Sample Capstone (DNP) project paper

How Does Organizational Culture Impact RN Engagement

Abstract

Lack of RN engagement in the acute care setting can result in poor staffing, nursing
shortages, increased stress levels for nurses and decreased morale. When nurses are not
engaged in their work setting, quality of care suffers. A wide range of literature focuses
on the importance of RN engagement; however, few health care organizations have taken
the initiative to implement programs that foster RN engagement, demonstrating a gap in
practice. This study examined the relationship between the levels of RN engagement and
their perceptions of their organizational culture. Kolcaba’s humanistic approach to
meeting the needs of RN staff was used to guide the study by recognizing that when
nurses’ needs are met, a culture of positive interactions between nurses and patients
enhances the quality of care delivered. The project question addressed existing levels of
RN engagement and perceptions of organizational culture in a small community hospital
in New York. All full-time registered nurses employed at the organization completed the
2 surveys used for this qualitative, exploratory project. RN engagement was measured
using the NDNQI RN engagement survey in combination with an organizational driven
interim survey. Data were explored for patterns and the project results indicated that
quality of care improved when nurses were engaged in hospital affairs, staffing, and
resource adequacy. Social change is impacted when a commitment to RN engagement is
established and the engaged caregivers influence improvements in quality of care and
patient care outcomes.

A Proposal for the Implementation of a Registered Nurse Engagement Program
Organizations
by
Veronica Ruffin-Ellis
MS, The College of New Rochelle, 2010
BS, The College of New Rochelle, 2005
Project Submitted in Partial Fulfillment
Of the Requirements for the Degree of
Doctor of Nursing Practice
College of Health Sciences
Walden University
May 2017

Dedication

Jeanette, Blanche and Sharon, you are the makings of me! To my husband Eric,
you have always encouraged me to soar. Donnice, my baby girl, you have always been
the wind beneath my wings. Elice, I could not ask for a prettier princess who has such a
big heart. Jaylin, you are an old soul that constantly reminds me that as a parent, I must
demonstrate role model behavior. I hope my journey inspires my children, nieces and
nephews to always pray, have faith, dream big and work hard knowing…GOD will do
the rest!

Acknowledgments

To my sisters, my “sister girlz”, and my brothers, for appreciating me, and the
work that I do. There are no words that can adequately describe your place in my heart.
To Thelma Green and Johnny Mae Stokes, you were my foundational rocks!
To my Calvary Hospital family, YOU taught me how to be a leader. To my
dedicated 6th floor team, thank you for your commitment to caring for others with your
heart and soul. You’ve inspired my ability to achieve this lifetime dream.
To my fellow DNP students, I’ve learned so much from you all; I appreciate your
knowledge and support when this journey seemed long.
To Dr. Dana Leach, every time I think of those moments when I was going left,
you steered me right with your patience, kind words, encouraging tone (even if it was via
email). I am overwhelmed with gratitude and appreciation for having you by my side,
holding me up and reminding me that, I could do this!
In addition, I want to thank Kathy Webster, Marie Galant & the NYPHVH
Nursing Education team, Alice Corbett and Dr. Tallier for their support in my practicum
environment. Kathy Geaney and the 4 south team, your unwavering support is priceless.

Table of Contents

Section 1: Nature of the Project ……………………………………………………………………………… 1
Introduction ……………………………………………………………………………………………………… 1
Problem Statement ……………………………………………………………………………………………. 1
Purpose Statement …………………………………………………………………………………………….. 2
Nature of the Doctoral Project ……………………………………………………………………………. 2
Guiding, Practice, and Research Questions ………………………………………………………….. 3
Significance of the Project …………………………………………………………………………………. 5
Summary………………………………………………………………………………..6
Section 2: Background and Context ……………………………………………………………………….. 8
Concepts, Models, and Theories …………………………………………………………………………. 8
Relevance to Nursing……………………………………………………………………9
Local Background and Context…………………………………………………………9
Role of the DNP Student………………………………………………………………10
Section 3: Collection and Analysis of Evidence ……………………………………………………… 12
Introduction ……………………………………………………………………………………………………. 12
Practice-Focused Question……………………………………………………………………………….. 13
Sources of Evidence ………………………………………………………………………………………… 14
Analysis and Synthesis ……………………………………………………………………………………. 15
Summary ……………………………………………………………………………………………………….. 16
Section 4: Findings and Recommendations ……………………………………………………………. 17
Introduction ……………………………………………………………………………………………………. 17
Findings and Implications ………………………………………………………………………………… 17
Recommendations …………………………………………………………………………………………… 18
Strengths and Limitations of the Project …………………………………………………………….. 18
Section 5: Dissemination Plan……………………………………………………………20
Analysis of Self………………………………………………………….……………..21
Summary……………………………………………………………………………….22
References………………………………………………………………………………..24
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Section 1: Nature of the Project

