Date of Graduation

Fall 12-13-2019

Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing and Health Professions




Executive Leader DNP

First Advisor

Dr. Juli Maxworthy

Second Advisor

Dr. Elena Capella


These are challenging times for nurse leaders. Over the last decade, debates on healthcare reform have focused on the cost of care in the United States. This discussion has placed increasing pressure on nurse leaders to operate organizations that are more efficient, while improving quality and patient outcomes.

The practice of commanding and directive leadership has never been effective long term. Nurses want leaders to make sense of a situation and explain the why. With the growing trend toward hospital reimbursement for performance measures that are nurse-driven and informed consumers with higher expectations than ever before, it is vital that nurse leaders help nurses reconnect to their purpose in order to obtain these goals.

A large, integrated, not-for-profit healthcare system in the Northern California (NCAL) region witnessed a decrease in their Hospital Compare Assessment of Healthcare Providers and Systems (HCAHPS) summary star rating. Despite the significant financial investments to improve patient satisfaction, this healthcare system was not seeing the benefits.

The intent of this project was to actualize Jean Watson’s human caring theory, support care experience best practices that promote patient satisfaction, and transform cultural norms that move the caring theory from a conceptual level to an operational level in a small urban hospital. “It is hoped that some level of this work will help us all, in the caring-healing profession, to remember who we are and why we have come here to do this work in the world” (Watson, 2008, p. 41). Outcomes were an improvement in summary star of 2.8 to 3.1 within three months of implementation of this project within the identified facility and sustained for 15 months, despite significant turnover in nursing leadership. Next steps will be to spread this project region-wide to continue to improve the organizational overall summary star rating.

Included in

Nursing Commons