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

Dr. Elena Capella

Second Advisor

Dr. Nancy Taquino



Problem: Declining registered nurse (RN) engagement in the maternal child health (MCH) department, despite improvements in RN staffing, some reductions in nurse-patient ratios, the addition of support staff resources, and a focus on quality and safety.

Context: The project setting is an MCH department of a 184-bed community hospital, part of a large national organization, serving a diverse population in Northern California. The initial stakeholders included RNs, managers, and assistant managers; the team was later expanded as the project developed (see Appendix A).

Intervention: The original aim of this project was to improve nurse engagement among frontline nurses through the implementation of a shared governance model. Shared governance, consistently recognized in the literature to positively affect nurse engagement and level organizational hierarchies, gives voice to RNs and increases RN involvement in decision making, impacting their practice and their work environment. As the project evolved, so too did it’s aim. Patient safety was a critical driver for the modification of the project. The revision laid a critical foundation for the future of shared governance by improving teamwork and communication among nurses, management, and providers using TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety).

Measures: The TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ) provided insight into the department’s culture and guidance for the development of the curriculum. The questionnaire is comprised of 39 questions, including three demographic questions and one free-text question. The T-TPQ employs a Likert scale, with anchors ranging from strongly agree to strongly disagree (see Appendix B). The goal for the project was to train 95% of the team in TeamSTEPPS to improve communication and teamwork, as evidenced by a 5% increase in strongly agree and agree responses on the post-training T-TPQ. See Appendix C for a breakdown of the targeted team by role.

Results: There were 166 respondents for the pre-training T-TPQ survey (see Appendix D). The TeamSTEPPS training goal was to train 95% of team members; the goal was met with 94.5% of team members trained. Of those trained, 90.5% completed the post-training course evaluation. Before implementation, less than 40% of participants scored their knowledge of TeamSTEPPS as very good or excellent, after implementation, 85% scored their post-training knowledge as very good or excellent. Overall, there was a 40% increase in excellent and very good responses. The plan to complete post-implementation T-TPQ six months after implementation was delayed due to a leadership decision to wait until People Pulse results were received. As such, the post-implementation T-TPQ data will not be available until the end of the first quarter of 2019.

Conclusions: While the post-implementation survey data are not available, there are indications of the project’s success. The post-training evaluations indicated the training significantly improved the knowledge level of participants (see Appendix E). Additionally, activities in the department aimed at sustaining the use of the TeamSTEPPS tools and strategies are evident six months post-training and have been embedded in department processes, including critical events debriefings; there is also evidence of ongoing commitment with the development and regular engagement of the steering committee and charter.

Included in

Nursing Commons