Date of Graduation

Fall 12-14-2018

Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing and Health Professions


Executive Leader DNP

First Advisor

Marjorie Barter

Second Advisor

Lisa Cowan



Workplace stress and burnout consistently rank among the highest concerns in surveys of caregivers. A gap analysis was conducted among a group of patient care coordinators and medical social workers. The gap analysis identified a need for tools to address stress, feelings of being overworked, and irritability.


The setting is an acute care trauma facility providing care to general medical–surgical adult patients, cardiac care, pediatrics, and maternal child care. This facility exists within a larger integrated health care system, consisting of more than 20 acute care facilities in Northern California. The participants were patient care coordinators and medical social workers.


Each participant received one 2-hour education session describing the usage of the Quick Coherence® technique (HeartMath®, 2017). In addition, four 15-minute one-on-one coaching sessions over 8 weeks were offered to each participant to support after the 2 hour educational session. The usage of the new tool was reinforced through leader-led usage in huddles and staff meetings.


This improvement project relied on a plan-do-study-act (PDSA) design, utilizing a group of 32 patient care coordinator registered nurses and medical social workers. Blinded participants were asked to complete a pre- and post-intervention Personal and Organizational Quality Assessment – Revised 4 (POQA-R4) questionnaire which measures four primary scales: emotional vitality, emotional stress, organizational stress, and physical stress.


Among the primary scales, positive shifts were identified in emotional vitality (18%), emotional stress (28%), organizational stress (38%), and physical stress (39%). Intention to quit was reduced by 26%.


This evidence-based project was successful in meeting its aim of reducing stress and increasing staff resilience. The personal nature of the phenomena attempting to affect, stress, which is both personal and broad, created unique challenges. The key findings for success were: significant consideration for appreciation of the readiness level for the participants, creating a clear personal value proposition, and a commitment by the organization to support the time for the practice of the intervention. In the case of this project, the key reasons for its success were the minimal time necessary to train, and efforts to increase the desire to participate, as well as ongoing support through one-to-one coaching and support for practice in a collective setting with peers. Lastly, the choice of the tool, Quick Coherence®, contributed to the success of this project because it could be engaged in the moment of the stress trigger without others being aware. The same tool could also be used to build a reservoir of resilience against both personal and professional stress triggers.


Techniques to reduce stress and exhaustion for employees

Included in

Nursing Commons