Theses and Dissertations at Montana State University (MSU)
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Item Superintendent efficacy and addressing community needs(Montana State University - Bozeman, College of Education, Health & Human Development, 2024) Kirchner, Derek Lee; Chairperson, Graduate Committee: Tena VerslandThe purpose of this intrinsic case study was to explore how a self-efficacious superintendent mitigates the challenges of addressing community needs. In previous literature on community dissatisfaction, superintendents who have neglected the needs of community members have lost their jobs. Despite being trained for and required to demonstrate knowledge on ways to identify and address the needs of the school district community, many superintendents fall short and end up being removed from their positions by the school board and community. Self-Efficacy theory postulates that individuals with a high degree of efficacy for their jobs seek out and are more receptive to innovations within their workplaces. This research study utilized a document review of school board meeting minutes, public voting data, and superintendent correspondence to determine instances of community needs. This information was utilized to conduct semiformal interviews with a superintendent to explore strategies he used to address needs in the community. The results of the document revealed that dissatisfaction occurred around four events: the Cougar's Cave playground structure, the Economic Development District, the High School project, and COVID-19. The analysis of the interviews indicated that the superintendent employed three strategies to mitigate community dissatisfaction: Developed a Culture of Learning within the District, Involved the Community, and Built Relationships. The strategies in this research echo what has already been written regarding successful superintendent leadership. Conclusions drawn from this project include the idea that both the superintendent and the school board should research each other prior to offering and accepting employment in a district to ensure superintendent skillsets match district needs. A second conclusion is the superintendent should develop a strong relationship with the school board but should remain open to feedback and concerns from the community. A final conclusion drawn from the research is that the superintendent should selectively choose mentors and be receptive to their advice.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.Item A multisite case study of state policy and teacher perceptions of recruitment and retention in rural school districts impacted by the critical quality educator shortage(Montana State University - Bozeman, College of Education, Health & Human Development, 2020) Hancock, Hailey Suzanne; Chairperson, Graduate Committee: Christine Rogers StantonThe purpose of this qualitative multisite case study is to explore the history of school funding and policy in Montana K-12 schools with a focus on how the State legislature is or is not providing equality of educational opportunity. Because teachers are the most significant school-related factor on student performance, the analyses will focus on data involving recruiting and retaining highly qualified teachers in rural contexts. This case study occurs from 2004-2019 when school districts sued the State legislature in Columbia Falls v. State of Montana (2004/2005) for not providing an adequate education. The Montana legislature revised their school finance model and, while the State claims the funding is sufficient, Montana continues to face a critical quality educator shortage in rural communities. Since 74% of Montana schools identify as rural this is especially problematic. Critical place-conscious theory was applied to the multisite case study, which consists of five interconnected phases where the semi-structured interviews influence critical policy discourse analysis. The study focused on two rural school districts impacted by the educator shortage, identified as the Glacier and Yellowstone sites. Findings demonstrate that there is a disconnect between Montana policies addressing teacher recruitment and retention, and the reality of educators' professional lives. The unsustainable workloads of teachers, inadequate staffing, low-compensation, and unaffordable housing are all challenges faced by Montana teachers. Rurality is not the primary cause of these challenges rather these issues appear to be systemic. A major conclusion is that teacher attrition impacts the quality of education students receive therefore equality of opportunity does not exist between rural and non-rural schools in Montana. Local school districts are integrating place-conscious solutions to fill this opportunity gap such as teacherages and innovative scheduling, however, not all schools have the financial capacity or leadership to do so, therefore the Montana legislature has a responsibility to provide more funding to schools impacted by the critical quality educator shortage. Furthermore, a new framework, the Place-Conscious Social- Ecological Model, is suggested to create education policy that values Montana's rurality.Item The impact of a middle grade professional development school on teacher training and retention(Montana State University - Bozeman, College of Education, Health & Human Development, 2020) Stierman, Catherine Rowan; Chairperson, Graduate Committee: Michael BrodyTeacher preparation and retention are in a state of crisis. Just under 20% of all pre-service teachers will still be in the classroom four years after graduation (AACTE, 2018; Cowen, Goldhaber, Hayes & Theobald, 2016; Darling-Hammond, 2003; Ingersoll, Merrill & Stuckey, 2018; Latham & Vogt, 2007; NCES, 2016; NCTAF, 2003). The quality of training and the sense of self have been identified as the determining factors for persistence in the education profession. The research is very clear that professional development school (PDS) prepared teachers are significantly more likely to enter and to persist in the field. This case study focused on ten undergraduate education majors in a middle grade professional development school with a significantly higher than average retention in the field. Both qualitative and quantitative data were collected