Master of Science in Nursing

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http://hdl.handle.net/20.500.11987/323

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Alternative Learning Strategies to Increase Clinical Judgment for the NCLEX Next Generation Exam
(Bryan College of Health Sciences, 2021-12) Nespor-Hartig, Elizabeth; Grummert, Kerri; Olerich, Melina
Purpose: To evaluate alternatives to traditional clinical experiences that can increase students’ clinical judgment and clinical competencies in order to better prepare them for the Next Generation NCLEX exam. Literature Review: An important goal of nursing education is to improve the competencies and clinical judgment of nursing students. Traditional clinical is utilized to help develop student’s clinical judgment skills and clinical competencies. In many locations, nursing programs are limited in enrollment due to lack of clinical resources. The field of nursing is growing rapidly with nursing educators working diligently to meet the challenges of faculty shortages and limited clinical sites (Curl, E. D. et al., 2016). The Theoretical Framework that was utilized was NCSBN Clinical Judgment Measurement Model. The Third layer was primarily utilized due to it being the measurable cognitive aspects of clinical decision making. Methods: A fishbone diagram was utilized to determine a gap. IRB approval was obtained. An extensive literature review was conducted and a coding procedure was developed. Articles were reviewed, categorized and coded. Expert interviews were conducted and categorized into themes. Spiral data analysis was utilized to determine themes within the research. Results: Simulation, case studies and reflections were found as valid tools to increase student clinical judgment skills. Faculty evaluation and feedback is needed to determine the level of clinical judgment and to address areas of clinical judgment that need improvement. Faculty can use evaluations to address gaps in clinical judgment. Conclusions: Through this review, it was determined that simulation, case study, and reflection are valid alternatives to traditional clinical time to increase student’s clinical judgment. Educators need to implement clinical judgment into curriculum to prepare students for the Next Generation NCLEX exam. Future recommendations include development for a standardized evaluation tool with governing body support and an implementation plan for faculty.
Assessing undergraduate nursing students' confidence utilizing simulated bedside shift report
(Bryan College of Health Sciences, 2018-12) Bratt, Julie; Ehmke, Courtney; Park, Emily; Barbara Sittner, Ph.D., RN, APRN-CNS, ANEF. Bryan College of Health Sciences
PURPOSE: The purpose of this quality improvement project is to use simulation training for bedside nurse reporting with undergraduate nursing students to increase their confidence levels. BACKGROUND: Typically, nursing students are not taught how to perform handoff communication systematically; handoff reporting is learned through vicarious observations and apprenticeship experiences. As a result, they may observe many clinical handoff reports but lack the ability to independently conduct effective reports during care transitions and critique the reports of others (Lee et al, 2016). Clinical simulation training helps to ensure participants receive the same content, affording them the opportunity to practice new skills, and help to work through challenging situations and learn from their own and others' mistakes in a safe environment (Connolly, 2017). METHOD: An educational power point was reviewed by the students at the beginning of their simulation day. Students completed a 4 question pre and post survey developed by the research team to assess student confidence utilizing SBAR format. RESULTS: Results were analyzed using a Paired T test. The average pre and post scores have a p value of <0.0001, and it was found that 267 percent of undergraduate nursing students said they strongly agreed feeling confident when delivering bedside shift report after participating in a simulated environment. CONCLUSIONS: The results of this survey indicate the need for continued bedside shift report during simulation experiences to increase future nursing students' confidence.
Compassion awareness
(Bryan College of Health Sciences, 2018-12) Belz, Marsha; Gerken, Ashton; Kimminau, Linda; Barbara Sittner, Ph.D., RN, APRN-CNS, ANEF. Bryan College of Health Sciences.
