Date of Graduation

Winter 12-13-2019

Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing and Health Professions




Executive Leader DNP

First Advisor

Dr. Mary Lynne Knighten

Second Advisor

Dr. K.T. Waxman


In nursing leadership, defining a culture of accountability is pivotal to ensure patient safety and achieve optimal patient outcomes. Nurse leaders play a significant role in transforming the professional environment, work culture, and professional behavior to deliver the highest-quality patient care. Often, nurse leaders are challenged in developing workplace environments and structures that encourage professional autonomy, advocacy, and culture climates as well as in motivating nursing staff to feel engaged. Despite an abundance of evidence underscoring the importance of staff engagement, a Gallup study revealed that only 30% of U.S. employees and 13% of employees worldwide are engaged in their work, while 26% are considered actively disengaged (Berson, 2015; Beck & Harter, 2015).

Nurse engagement degenerates in a stagnant environment, posing a major threat to nurses themselves, patients, and the health care organization. Literature supports the notion that ineffective leader–follower exchange, among other high stressors, in an organization increases nurse burnout (Crawford & Daniels, 2014). Nurse leaders heavily influence subordinate productivity and professional culture engagement through the development of valuable and exemplary leadership practices that target nurse staff empowerment, transformational culture climate, and executive engagement. Therefore, a leadership toolkit based on the Mile One framework was developed over 18 months with the purpose of improving leadership influence over professional practice and cultural environments and reducing low employee engagement levels. This toolkit was derived from Dr. Jeffrey Adams’ Model of Interrelationship of Leadership, Environments, and Outcomes for Nurse Executives and was created for experienced nurse leaders and new aspiring nurse leaders.

Comparison of pre- and post-implementation data revealed a significant change in perceived influence and the acquisition of new-found knowledge about the Mile One leadership framework. Additionally, cost savings are associated with the decrease of nurse leader turnover when hospital organizations offer developmental strategies for new or aspiring nurse leaders. Successful implementation of the Mile One Leadership Simulation Toolkit highlights the critical role nurse leaders assume in improving empowerment and staff engagement while fostering a high-performing environment and team capable of achieving superior patient care outcomes.

Keywords: Leadership development, model of interrelationship, professional practice work environment, nurse leader, nurse leader burnout, nurse leader retention, Mile One, triple aim, quadruple aim, professional development, nurse leader influence

Included in

Nursing Commons