70% before the education program to 100% after the program. Participants also indicated interest in using a tool capable of ensuring an effective student-preceptor encounter, and 100% stated they would use the information presented in future preceptor–student interactions. Continuing education program evaluation results indicated participant satisfaction with the presentation. To positively impact social change, the findings of this project may be used by NPs and preceptors to effectively and efficiently impact patient outcomes early in practice.

Lateral violence is an intentional and harmful behavior in the workplace by one employee against another. In nursing lateral violence has impacted the performance of nurses as well as patient care. Research suggests that lateral violence behaviors are still prevalent in the nursing workplace and that there have been few interventions to change these behaviors or address the power dynamics that cause them. Though most of the research on lateral violence has been conducted on female nurses, the population of male nurses is growing. Thus, the purpose of the study was to explore lateral violence in the workplace from the perspective of male nurses. A phenomenological approach with Marion Conti-O'Hare's theory of the wounded healer as the theoretical framework was used to address the research question on male nurse perception of lateral violence in nursing. The data for this study were drawn from interviews of 10 male nurses who were recruited with criterion sampling. Exploratory questions and vignettes were used to gather participants' responses. This allowed for larger themes and core ideas to establish codes. The data were analyzed using thematic analysis. The results of the study indicate that lateral violence is a problem in nursing and that there is a gender bias that perpetuates this phenomenon. Results of this study have the potential to contribute to positive social change regarding male perception of lateral violence in nursing by encouraging interventions for lateral violence based on communication differences between genders.

The nursing shortage and high turnover rates are a problem in the United States. The purpose of this multiple case study was to explore leadership strategies that hospital senior nurse managers in the Rocky Mountain states use to improve nurse retention. Participants were 6 hospital senior nurse managers including 3 chief nursing officers, 1 assistant chief nursing officer, and 2 directors who had demonstrated effective leadership strategies in retention of nurses. The leadership-motivated excellence theory was the conceptual framework. Semistructured interviews with open-ended interview questions were used to collect data; organization websites and documents were used to help corroborate evidence for triangulation. Data were analyzed using Yin's data analysis method. The major themes were leadership and retention strategies. The leadership strategies were senior nurse managers guiding, coaching, and mentoring registered nurses, and the retention strategies were tools used to motivate and retain registered nurses. The results may bring about positive social change by providing hospitals with leadership strategies to retain nurses. Improved retention rates of registered nurses may enhance the competitive advantage for hospitals by improving patient satisfaction scores and improving care. This improvement may result in increased hospital reimbursements and may influence organizational commitment to improving patient outcomes.