Theses and Dissertations at Montana State University (MSU)
Permanent URI for this collectionhttps://scholarworks.montana.edu/handle/1/733
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Item Accreditation of a Nurse Residency Program(Montana State University - Bozeman, College of Nursing, 2024-05) Belt, JenniferBackground. This quality improvement project proposal focuses on creating a pathway to ANCC PTAP accreditation for the nurse residency program at a 99-bed hospital in Montana. The proposal aims to gain key stakeholder engagement and support for anticipated program changes. Local Problem. Following the COVID-19 pandemic, high turnover among nursing staff highlights the need for quality onboarding and retention of newly graduated nurses. Addressing this problem requires the implementation of a standardized and evidence-based nurse residency program to improve nurse satisfaction and decrease 1-year nurse turnover. Methods. A nurse residency program steering committee, stakeholder survey, and gap analysis tool were utilized to evaluate the current state of the program and inform change satisfactory of ANCC-PTAP accreditation requirements. SMART goals were implemented to establish baseline outcome data, set outcome goals, and track program progress over time. Interventions. Anticipated program changes were addressed including, but not limited to, the revision of the preceptor program, the creation of a mentorship program, the development of a content revision policy, additional NPD practitioner training, the inclusion of more competency-based learning activities, and the creation of a newly licensed nurse onboarding pathway.Item Peripheral Intravenous Catheter Compliance in the Acute Care Setting(Montana State University - Bozeman, College of Nursing, 2024-05) Lee, Mandilynn ReneeThe intent of this quality improvement clinical project aimed to improve peripheral intravenous catheter (PIV) compliance and reduce poor patient outcomes on Unit B. Currently, there is a lack of compliance with PIV standards, poor documentation, and no data collection for closer monitoring. The Model of Improvement and establishing SMART goals, with subsequent PDSA cycles was used as the premise framework for this quality improvement project. To establish PIV knowledge of the initial PDSA cycle, the use of a single page questionnaire and education sessions interventions was proposed. In the acute care population, reducing PIV complications and maintaining continual focus on improvement measures, can directly impact a patient’s length of stay, and be a cost saving measure for the facility.Item Nurse Residency Program: Road to Accreditation with Distinction(Montana State University - Bozeman, College of Nursing, 2024-05) Leese, MirandaThe purpose of this project was to help Hospital Z’s nurse residency program meet the American Nurses Credentialing Center (ANCC) practice transition accreditation program (PTAP) with distinction criteria by earning ANCC nursing continuing professional development (NCPD) contact hours for the didactic curriculum classes. Hospital Z’s entire nurse residency program was ANCC PTAP accredited, but the program must reapply for this accreditation in 2024. This project aimed to help the residency program earn ANCC PTAP accreditation with distinction, showing a commitment to excellence, evidence-based practice, and quality improvement initiatives by updating the didactic curriculum to meet ANCC NCPD criteria. Without reevaluating the program, Hospital Z risked decreased nurse recruitment into the program and increased nurse turnover due to difficulties transitioning into professional nursing practice. Utilizing the Donabedian Quality Improvement Framework, the current residency program’s structure, processes, and outcomes were assessed to identify areas that prevented the program from meeting ANCC NCPD criteria. Following the direction of this author and the ANCC NCPD expert at Hospital Z, the residency coordinators started process changes to move toward ANCC NCPD accreditation. The residency coordinators planned to assess resident confidence, competence, and retention after implementation of the new program. Once the didactic curriculum meets ANCC NCPD criteria for contact hours, the residency program coordinators could highlight this achievement in their 2024 application for PTAP accreditation with distinction. Earning ANCC PTAP accreditation with distinction is the highest honor for a residency program and could increase national recognition of the program, draw more qualified applicants, and increase funding for the program.Item Use of Information Dispensing in the Emergency Department to Improve Patient Satisfaction and Reduce Leave-Without-Treatment Rates: A Quality Improvement Project(Montana State University - Bozeman, College of Nursing, 2024-05) McIntosh, Delaney M.Ineffective communication between healthcare professionals and patients results in decreased patient perceptions regarding the quality of care received and contributes to reduced patient satisfaction, negative patient care outcomes, and decreased compliance with treatment recommendations. A microsystem assessment completed within a rural region trauma transfer facility identified a need for improved communication between clinicians and patients to improve patient satisfaction. Information dispensing is a form of intentional knowledge