PURPOSE: To increase awareness and educate on compassion fatigue versus compassion satisfaction, with two progressive care units, at a midwestern medical center. Following education, does this improve the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) nursing composite scores? BACKGROUND: Since the implementation of the HCAHPS, hospital reimbursement has been associated with quality metrics and patient experience ratings. The transparency and focus on metrics has created additional stress on critical care nurses. These nurses report less capacity for compassionate feelings toward patients when they perceive their role expectations are not met. METHOD: There were 29 participants involved. The nurses were educated on compassion satisfaction and compassion fatigue and were invited to take the Professional Quality of Life survey (ProQOL). Chi-Square analyzes were used to find the relationships between burnout and age, education, unit tenure and nursing experience. A statistically significant relationship was found between burnout and unit tenure (chi sq = 15.3, p <.009). Nurses, with a tenure between one and three years were almost three times as likely to experience burnout compared to nurses with less than one year and more than three years of unit tenure. A statistically significant relationship was also found between burnout and nursing experience (chi sq = 10.6, p <.05). However, there was no correlation with the HCAHPS. CONCLUSIONS: Strategies were provided to the nurse managers on ways to identify and prevent compassion fatigue. These recommendations include: utilizing the ProQOL, being a transformational leader and implementing a meaningful recognition program.
Evaluating Components of Nurse Residency Programs That May Impact Nurse Retention Rates Beyond the Initial Year of Hire
(Bryan College of Health Sciences, 2021-12) Coleman, Chrissie; Middlekauff, Jennifer; Nash, Wendie
Purpose: To create a framework of components for successful nurse residency programs (NRP) where the key goal is for improving nurse retention rates in the second year of hire. PICO: Among new graduate nurses who participate in a nurse residency program, what components of the NRP can increase an organization’s second year retention rate? Literature Review: Research studies have shown that participation in a NRP leads to an increase in retention in the first year of hire. While NRPs offer a way to improve first year retention rates, further research is needed to assess the effectiveness of content, structure, and to assess retention rates past the initial year of hire. Theoretical Framework: Benner’s Nursing Theory, From Novice to Expert provides a framework for use as a consistent guide for the key elements of NRP’s and this project. Methods: IRB approval was granted for an evidence based project to proficiently analyze relevant and current evidence, and conduct expert interviews with Human Resources (HR) and NRP experts. Data were collected through guided NRP and expert HR interviews to determine possible components of NRP programs that could impact second year retention rates. Results: This evidence based project has created an opportunity to disseminate knowledge for best practice, as well as recommending revisions for NRP’s to meet the contemporary needs of healthcare systems. An NRP’s utilization of the Framework of Successful Components may optimize retention among second year nurses. Recommendations: Next steps needed are to begin building relationships between HRs and NRPs beyond the initial year of hire, supporting an assessment of current technological capabilities, and lastly, to consider potential benefits of rural communities participating in an NRP program and the support needed for this to occur.
Exploring the methods and value of retaining Master's prepared nurses at the bedside
(Bryan College of Health Sciences, 2019-12-11) Meyer, Kris; Hayes, Bryanna; Bedient, Kama
The purpose of this quality improvement project was to explore the methods and value of retaining advanced degree nurses at the bedside and determine incentives that would support this action. BACKGROUND: Literature supports the benefit of master’s prepared nurses (MPNs) providing bedside care to improve patient outcomes, decrease mortality and failure to rescue, and address the nursing shortage. METHODS: A survey was developed using Google Forms to evaluate the nurses’ awareness of the supporting literature and identify desired incentives. The key stakeholders included nursing directors. The setting was a large medical center located in the Midwest. The survey was emailed to all registered nurses at the medical center and yielded 208 responses. The sample included 66 nurses with a master’s degree or higher, or planning to obtain a master’s degree in the next 5 years. RESULTS: Over half of the respondents had minimal to no knowledge of the benefits of having MPNs at the bedside and only 16.1% of nurses were motivated to remove themselves from the bedside by seeking a higher degree. The most significant incentives to keep MPNs at the bedside included pay increase (90.3%) and weekend/holidays off (71%); 67.7% of MPN respondents were currently practicing bedside nursing. The qualitative data identified a tuition assistance program and recognition on name badge as common incentives. RECOMMENDATIONS: Take the findings to an interprofessional focus group for further analysis, educate employees of the benefits of having MPNs at the bedside and discuss the results with the stakeholders.