Introduction

From the bedside, outpatient areas, in academia, the board rooms, and in policy forums, it
is essential for Registered Nurses (RN) to be engaged in order for health care to be successful
(Bodenheimer & Grumbach, 2012). The concept of engagement in health care has developed
over the past decade. Keeping employees engaged in their roles is essential to the success of any
organization (Bakker & Demerouti, 2008). Health care reform and the Centers for Medicare and
Medicaid Services have mandated health care organizations to provide their consumers with
safe, quality, effective care (Ball et al., 2011). Regulatory agencies such as the National
Database for Nursing Quality Indicators (NDNQI) and the Institute of Medicine (IOM) have
both acknowledged the implications of RN engagement in health care (IOM, 2010). A work
environment that consistently lives its mission, vision and culture, and demonstrates respect and
support for the RN staff, will foster an environment where RNs are loyal and engaged. The
culture of a health care organization contributes to their ability to recruit and retain RNs who are
engaged (Lambrou et al., 2014).

Problem Statement

The culture of a health care organization can greatly influence its ability to motivate and
retain RNs who are loyal and engaged (Manley, Sanders, Cardiff, and Webster, 2011). When the
culture is lived daily, employee trust is reinforced (White & Dudley-Brown, 2012).
Burston and Stichler (2010) emphasized nurse satisfaction in relation to stress, burnout,
and compassion fatigue. Poor staffing and nursing shortages add to the stress levels, decreasing
morale and engagement. The Institute of Medicine (IOM) notes RNs are an essential part of the
health care workforce, recommending they be full partners, with all disciplines, and identify
2
problems, and establishing goals (IOM, 2010). It is important administration respects and
supports the RN discipline as collaborative team members, welcoming them to participate in
important decision making that impacts patient care and outcomes (Pfaff, Baxter, Ploeg, and
Jack, 2013). In order to retain quality RNs, health care organizations should assess how their
culture influences RN engagement.

Purpose Statement

Health care is constantly changing, forcing health care organizations to become more
strategic and competitive in how they deliver health care (Kotter, 2007). With RNs being the
primary and perhaps the most influential caregivers, it is imperative that health care
organizations create a culture where RNs are made to feel like important stakeholders
(Bodenheimer & Grumbach, 2012). The long-term purpose of this project is to demonstrate the
importance of organizational culture and its impact on RN engagement. Due to the time
constraints, I will request an evaluation of the recommended RN engagement program by five
experts in the related field. The evaluation tool is a five question Likert scale evaluating the
proposed program.

Nature of the Doctoral Project

The main objective of this project was to share the idea of a proposed RN engagement
program that would demonstrate respect and value for organizational culture and its influence on
RN engagement. The development of an RN engagement program that supports this endeavor
may meet the objective of better administrative and RN relationships (Tomey, 2009). This can
be measured by nurse attendance and participation at these forums. This objective will be
measured and may show evidence from in-hospital surveys and NDNQI RN surveys.
3
A long-term objective is to sustain a successful RN engagement program that could be
shared with other health care organizations, especially those seeking Magnet designation locally
and abroad. Magnet designation by the American Nurses Credentialing Center (ANCC) is a
designation granted based upon nursing excellence within an organization. The engagement of
the Registered Nurse is imperative in order for a health care organization to meet the tenets of
Magnet which include: structural empowerment, transformational leadership, exemplary
professional practice, new knowledge and innovations, as well a research resulting in evidence
based practices. Publishing the details of the development and successful implementation and
sustainment of such a program would reach stakeholders who share the same goals (Oerman,
2016).