sharing between healthcare professionals and patients used to proactively engage patients and improve patient satisfaction. Review of the literature identified contributing factors to patients who sought care in the emergency department (ED) and reported low patient satisfaction or left-without-treatment (LWOT) such as inadequate communication, unmet expectations, and negative patient-clinician interactions. The literature supported the use of a patient-information-leaflet (PIL) in the ED as a sustainable and cost-effective method to communicate commonly sought information requested by patients to improve patient satisfaction and reduce LWOT rates.Item Nursing Mentorship in an Associate of Science Registered Nursing Program(Montana State University - Bozeman, College of Nursing, 2024-05) Senn, LauraRigorous nursing school programs and the transition to nursing practice can be difficult for nursing students leading to attrition from nursing school and rapid burnout in the field of nursing. Mentorship programs have been proven to increase student abilities and confidence leading to successful nursing careers. This quality improvement project proposes to use the Plan Do Study Act framework to research and design a nurse-to-student mentorship program for associate registered nursing students. Nursing school mentorship programs have demonstrated a wide variety of benefits for all participants and involvement in these programs leads to future success as a nurse. This mentorship program aims to establish a supportive nursing community to increase nursing school retention as well as job satisfaction and longevity for recently graduated nursing students.Item Integration of a Perinatal Specialty Curriculum into a PTAP Accredited Nurse Residency Program(Montana State University - Bozeman, College of Nursing, 2024-05) Sweet, TeresaBackground. Nurse residency programs including the one at a regional Montana healthcare system play a crucial role in supporting new graduate nurses during transition to independent practice, enhancing retention rates, and fostering organizational commitment. The predominant focus of these programs lies in medical/surgical inpatient nursing. While this approach is justifiable due to the substantial representation of med/surg nurses in the workforce, it often neglects the unique needs of specialty nurses working in pediatrics, NICU, and perinatal services. Local Problem. Despite the documented success of nurse residency programs, one-year turnover rates persistently outpace other categories. RN turnover rates within the first year remain stagnant. At this facility, this turnover disproportionately impacts perinatal specialty nurses, constituting up to 83.3% of their turnover. Methods. This quality improvement project proposes the integration of perinatal specialty curriculum into an existing PTAP (Practice Transition Accreditation Program) accredited nurse residency program. By incorporating evidence-based practices, tailored content, and specialized training modules, we aim to address the unique challenges faced by perinatal nurses. Interventions. Interventions will include curriculum enhancement and simulation training. We will develop and incorporate perinatal-specific modules within the existing nurse residency curriculum. These modules will cover topics such as neonatal care, maternal health, and perinatal complications. High-fidelity simulations will allow nurses to practice critical scenarios encountered in perinatal care, enhancing their confidence and competence. Results. We anticipate that the integration of perinatal specialty curriculum will lead to improved job satisfaction, reduced turnover rates, and enhanced patient outcomes. By addressing the unique needs of perinatal nurses, we aim to create a more resilient and committed nursing workforce. Conclusion. The proposed integration represents a strategic investment in the professional development of perinatal nurses. By fostering their expertise and confidence, we contribute to better patient care and organizational stability.Item Addressing Communication Challenges Related to Nursing Unit Design(Montana State University - Bozeman, College of Nursing, 2024-05) Thorson, Hannah L.When nurses transition from a centralized nursing unit to a decentralized nursing unit, significant workflow changes can occur. A literature review identified four significant themes related to the transition to a decentralized unit. These themes are challenges with collaboration and teamwork, decreased nurse work efficiency, improvement to patient outcomes, and the importance of nurses’ role in departmental design. Additionally, literature related to the efficacy of electronic communication systems for bedside nursing staff was reviewed. The aim of this scholarly project is to propose a quality improvement intervention to increase nurse usage of clinical phones in an intermediate care unit (IMCU) to help with communication challenges caused by the transition to a decentralized nursing unit. By improving communication through use of the phones, nurses will be able to deliver care more efficiently and enhance communication with other members of the multidisciplinary care team. This quality improvement project falls within the scope of the Clinical Nurse Leader, and has the potential to improve job satisfaction for nurses, as well as provide a safer care