Formal mentor toolkit
(Bryan College of Health Sciences, 2018-12) Baer, Nichole; Barker, Molle; Melcher, Candace R.
BACKGROUND: The nursing profession is plagued with a major nursing shortage due to the aging population of the nursing workforce, baby boomers and due to the increasing demands of the healthcare organizations. The turnover rate of new graduate nurses within the first year of employment only compounds this problem. Up to 50% of new graduate nurses change jobs during their initial year of employment, 13% contemplate leaving their job, and some leave the professional altogether (Boamah & Laschinger, 2015). Nurse residency programs (NRP) were found to decrease the 12 month turnover rate from 36% to 6.5% (Trepanier, Early, Ulrilich, & Cherry, 2012). In addition, the retention rate of new graduate nurses assigned to a mentor was 91% compared to non-mentored nurses with a retention rate of 66% (Schroyer, Zellers, & Abraham, 2016). PURPOSE: The purpose of this project was to focus on developing a toolkit to be utilized as a resource for implementing a formal mentor program to support the retention of new graduate nurses. The population of interest were new graduate nurses participating in the Nurse Residency Program at a Midwestern regional hospital. METHOD: Researchers reviewed literature that supports a formal mentor program. Based off of information obtained in the literature, the formal mentor program was developed. This proposal was then formally presented to key stakeholders, including the Chief Nursing Officer. RESULTS: After presenting the toolkit to the key stakeholders, dialogue took place that afforded the opportunity for further clarification and suggestions to take place. Recommendations from the stakeholders for various changes were made and notes were taken of their questions and recommendations. Key recommendations for strengthening the formal mentor program were: offer the mentor program to experienced nurses new to the organization as well as to the new graduate nurses; change the timing of the initiation of the program from 6 months to 12 months for the new graduate nurses; offer the formal mentor program to experienced nurses beginning just prior to their orientation ending; the mentor may need to be assigned to more than one mentee due to the volume of new hires or experienced nurses interested in participating in the program; the mentor/mentee would ideally be paired together from the same unit however if the volume of new hires outnumbered the qualified mentors, mentors from sister units could be assigned to the mentee. CONCLUSION: The results of the presentation of the formal mentor program to the key stakeholders was favorable. Additional collaboration to further develop the formal mentor program is necessary for further development and successful implementation.
A framework to standardize faculty development of interprofessional education
(Bryan College of Health Sciences, 2019-12-11) Kinnett, Katie; Francis, Lindsey; Kornfeld, Dixie; Wehrman, Kristi
The purpose of this capstone project was to create a framework to standardize the process of faculty development of Interprofessional Education (IPE). Background & Significance: Current research focuses on the learner and fails to address the educational needs of faculty with IPE. Standardized faculty development of IPE is essential due to faculty being taught in the traditional single-professional models. A lack of understanding of IPE exists in all aspects, making a framework imperative to create meaningful learning experiences for students. Methods: SMART objectives with Plan-Do-Study-Act (PDSA) cycles were utilized as follows: finding evidence-based IPE guidelines, framework building, and collaboration with an instructional design expert to solidify the framework presentation. Stakeholders within academia were found and provided insight into the use of a framework. Literature was reviewed and themes were selected as a guide for faculty development. The theoretical frameworks of Lewin’s Change Theory and the Transformational Learning Theory drove the construction of the framework. Results: The completed framework depicts how the themes intertwine with Lewin’s Change Theory and the Transformational Learning Theory to guide faculty development in a continuous process. Conclusion: The vision of the framework is to provide a standardized guide for development of faculty to increase the implementation of meaningful IPE learning activities into the curriculum.
