Date of Graduation

Fall 12-11-2020

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions

First Advisor

Dr. Cathy Coleman


Problem: The healthcare industry suffers from a high level of burnout and unhealthy work environments, which has been heightened by the COVID-19 pandemic. The consequences of burnout may be expressed in both individuals and teams as a lack of caring, disengagement, incivility, and staff turnover.

Context: One department in an integrated healthcare organization displayed a pattern of annual low employee engagement scores and alleged workplace bullying. Team members also observed that employees failed to speak up when experiencing incivility. The Clinical Nurse Leader (CNL) student determined that an improvement initiative was needed to create a culture of caring to improve team cohesion and resilience and potentially reduce burnout and prevent incivility. As described by Watson (2012) and Perlo et al. (2017), healthy work environments include intentional change behaviors that promote mutual caring, positive values, trustworthiness, loving-kindness, and self-reflection.

Intervention: To improve the team dynamics and vitality, a new 13-week program (From Team Huddle to Team Cuddle, a.k.a. Team Cuddles) was created and implemented. The Team Cuddles program was guided by evidence-based practices to cultivate a positive work environment and culture of caring to support individuals and the team. Each weekly session included Caring Science practices and HeartMath exercises.

Measures: Quantitative and qualitative measures were assessed. The primary outcome measures included overall employee attendance and engagement. The process measures evaluated participation, engagement, and improvement in several multi-dimensional surveys. Qualitative themes were captured through direct observation and open-ended survey questions during implementation.

Results: The improvement project recruited 18 volunteer team members to participate. The pre-intervention survey response rate was low (16%); however, there was a significant increase to 50% in the post-intervention surveys. The final survey results showed a high degree of improvement in caring, team cohesion, and to connect with others; in alignment with some of the common themes observed. A majority of responders wanted the program to continue.

Conclusions: Leadership must pay close attention to the signs and symptoms of burnout at all levels of the organization to foster healthy work environments. Creating and sustaining a culture of caring is multifaceted and requires leadership support. Team interventions that are intentionally implemented and based on evidence from Caring Science are vital. When team huddles are transformed into team cuddles, they should improve employee resilience, self-compassion, and joy in work.