Guiding, Practice, and Research Questions

While health care requires an interdisciplinary team approach, it is often the RNs who
have the greatest influence on a patient’s experience, often determining whether or not the
patient trusts the care being rendered and was satisfied with their overall experience (Tillot, et
al., 2013). The concept of RN engagement in health care continues to develop (Manley, Sanders,
Cardiff, & Webster, 2011). In previous literature, Manley notes 10 core values that focus on
interpersonal relationships and RN engagement:
• An environment where lifelong learning is promoted
• Leadership is developed,
• Stakeholder involvement in decision making processes
• Evidence Based Practice (EBP) is promoted
• Commitment to change and innovation,
• Open, respectful communication
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• Teamwork
• Safety
When these core values are present, RNs feel a sense of importance and belonging. The ability
to obtain and retain loyal RNs, sustaining engagement, is essential to the success of health care
organizations (Harmon, et al., 2010).
The United States has a shortage of nurses that is estimated to increase to over 200,000
by the year 2025 (Crum, 2014). Ginter (2014), DNP student at Walden University noted in her
dissertation the challenges of novice nurses being able to think critically and collaborate with
other disciplines. Ginter highlighted the importance of providing education, mentoring,
coaching, leadership building, and improved communication to ensure a smooth transition into
the professional role and facilitate the retention of these novice nurses. This organized program
provided some of the essential core values noted by Manley, et al. (2011).
In consideration of an aging and health care savvy population, the supply and demand of
RNs is of major concern.
RNs and patients are considered internal and external customers. Both have choices in
which health care organization is going to best meet their needs (Collins et al., 2008). A healthy
relationship amongst RN staff and administration make a work environment enjoyable, while
ultimately positively affecting the organizations bottom line. Engaged and loyal employees will
affect the organizations bottom line as it relates to (Jones & Gates, 2007, Schifalacqua et al.,
2011):

Vacancy costs

Recruitment costs

Hiring costs
5

Orientation & Training costs

Termination costs
What sacrifices are health care organizations willing to make in order to ensure that their RN
staff are present and engaged?
Significance of the Project
Safe, quality, effective care has been declared mandatory by various regulatory
agencies and accrediting associations. The 2010 Affordable Care Act supported this same
declaration (IOM, 2010). Nurses work well beyond their expected hours to ensure quality care is
rendered. While mandatory overtime is not universal, it presents genuine concerns and
repercussions that impact the health of the nurse and safety of the patients (Bae, & Brewer,
2010). Some of these repercussions include sick calls and burn out (Bae, 2012).
The current state of nursing is quite different than that of the past. With the baby boomer
generation living longer, there is a lack of balance between the population and supply of nurses
to care for them. Safe staffing has to be a priority (Bodenheimer & Grumbach, (2012).
As nurse leaders, we are responsible for leading innovation and impacting change in
health care. This is easily made possible when health care environments are focused on
improving their culture and supporting the needs of RNs (Hyrkas et al., 2010). These matters
are important to the RN staff. Health care organizations strive to demonstrate excellence in
quality care. The magnet model demonstrates excellence in nursing care and patient outcomes.
While there are 22 health care organizations and systems that have obtained Magnet designation
in the New York area, it continues to be the goal for others. The tenets of Magnet include
structural empowerment, transformational leadership, exemplary professional practice and new
knowledge and innovations. These tenets encompass the same attributes, which foster RN
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engagement, noted by Manley (2011).
RN staff are required to use their critical thinking skills, life, and professional
experiences as well as their emotional and ethical being when assessing the needs of their
patients (Zaccagnini & White, 2011). Health care organizations should make this same effort
when addressing the needs of the nursing staff. Acknowledging the feelings of employees,
respecting their dignity and privacy, and being transparent with organizational matters would
foster better relationships between RNs and administration. Open, honest relationships do not
always deliver what is expected; however respect and trust is key to sustainment and longevity in
any relationship (Kelly, 2007).
The project plan is to develop a program that seeks to create a work environment where
RN staff is content with mission, vision and support received by their health care organization.
An RN engagement program that increases knowledge, and understanding of the mission, vision,
and culture will foster a work environment where RNs are empowered and loyal (Bowers, 2011).

Summary

The data obtained thus far from researching the engagement of RNs, demonstrates
meaningful support for the proposal. This proposal for a RN engagement forum may not only
foster improved communications amongst RNs and hospital administration, it may also hold
those organizations who have Magnet Status accountable to sustaining RN engagement with
perhaps more frequent NDNQI RN surveys and Magnet visits. This would place emphasis and
accountability on health care organizations and systems to sustain programs and systems that
support their relationships as well as the tenets of Magnet.
The proposal of such an educational program stands the chance of becoming a
standardized expectation throughout health care organizations. Routine committee meetings do
7
not attract RNs. While they may attend, attendance is not sustained if they feel their voices are
not being heard and repetitive discussions occur about the same topics. Relationship amongst
RNs and administration are then jeopardized. If trusting relationships between RNs and
administrators are to be established and sustained, and the intent is to connect people with a
purpose, the translation of practice and behaviors have to start at the top with role model
behaviors (Crum, 2014; Hewison; Richardson & Storr, 2010; White & Dudley-Brown, 2012). ,
Crum, 2014, Richardson & Storr, 2010, & Hewison, 2007).
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Section 2: Background and Context