simultaneously. Sources included five inventories, twelve sets of interviews, and eleven reflections. It was determined that governance at both the university and middle school sites allowed the classroom teachers and professors to provide a curriculum that centered on the identification, practice, and internalization of effective educators through active learning and student-centered pedagogy. Three curricular practices were identified by the participants as being significant influences on their development and success as teachers: opportunities to see classroom teachers and professors model best practice, substantial time to practice their own skills, and a structure for reflection and processing of learning events.Item Design of a primary care advanced practice nursing fellowship(Montana State University - Bozeman, College of Nursing, 2019) Weber, Anna Katherine; Chairperson, Graduate Committee: Jennifer SofieNew graduate nurse practitioners (NPs) can find the transition between student and independent practitioner to be difficult. Residency and fellowship programs are becoming a popular option to help support NPs with this transition. The Institute of Medicine has called for support through residency and fellowship programs. These programs have shown positive outcomes including increased job satisfaction, retention, positive patient outcomes, and increased interprofessional collaboration. A hospital located in the northwestern United States is struggling with NP satisfaction and retention. Purpose: A graduate scholarly project was initiated to design a fellowship for NPs in the primary care setting in response to this problem. Methods: The American Nurses Credentialing Center Standards, National Nurse Practitioner Residency and Fellowship Training Consortium Standards, a current program at the Carolinas HealthCare System, and the National Organization of Nurse Practitioner Faculties Competency areas was used as a foundation to the design. Guidance used was Benner's Novice to Expert Theory. Results: A twelve-month program was designed that includes didactic learning sessions, primary care clinical experience, specialty area clinical experience, interprofessional teamwork, and structured evaluation. Intended outcomes of the project for the sponsoring organization are 1) retention of NPs for twelve months after completion of the program and 2) increased employee satisfaction. The graduate nursing student concluded that more input from current programs and increased participation from the sponsoring organization would have made this project more successful. Further research into the best practice for evaluation tools for personnel and participants in these types of programs would also strengthen the design. Foundation based on current accreditation standards helps to strengthen this design.Item The space between: the plight of rurally isolated, impoverished Montana school districts(Montana State University - Bozeman, College of Education, Health & Human Development, 2019) Patterson, Joshua Glenn; Chairperson, Graduate Committee: David HendersonDespite growing awareness of the teacher staffing crisis in rurally isolated, impoverished Montana school districts, little has been done to effectively address the issue. As opposed to a general lack of supply, current state and national research attribute the problem to challenges in teacher recruitment and retention. While many of these studies have identified factors associated with teacher staffing challenges, none have fully conveyed the essence of the struggle through the experiences of school leaders who endure the crisis. Therefore as revealed through the experience of eligible superintendents, the purpose of this qualitative study was to investigate teacher staffing challenges in rurally isolated, impoverished Montana school districts and the role of state school funding policy in the recruitment and retention of high quality teachers. Anchored by punctuated equilibrium social theory, the study's conceptual model provides a basis for multiple instrumental case studies. Investigative research began with two focus groups of eligible superintendents and was followed by multiple interviews with the superintendents of four representative case study school districts. Audio recordings of interviews were transcribed and reviewed using typological data analysis methods to identify semantic relationships, themes, and significant statements. Study trustworthiness was established through bracketing the researcher's personal experiences with teacher staffing challenges, thick description, peer review, member checking, and triangulation with school district related information and other state research. Findings indicate that current Montana school funding policy may exacerbate the staffing challenges experienced in these remote and poor districts as well as their organizational functioning.Item Rural nurse residency: promoting the nurse graduate transition to frontier critical access hospital(Montana State University - Bozeman, College of Nursing, 2018) Williams, Christine Dee; Chairperson, Graduate Committee: Polly PetersenPurpose/Aim: The purpose of this pilot project was to test the feasibility of a rural nurse residency program to support the new graduate nurse in their transition to the role of a professional rural nurse, resulting in increased retention. It was hypothesized that graduate nurses' function with increased competence as a nurse clinician in a critical access hospital (CAH) following participation in a rural nurse residency program and remain in practice in the rural healthcare setting. Organizing framework for this project focuses on Duchscher (2008) Process of Becoming: The Stages of New Graduate Professional Role Transition. Background: Current research demonstrates that graduate nurses are not fully prepared to transition from the role of student to nurse (Fink, Krugman, Casey, Goode, 2008). Molinari et al., (2008) found that graduate nurses do not have the ability to assess complex situations, develop flexible problem solving, and direct limited resources to manage patient care, all needed to serve as a rural generalist. Providing a new graduate with a residency transition-to-practice supports development of skills needed to function in the complex rural