Generational Diversity Among Registered Nurses in the Workplace: A Quality Improvement Project for Enhancing Communication and Collaboration
(Bryan College of Health Sciences, 2020-12-09) Weise, Jackie; Bernecker, Whitney
Purpose: The purpose of this quality improvement project was to enhance intergenerational communication and collaboration among staff RNs in the workplace. What are the strategies to enhance communication and collaboration among generationally diverse RNs? Literature Review: The RN workforce is currently comprised of three generational cohorts including baby boomers, millennials, and generation X. RNs from generation Z will soon be entering the workforce. Generational diversity influences many workplace outcomes including morale, commitment, and patient care. Generational diversity among RNs effects communication and collaboration in the workplace. The Dynamic Social-Ecological Model of Generational Identity in the Workplace identifies how differences in generational diversity can negatively impact workplace outcomes. Methods: A comparative correlation design was used to analyze three generational cohorts on six acute care hospital units. The units’ nursing directors served as stakeholders. The SMART objective was to identify ten strategies to improve communication and collaboration among staff RNs to foster an inclusive, intergenerational work environment. The Workplace Intergenerational Climate Scale (WICS) was utilized to collect data. Data were analyzed using descriptive and inferential statistics. The IRB determined this to be a quality improvement project. Results: The results guided the identification of strategies which included generational competence and sensitivity education, team building, reverse mentoring, embracing generational strengths, and building a culture supportive of generational diversity. The strategies were shared with the stakeholders and unit staff via posters. Conclusion: An implementation plan and timeline are necessary to incorporate the recommended strategies within the project’s setting.
Troubleshooting Vascular Access Device Selection
(Bryan College of Health Sciences, 2020-12-09) Badura, Nicole; Beil, Lindsay
Purpose: To educate registered nurses (RN) regarding the necessity for pre-assessment of risk factors, and importance of vascular access device (VAD) selection. Will providing this education to RNs, improve understanding of appropriate VAD selection? Literature Review: Identified knowledge gaps and patients presenting with co-morbidities and associated risk factors are affecting VAD selection, leading to inappropriate prescriptions from providers. Central lines (CL) are associated with central line associated bloodstream infections (CLABSI), leading to increased morbidity/mortality rates. Even with national initiatives created to improve safety and education regarding VAD selection, CLABSIs are still occurring. Three factors leading to complications with VADs (host factors, device factors, and provider factors) have been identified. Mandatory annual training on maintenance of VAD improves confidence and competence. The Plan, Do, Study, Act (PDSA) cycle provides a framework for developing, testing, implementing change and improvement in VAD selection. Methods: The setting for the QI project was general/progressive/critical care areas in an urban hospital. Project stakeholders were a Clinical Educator, and a Clinical Nurse Specialist. The RNs on selected units were given comprehensive VAD education on pre-assessment of risk factors, and importance of appropriate VAD selection. The participants completed a pre-test, and then completed a post-test following education, to determine understanding. The data were reviewed and analyzed. IRB reviewed the project and deemed it a quality improvement project. Results: The project question was supported by the outcomes, as evidence by, improved post education scores. It was determined that the location of the education session can be detrimental to the learning outcomes. Future testing considerations would include review of test question verbiage to be more succinct and unit directed. Conclusion: VAD selection education improved the knowledge of the RNs regarding appropriate VAD selection. Plan to disseminate education to all units, and commit to implementing annual education.
Using a Checklist as a Strategy to Reduce Errors During the Administration of High Alert Continuous Intravenous Medications
(Bryan College of Health Sciences, 2020-12-09) Gowan, Christine; Schwartz, Lindsay; Buchholtz, Abbi
Purpose: The purpose of this quality improvement project was to create a medication safety checklist for high alert medications (HAMs) to be used by nurses during any patient handoff, and to evaluate its effectiveness. Will the implementation of a checklist, to be completed at all nurse to nurse handoffs, improve patient safety by decreasing the risk of HAM errors compared to not using a checklist or other double check processes? Literature Review: Reason’s Swiss cheese model of accident causation likens failures that occur on human and systematic levels to a stack of Swiss cheese slices. Research supports that when nurses do not utilize double check systems to their full potential, errors occur and negatively impact patients. Utilizing a medication safety checklist can aid in the reduction of errors by adding an additional layer of defense. Methods: After IRB review of the quality improvement (QI) project the stakeholders granted permission to begin the project. The stakeholders were managers of two ICUs in the Midwest. A checklist and survey were provided to bedside nurses. The checklist was utilized for HAMs at all nurse handoffs. Nurses also answered a short survey regarding their experience with the checklist. Completed forms were kept in a secure folder. Results: Three errors were identified by the checklist. Results showed that 81.5% of participants felt that the checklist helped improve patient safety. In total, 96.2% of participants felt that the checklist was easy to use. Some felt that the checklist added to their workload. We recommend stakeholders implement the checklist into the current workflow. Stakeholders received results via email along with a visual aid for them to use at their discretion. Conclusions: The utilization of a checklist as a double check is a valuable tool to help reduce or prevent patient harm and aids in positive patient outcomes.
