Date of Graduation

Summer 8-4-2026

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Program

Kaiser cohort MSN capstone

First Advisor

Catherine Coleman, DNP, RN, CPHQ, CNL

Second Advisor

Sara Horton-Deutsch

Abstract

Problem

Childhood caries is a preventable public health issue disproportionately affecting the underserved. National guidelines recommend fluoride varnish (FV) application during well‑child visits. In California, fewer than 15% of children under age six received FV. In a pediatric primary care clinic, baseline performance was 11% in 2025.

Context

A six‑month quality improvement project was implemented. Key barriers included reduced team cohesion, workflow variability, unclear roles, and underutilized electronic health record (EHR) prompts.

Interventions

The change package standardized medical assistant–led workflows, activated EHR prompts, and provided targeted education. Leadership reinforcement through regular huddles supported adoption, consistency, and team engagement.

Measures

Outcome evaluation included baseline and comparative EHR audits (n=160). Qualitative feedback identified barriers, including lack of awareness, limited time, concern about multiple vaccines, and reliance on dental visits. Parents (n=50) reported 80% willingness for FV at future visits.

Results

FV application rates increased over six months, rising from 11%, culminating in June 2026 at a rate of 17%—exceeding the 16% project goal. Team building and trust building increased engagement.

Conclusions

Clinical nurse leaders (CNLs) can strengthen preventive care delivery. Attention to team morale unequivocally enhances readiness for systems-level change. Standardized processes, leadership engagement, and EHR prompting are essential to increasing FV rates and reducing missed opportunities. True transformation begins in the everyday relationships and work environments that CNLs foster and cultivate to improve patient and organizational outcomes. This quality improvement initiative reflects a meaningful expression of leadership philosophy that strengthens healthcare from the bottom up and from the inside out.

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