healthcare setting (Kulig et. al., 2015, Molinari et. al., 2008). Methods: A quantitative pilot project with survey methodology to measure intervention effectiveness. Rural Nurse Residency (RNR) meetings occurred monthly for 12-months, for four hours sessions. Curriculum is based on Quality and Safety Education for Nurses (QSEN) and the Institute of Medicine's (IOM) core competencies; focusing on civility, communication, conflict resolution, critical thinking, delegation, leadership, and prioritization. Graduate nurses work with a preceptor during the first six months of the RNR. Three evaluation tools were utilized: Hagerty-Patusky (1995) Sense of Belonging Instrument (SOBI) measuring nurse confidence, Schwirian Six-Dimensional Scale of Nursing Performance Measures, a self-reflection of skill competency and Organizational Commitment Questionnaire, measuring integration into the organization through commitment to organizational goals and values (Anderson, et al., 2012). Questionnaires were distributed to participants at program onset, month six and program conclusion. Results: The RNR pilot study started in November 2017 and concluded in October 2018. Participants learned from reflecting on personal experiences and gained group support, decreasing a sense of isolation (Duchscher, 2008). Participants reported feelings of support and growth, increased confidence after participation in the RNR at month six. Implications: RNR programs have potential to increase nurse retention and quality of care in rural healthcare settings.Item Program evaluation of a nurse-residency program(Montana State University - Bozeman, College of Nursing, 2018) Hastings, Deanna Dawn; Chairperson, Graduate Committee: Susan LuparellWhile the number of graduates from schools of nursing is increasing, there is a national trend that shows they are leaving the profession at alarming rates. This problem could potentially contribute to decreased patient outcomes and increased costs to facilities as they are continuously recruiting and training new nurses. Furthermore, research suggests that the transition to practice is a stressful period, and new graduates who receive support and guidance through nurse-residency programs tend to have higher satisfaction rates, deliver better patient care, and have lower turnover rates. Therefore, the purpose of this project was to evaluate the nurse-residency program in a local, level-two trauma center in rural central Montana that can serve up to 34,000 patients a year. A convenience sample of 13 registered nurses who completed the nurse-residency program or who were currently enrolled in the program and graduated within a year of beginning the residency program were surveyed using the Casey-Fink Graduate Nurse Experience Survey (New Graduate Survey). Also, a convenience sample of 41 staff members of the local emergency department, which included registered nursing staff who didn't participate in the nurse-residency program, operations specialists, physicians, and paramedics, were given an adapted Casey-Fink Graduate Nurse Experience Survey to evaluate their perception of the new graduates' readiness to practice. Project results indicate that new graduates who participated in the program tend to be more confident, the nurse-residency program is meeting the needs of the new graduates, and retention rates of the new graduates has increased since the inception of the program. Facilities and management can incorporate these findings into developing and maintaining nurse-residency programs in order to improve patient outcomes and new-graduate satisfaction and retention rates.Item Best practice components for nursing new graduate residency programs: an integrative review of the literature(Montana State University - Bozeman, College of Nursing, 2018) Wacker Happel, Amanda May; Chairperson, Graduate Committee: Susan LuparellThe need for an effective transition to practice program, such as nurse residency programs (NRPs), has been documented for over 80 years (Townsend, 1931 as cited in Spector et al., 2015). Anderson, Hair, and Todero (2012) stress how new graduate registered nurses (RNs) face high patient acuity and complex situations, nursing shortages, high turnover, burnout, excessive overtime demands, reduced new RN orientations, and heavy use of agency/traveling nurses to fill gaps (Joint Commission on Accreditation of Healthcare Organization, 2002; Jones & Gates, 2007 as cited by Anderson et al., 2012). Not only does this turnover negatively affect morale and job satisfaction, it's also very expensive with the estimated cost to replace these nurses ranging from $49,000 to $92,000 per nurse (Kram & Wilson, 2016). NRPs have been recommended to combat turnover and provide support during the transition into professional practice (Benner, Sutphen, Leonard, & Day, 2010; IOM 2011; The Joint Commission, 2002 as cited by Spector et al., 2015; Cochran, 2017). However, despite these recommendations, there continues to be a lack of comprehensive, evidence-based NRPs offered by employers (Spector, et al., 2015). The purpose of this integrative review of literature was to explore the best practice components of NRPs. This integrative review was performed by mining relevant literature from predetermined databases and all reference lists of the selected literature. A total of 13 publications met the predetermined inclusion criteria. After reviewing how different factors affect the transition of new graduates, it was concluded that an NRP that was based on a national model or developed internally in congruence with national models would provide best chance for a successful transition for new graduates. This model would include an adaptive, evidence-based curriculum that is customized to the patient populations and unit specifics, a program length of at least 12 months, and training and careful selection of preceptors and mentors. Additionally, it is recommended to that NRP staff have an awareness of differences in new graduate ADN and BSN preparedness and skill sets and adapt the NRP as needed to accommodate both cohorts.Item An investigation of factors related to teacher retention in small rural school districts in Montana(Montana State University - Bozeman, College of Education, Health & Human Development, 2002) Davis, Marsha Smith