Concepts, Models, and Theories

Kolcaba’s (2006) comfort theory was the guiding theoretical bases for this proposal.
Successful health care organizations that deliver quality care, resulting in positive patient
outcomes, and patient satisfaction, owe this success to their RN staff (Heathfield, 2013). The
literature reinforces the value of this fact. Engaged RNs will retire from organizations that
nurture this type of culture. Being current and involved is key in bonding with the patients you
are caring for (Lundin, Paul, & Christensen, (2000).
Kolcaba began her work on comfort theory in 1988 (McEwen & Wills, 2011). In 1994,
comfort theory was published and has since been revised. Administration expects the RN to be
the caregiver. RNs have the same humanistic needs as their patients. Kolcaba, Tilton & Drouin
(2006) note that an organizational culture that addresses the humanistic needs of their RN staff
will reap the benefits of one who performs well above the call of duty.
To understand Kolcaba (1991) comfort theory, it was important to recognize the
components of the framework. The primary conclusion made by Kolcaba was that, as human
beings, a holistic approach should be taken when addressing one’s comfort. Those areas noted by
Kolcaba are our physical well-being, psychological well being, sociocultural well being and our
environments. Kolcaba applied this concept to approaching patients and RNs in a holistic
manner. This holistic approach to caring for an individual demonstrates the relationship between
needs, interventions and outcomes (Kolcaba, 1995).
9
Figure 1. Factors Influencing RN Engagement
Relevance to Nursing Practice
Kolcaba’s (2006) comfort theory provides the guiding theoretical foundations for this
proposal and future project. Patient outcomes, patient satisfaction, organizational success and
their return on investment will always be dependent upon RN engagement (Heathfield, 2013).
The inference is that RN engagement results in loyalty that leads to recommendations and repeat
customers. Engaged RNs will stay with organizations that foster this type of culture. Being
present and engaged is key to connecting with the patients RNs are caring for (Lundin, Paul, &
Christensen, (2000).

Local Background and Context

Kolcaba began her concept examination toward the phenomena of comfort theory in 1988
(McEwen & Wills, 2011). In 1994, comfort theory was published and has since been revised.
Like patients, RNs have basic needs. Kolcaba, Tilton & Drouin (2006) relate this same
phenomenon to nursing practice in that their needs, when met, foster a positive outlook on how
they perform which enhances the quality of care they deliver. Any health care organization
would benefit from comfort theory.
10
Employees who are content in their organizational relationship go above and beyond to
maintain the organizational mission. Collins, Collins, McKinnies and Jensen (2008) surveyed
human resource managers regarding their biggest challenges. The most paramount findings were
that of employee turnover rates. Retention and an aging population are areas of concern for any
human resource managers, nurse manager, and health care organization. Routinely assessing the
needs of the RN staff to find out what they want and need is highly recommended by Geyer,
(2005). Kolcaba’s comfort theory addresses the needs of the RN as the caregiver and as a human
being. These needs are met by an organization that is committed to their relationship with the
RN staff. RN staff needs to feel safe and secure in their organizational relationship. If concerns
such as resources are an issue, RN’s will not feel safe. Safe staffing has to be a priority
(Bodenheimer & Grumbach, (2012).

Role of the DNP Student

My affiliation with the participating practicum environment began in December 2014.
This facility has been the site for the my practicum experience. This facility is the intended
forum for which the program will be implemented. Due to the small nature of this community
hospital, these key stakeholders strongly believe that an RN engagement program where the
administrative team respects RNs as partners in care, would prove appropriate ( KW, DG, and
KG, personal communications, February, 2015).
I have been involved in efforts to promote RN engagement since December 2014. A
constant theme noted with RN staff is their concerns with available resources and their voices
being heard (Grant, Colello, Riehle, and Dende, 2010). Thus, in an effort to initiate change and
provide support for the RN staff, interest for an RN engagement program was awakened.
Authorization from the VP of Nursing allowed the DNP student to have access to and review
11
previous NDNQI RN survey data as well as data from the interim survey conducted by the
organization. It was very important for me to acknowledge the importance of leadership in its
representation of administration as well as advocacy of the RN staff.
12

