Date of Graduation

Fall 12-14-2018

Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing and Health Professions




Family Nurse Practitioner

First Advisor

Robin Buccheri

Second Advisor

Marjorie Barter


Problem: A medical center in an integrated health care system in Northern California has experienced high turnover for unit level leaders employed in an acute care setting. The role of unit level leaders (managers, assistant managers, and supervisors) in this organization is complex, often stressful, and includes 24/7 accountability. These leaders must simultaneously deliver on organizational goals, patient safety, quality, budgets, and staff satisfaction (Loveridge, 2017). Increasing resilience can help these leaders cope with stress and find joy in their work, making them less likely to leave their leadership positions (Hudgins, 2016).

Context: According to Loveridge, the turnover rates of nurse managers in the U.S. in 2010 was 8.3%, higher than that of senior leaders, chief nurse executives, and vice presidents (2017). The cost to replace a nurse manager can be as much as 75%-125% of their salary (Loveridge, 2017). Sources of fatigue for nurse managers that are related to high turnover have been identified as 24-hour accountability to an organization, visibility and responsiveness to staff, and interruptions in day-to-day operations. (Steege, Pinekenstein, Arsenault Knudsen, Rainbow, 2017).

Intervention: The intervention for this Doctor of Nursing Practice (DNP) project included the introduction and implementation of the Institute for Healthcare Improvement (IHI) framework for improving joy in work. This consisted of a 12-week education program offered by the IHI, called “Finding and Creating Joy in Work” which included biweekly video lectures and was facilitated in a peer group practice setting for unit level leaders. The focus of the program was to use the framework to help discover and improve the conditions that contribute to joy in the workplace.

Measures: The efficacy of the intervention was measured using two tools, the Conner-Davidson Resilience Scale and the Anticipated Turnover Scale. Both were given to participants prior to the intervention, and then again following program end date. The goal was to see whether there was an increase in resilience scores and a decrease in the anticipated turnover scores for unit level leaders. During the 3-month intervention, participants were also encouraged to identify and implement quality or staff engagement/improvements projects.

Results: There was an 18% decrease in the mean anticipated turnover scores following the program. This suggests that providing tools to help unit level leaders measure and track joy in their departments, could help reduce turnover. There was no measurable difference between mean pre and post-intervention resilience scores for unit level leaders who completed the IHI program.

Conclusions: Education in performance improvement methodologies using the IHI framework for improving joy in work, may keep unit level leaders in their roles longer. A longer term project needs to be conducted to determine if the IHI framework can increase resilience among unit level leaders. Also, a project that includes staff at all levels within an organization would be important in testing this framework.

Included in

Nursing Commons