Workplace Attributes Leading to Job Satisfaction of the Bedside Nurse
(Bryan College of Health Sciences, 2020-12-09) Johnson, Stephanie; Speer, Katie
Purpose: The purpose of this quality improvement project is to better understand workplace attributes of selected units within an acute care hospital to provide recommended strategies for improving the workplace attributes as a way to promote nurses’ job satisfaction. The guiding question was “What are the attributes that promote nurses’ job satisfaction within the workplace?” Literature Review: Communication, relationships with physicians, and nursing involvement in decision making are workplace attributes discussed in the literature leading to job satisfaction. Nurses having autonomy and control over their work environment are also strong factors for satisfaction with the work environment. Methods: The project took place on both intensive care and progressive care units. The stakeholders were the nurse managers and directors of these units and the CNO of the organization. A Google Form was developed to administer the questionnaire and participants were invited via email. SMART objectives were created, partially met, with one being delayed. The PDSA framework relates to change theory in planning, implementing, and evaluating the project. Data were collected via the NWI-R as the instrument. The capstone project was reviewed by the IRB and deemed as a quality improvement project. Results: The outcome of this quality improvement project was to identify strategies as recommendations, which included implementing task forces for nurse's involvement in controlling costs, employee forums increased to bi-monthly, twice monthly informal CNO rounding, maintaining a culture of safety, and professional/career development opportunities with improved marketing. Recommendations were given via a flyer and presentation. Conclusion: The project's outcomes supported the guiding question, in that we learned work attributes that scored higher on job satisfaction, which were also supported in the literature. Initially, stakeholders should focus on the most influential recommendations provided and create SMART goals as a framework to implement strategies going forward.
Years of Nursing Experience and Resiliency During a Pandemic
(Bryan College of Health Sciences, 2020-12-09) Martin, Ginnie; Townsley, Karen
Purpose: This quality improvement project was conducted to understand resiliency of new nurses during the COVID19 pandemic. What is the self-reported resiliency of newly graduated nurses with 0-3 years of experience during the COVID19 pandemic? Literature Review: Nursing is a rewarding, often challenging, and at times emotionally draining profession. Stress in nursing can lead to burnout, nurse turnover, and potentially contribute to poor patient outcomes. Providing care within a pandemic can increase the stress. Literature shows the first year of practice is the most stressful in a nurse’s career, and nurse residency programs (NRP) are beneficial with the transition. Resiliency, defined as the “ability to thrive in the face of adversity”, is teachable and can provide nurses with emotional adaptability. Patricia Benner’s Novice to Expert Theory provides a theoretical framework which can be utilized to understand the nurse’s growth and development. Methods: NRP co-coordinators, as the stakeholders, provided permission to conduct this project within the NRP. The Connor-Davidson Resilience Scale (CD-RISC) was used. The CD-RISC assessed resiliency differences of nurses with less than one-year experience and nurses with 1-3 years of experience. After IRB review, data were collected and analyzed for 62 valid responses. Results: Nurses completed the survey with n=23 reporting having less than one-year experience and 39 reporting having 1-3 years of experience. The mean resiliency scores for nurses with less than one-year experience was 26.83 and nurses with 1-3 years of experience was 28.31. The results did not show a statistically significant difference. Conclusion: This data suggests that utilizing a resiliency scale and providing training to all nurses in the organization would be beneficial. This allows the individual the opportunity to see how they score regarding resiliency to identify areas of strength and potential areas for improvement.

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