Section 3: Collection and Analysis of Evidence

Introduction

Through this project I seek to determine the correlation between the culture of a health
care organization and RN engagement. While the organization is designated as a Magnet Model,
the actual possession of the characteristics of Magnet cannot be assumed. The sample
population to be used in this study is RN staff from a small community hospital in the upper
Hudson Valley area of New York. There is no cap on the number of participants, as more
participants will justify the positive correlation (Terry, 2015). This sampling is convenient as it
relates to their participation in recent NDNQI RN surveys and upcoming redesignation. Some
new employees may not have been involved in the recent surveys.
Participant criteria includes qualifying as the following:

Registered nurse

Full time status

611 per diem staff
Exclusion criteria includes:

Part time registered nurses

Casual per diem registered nurses

Leadership/Administrative registered n

Nurses
Participation in the NDNQI RN survey is confidential. Although highly encouraged,
participation is voluntary with no information highlighting their identity and participation (Grove
et al., 2013).
13

Practice-Focused Question

Careful consideration of those factors that promote and hinder RN engagement are important
to review (Freeney & Tiernan, 2009). Once implemented, this project may stimulate social
changes in practice and how organizational cultures are developed and sustained. As nurse
leaders, we are responsible for constantly assessing our clinical areas and work environments,
taking advantage of the available resources that will lead to improvements in our work
environments, treatment and processes, as well as patient satisfaction (Hodges & Videto, 2011).
The current health care organization is due for Magnet re-designation. While administration is
optimistic, there have been concerns regarding RN engagement. Aside from the May 2014
NDNQI RN survey, there was an interim survey conducted in March 2015. A successful RN
engagement program might help alleviate those concerns, as the program will allow for ongoing
assessment and evaluation to meet the needs of the RN staff (Grant, Colello, Riehle and Dende,
2010).
The efforts made to nurture and develop a collaborative relationship between
administration and RN staff will prove beneficial to all parties, the patient population they serve
and the organizations bottom line. With constant changes in health care, nurse leaders are
charged with creating strategies that not only foster better outcomes, but also demonstrate
sustained improvement (Shirey, 2011). While the concept is new, transformational leadership
demonstrates one’s ability to take their team from point A to point B (Warrick, 2011). It is
always the hope that one’s team is engaged and willing to work toward improvement and
successful patient outcomes.
One of the most significant changes that could result from an effective RN engagement
program is an effective health care environment that consistently provides quality patient care
14
and outcomes (Parsons & Cornett, 2011). If this level of care is a priority in the organization, are
they willing to make the commitment to the RN staff that provide such care?
Sources of Evidence
Nursing education will provide the results of the NDNQI RN surveys. While data will
provide information on the various departments within the organization, the focus area for RN
engagement will be the inpatient care area. It is important to note that the inpatient care areas
have had some significant adjustments in their availability of resources over the past 2 years.
Considerations are being made to propose another interim survey after program
implementation. Leadership rounds are an ongoing practice for me. This practice will provide
real time feedback from RN staff regarding concerns and challenges. There is no direct patient
participation in this project other than the use of their feedback in the Press Ganey and HCAHPS
surveys which offers questions specific to:

Nurses overall

Courtesy and respect

Response time

Careful listening
The guidelines of the Health Insurance Portability and Accountability Act are not of concern as
no patients will be involved.
Leadership support was previously been encouraged by the Chief Nursing Officer
(CNO). It is important to note that some clinical nurse managers are new to the role and may
have previously worked directly with the teams they are now managing. The development of
these clinical nurse manager relationships has been challenging due to the various levels of
experience with leadership, leadership style and approach to systems changes. Nursing
15
education has demonstrated ongoing support. The administrative team has changed significantly
at my practicum site. leadership has changed over the past year.

