Date of Graduation
Summer 8-8-2025
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
Dr. David Ainsworth, DNP, RN
Abstract
Abstract
Problem: A 2024 assessment at a 250‑bed Northern California medical center revealed that 76% of 16 inpatient nurse leaders met "high‑burnout" criteria on the Maslach Burnout Inventory, and leader turnover had climbed to 25%, more than triple national benchmarks, threatening patient care quality, financial stability, and alignment with Magnet® and employee engagement goals.
Context: Root causes included pandemic‑era promotions without development support, a task‑oriented leadership culture, and eroding psychological safety (Press Ganey engagement ≈ 30%). An integrative logic model positioned Watson's Caring Science as the theoretical base, Schön's Reflective Model for adaptive learning, and the Prosci ADKAR change framework to sequence individual behavior change, all consistent with IHI Joy-in-Work principles.
Interventions: Two targeted interventions delivered over 12 weeks: (1) a 120-minute Guided Meditation session embodying Watson's Caritas Processes 1 & 5, and (2) Reflective Modalities centered on Caritas Processes 2 & 4. Five discrete "changes to test" targeted centering, empathic communication, inclusive decision‑making, protected reflection, and leadership sustainability. Direct cost: US $18,259.
Measures: Outcome, proportion of leaders scoring ≥ 27 (high) on MBI emotional‑exhaustion. Process, workshop attendance, and Caritas Leader self‑ratings. Balancing, patient-safety events per 1,000 patient-days.
Results: Emotional exhaustion fell 32% (mean 32.4 → 22.0; p = .004; Cohen d = 1.98); depersonalization declined 28% (p = .007); personal accomplishment increased 15% (p = .012). High‑burnout prevalence dropped from 76 % to 44%. Attendance averaged 94%, and safety event rates were unchanged. Conservative cost‑avoidance modelling projected $933,200 in first‑year savings, yielding a 51:1 ROI.
Conclusion: A low-cost, theory-aligned program integrating Caring Science, mindfulness-based reflection, and ADKAR structured change rapidly reduced nurse leader burnout while safeguarding patient safety and delivering exceptional financial value. The curriculum framework and strong ROI support sustainability and scale‑up across service lines to advance the Quadruple Aim and leadership effectiveness.
Keywords: Nurse burnout, leadership effectiveness, healthy work environment, Magnet, Caring Science, mindfulness, reflective practice
Recommended Citation
Elliott, Matthew S., "Illuminating Leadership Excellence: An Evidence-Based QI Intervention Reigniting Nurse Leaders from Burnout to Brilliance Using Caring Science and Reflective Practice" (2025). Master's Projects and Capstones. 1929.
https://repository.usfca.edu/capstone/1929
