Date of Graduation

Fall 12-14-2018

Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing and Health Professions




Healthcare Systems Leadership DNP

First Advisor

Dr. Catherine Coleman

Second Advisor

Rev. Timothy Godfrey



Average hospital turnover rates in the US reached 18.2% in 2017. Turnover rates for registered nurses (RNs) were also at an all-time high of 16.8%. RN turnover can cost up to $61,100 per nurse resulting in the average hospital loss of $5.7 million per year (NSI, 2018). Employee engagement and job satisfaction levels are predictors of nursing turnover and patient outcomes and should be a top priority for nurse leaders. A disengaged workforce not only affects team morale and organizational spending, but it also impacts the quality of patient care. Multiple studies suggest that employee engagement is the number one variable linked to patient mortality (Kruse, 2015; Zwillinger & Huster, 2017). Therefore, a Nurse Manager Employee Engagement Toolkit (NMEET) was created and implemented over 18 months with the intent to mitigate low engagement levels, high rates, and unsustainable spending within an urban, academic organization.

Comparison of pre- and post-implementation data revealed significant improvements in employee engagement and team morale leading to a decrease in departmental turnover by 11.5%. Additionally, substantial cost savings are associated with increasing the size of the float pool as a safe staffing strategy to decrease the use of overtime and contract RNs. Successful implementation of the NMEET highlights the critical role nurse managers play in improving staff engagement through investing and empowering frontline staff while simultaneously creating a work environment that fosters high performing teams capable of achieving superior patient outcomes.

Keywords: engagement, turnover, job satisfaction, toolkit, nurse manager, float pool