environment for patients.Item Chronic Pain Management, Opioid Tapering Guideline(Montana State University - Bozeman, College of Nursing, 2024-05) Wheeler, Madisen M.Chronic pain is an ongoing issue facing many Americans and individuals globally. Patients have historically been prescribed opiates and narcotics as a common care plan to help manage the chronic pain that they are experiencing. Recent guideline changes to the CDC’s recommendation on opioid prescribing, has had a monumental impact on chronic pain and chronic care management patients. Many patients in a rural access facility in the United States, are discontinued from their opioid pain medications, with no taper, leading to negative and poor health outcomes not only for the patient, but for the community.Item Fostering nursing student resilience(Montana State University - Bozeman, College of Nursing, 2023) Marquardt, Gina Nicole; Chairperson, Graduate Committee: Sandra KuntzThe purpose of this quality improvement project was to identify components of resiliency and create a solution to develop senior-level nursing student resilience. Assessment of Location X nursing school highlighted the need to identify components, tools, and measures of seniorlevel nursing student resiliency. The American Association of Colleges of Nursing (AACN) cites the importance of the development of nursing student wellbeing and resilience in the 2021 Essentials Domain 10 titled Personal, Professional and Leadership Development. The AACN further advocated for resiliency development during a 2020 Call to Action of United States nursing programs to promote and create a culture of wellness and resiliency among nursing students. The "Thriving in Nursing School" workshop was developed as a solution to equip students with the necessary tools, practices, and skills to develop resilience. The workshop consists of five evidence-based components: relaxation strategies, coping techniques, communication skills for problem solving, community and university resources available, and faculty mentorship. Formal focus and education about resilience has the potential to increase resiliency skills and was measured using the Connor-Davidson Resilience Scale (CD-RISC-10). It was hypothesized that resiliency-development quality improvement implementation will contribute to further development of nursing students' resiliency skills to meet the demands of the nursing profession. Through a focus on student wellbeing and resiliency, this project has the potential to increase student success and improve skills to thrive in a rigorous education program. This quality improvement project was implemented to gather data and analyze workshop efficacy.Item Impact of nurse residency programs on new graduate nurse retention outcomes: an integrative review(Montana State University - Bozeman, College of Nursing, 2023) Evans Nero, Tory Rose; Chairperson, Graduate Committee: Sandra KuntzProblem/Purpose: New graduate nurses are essential employees. Given the nationwide nursing shortage and the turmoil caused by the COVID-19 pandemic, there is a need to focus on new nurses' transition to practice. The transition from an academic setting into real-life practice is often stressful; therefore, nursing organizations have shifted their focus to emphasize new nurse satisfaction, support, and retention through the implementation of nurse residency programs. Nurse residency programs are hospital-implemented programs lasting about a year, and can vary in format, length, and structure. The programs aim to support new nurses' growth in essential skills like critical thinking, prioritization, and delegation. The purpose of this study was to conduct an integrative literature review to identify and evaluate the influence that nurse residency programs have on new graduate nurse attrition and retention outcomes. Procedure/Methods: Electronic database search of CINAHL, PubMed, and Web of Science discovered studies completed in the United States from 2017 to 2022. English-language articles were selected and reviewed for inclusion of registered nurses in an acute care setting that addressed new graduate nurses and intent to leave (attrition or retention) as a primary or secondary measure. Twelve articles met the inclusion criteria. The studies were evaluated for quality using Whittemore and Knafl's (2005) data analysis process. The application of Benner's Novice to Expert (1982) nursing theory provided the framework for the transitional experiences of new nurses. Results: Evidence supports new nurses participating in nurse residency programs experience positive outcomes, including increased confidence, social support, and decreased turnover rates. Workplace challenges and personal stressors were found to negatively impact turnover. Communication, recognition, rewards, and preceptor/mentor support positively influenced retention for at least a year, which provided hospitals with break-even to positive return on investment. Conclusions: New graduate nurses require time to grow and learn during the first year of practice. Three new phases of the novice nurse transition, supported by nurse residency programs, are proposed to enhance the expansion of Benner's theoretical model. The major thematic findings and improved retention rates demonstrate the need for resources and structured support encompassed within nurse residency programs.