Date of Graduation

Winter 12-17-2021

Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing and Health Professions




Executive Leader DNP

First Advisor

Dr. Elena Capella

Second Advisor

Dr. Jonalyn Wallace


Background: Primary care (PC) is increasingly the setting for affordable, coordinated, end-to-end patient care, with PC managers in charge of organizational performance. While PC managers are central to high-functioning teams, they often receive inadequate onboarding.

Local Problem: Primary care onboarding competes with other operational priorities and faces time constraints, lack of mentorship, and cost.

Context: At an integrated healthcare system, a need was identified to develop structured, role-specific onboarding for newly hired PC managers to improve knowledge and confidence to lead.

Interventions: Bauer’s Four Cs framework for onboarding guided the development of a manager onboarding program for 12 new PC managers. Content drew on best practices from the literature and was informed by the knowledge gap discovered through a needs assessment.

Outcome Measures: Knowledge, confidence to lead, and intent to stay were chosen to

assess the impact of onboarding on the competencies of new PC managers to be successful in their roles. The metrics were percent change from pre- to post-implementation. Data to evaluate outcomes were obtained from the pre- and post-intervention surveys.

Results: Confidence to lead increased 13% (t(21) = 2.33, p = .03); knowledge increased 29% ((t(21) = 2.94, p = .01). Intent to stay in the role did not show a significant increase.

Conclusions: Evidence from the literature and the project results suggest strong connections between structured onboarding practices for new managers and preparedness to lead high-functioning teams. Empirical research is needed to examine the implications of onboarding relative to hire date on intent to stay in the role.