Analysis and Synthesis

The variables in this project are RN engagement and organizational culture. These
variables are independent of each other (Grove, Burns, & Gray, 2013). It should be understood
that perception can be influenced, not controlled. Hence the RNs interpretation of the questions
on the NDNQI RN survey. The online NDNQI RN surveys do not afford the opportunity for me
to connect with human feelings. Each participant, RN and patient may perceive the same
questions differently. While there is a plethora of data that demonstrate the positive impact of
one variable over another, more research with direct tools and less generalized questions like
those on the survey would prove beneficial to the project problem statement.
Governmental and other regulatory agencies have made the expectations clear as it relates
to safe, quality, effective health care. The implementation of a program within an organization
that intends to remain viable in this competitive health care environment, must assess, design,
plan and implement systems that will sustain improvement. The key to sustained improvement
is continuous assessment and evaluation of programs and systems (Kettner et al., 2013).
Havelock’s theory of planned change offers employees the opportunity to understand and
perhaps adjust at a better rate, offering cycles of the process (White & Dudley-Brown, 2012).
One of the most common reasons that change is not sustained is because of what appears to be an
ending point. It is the assumed point at which the goals and have been obtained and the
stakeholders are often left to proceed. With health care constantly changing, hence
organizational changes, it is a never ending process to adjust, change and improve, making the
cycle action of Havelock’s Theory appropriate. Changes often fail due to processes ending.
16
Havelock’s process has a renewal phase, which continues to look at improvement. This is how
an RN engagement program should look in order to sustain engagement. A quarterly educational
module that meets the needs of the RN, fostering engagement, has to constantly evolve.
The long-term plan will be to use the Utrecht work engagement scale once the program is
implemented. The evaluation plan for a successful RN engagement program may include the use
of a Lickert scale questionnaire containing five to 10 questions, as well as recruitment and
retention data. The organization has recently participated in it’s NDNQI RN Engagement
Survey between June 7th to June 28th. It has also participated in a hospital wide employee
engagement survey conducted by a third party.

Summary

The concept of RN engagement should be the priority of all health care organizations. It
is imperative for health care organizations to assess their culture, noting its impact on the ability
to recruit and retain engaged RNs (Collins et al., 2008).
Human resources departments are challenged to look at processes when once loyal
employees begin to leave an organization. Relationship building efforts on the part of
administration makes a strong statement to the RN staff, that administrators care about those
matters that are important to them, Kelly (2007). Placing RNs first is not the norm for most
health care organization. Those organizations that place their employees first, will reap the
benefits of loyal and engaged RN staff (Spiegelman & Berrett, 2013).
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Section 4: Findings and Recommendations

Introduction

The main objective of this project was to demonstrate how organizational culture impacts
RN Engagement. With the recent changes in hospital administration, there has been a genuine
concern that the culture, being a family like environment, will change. An administrative team
who understands change and the fears that come with it, would be most appropriate in it’s
proactive approach in alleviating these concerns by being present and engaged with the RN staff.
This administrative team would continuously live the mission and vision of the organization,
respect the importance of the RN role, acknowledge how the RN role impacts healthcare and
how important the RN role is in the success of the organization.

Findings and Implications

During the Nursing Leadership meeting held in early August, it was announced that the
2016 NDNQI RN survey scores were in. Not only were nurse leaders excited to hear their
individual unit results, with the impending Magnet re-designation Survey in the fall, everyone
wanted to get started on their action plans, moving forward with staff preparation for the Magnet
mock survey to be held September 19th and 20th. The CNO shared the fact that while most units
had demonstrated improvement, one of the significant areas of concern was the presence and
visibility of the CNO. With this small community hospital being the only Magnet designated
hospital within this now larger organization since their merge in March 2015, the focus was
indeed on this community hospital. The main campus had recently taking the necessary steps in
applying for their first Magnet designation, there has been a sense of expectancy that the
community hospital would be the role model.
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The Magnet Mock survey, later called the Magnet prep survey, was a worthy investment
on the part of the organization. While there had indeed been a turn over in staffing with some
RN’s having never experienced working within a Magnet designated organization, there was a
lot to be said for those RNs with a longer tenure, who did not know how to speak to the tenets of
Magnet. Not only had the consultant noted this in the presentation of her findings, but she also
reiterated the findings from the recent NDNQI RN survey in which some of the RN staff did not
know who their CNO was. The implication is clear, the concept of RN engagement should be
the priority of all health care organizations.
With the Magnet survey having been completed between, October 19th and the 21st, most
RNs were relieved and confident that the organization will receive its third redesignation. In
consideration of the popular crunch preparation, I too must say that the outcome looks positive.
Nevertheless, a lot can be said about how most organizations exemplify the tenets of Magnet.
Nursing has profound contributions to health care are priceless and never ending. Any
healthcare organization that lends itself in the prioritization of the RN engagement level, will
reap the benefits two fold.

Recommendations

The evidence is clear in demonstrating how the culture of an organizational can impact
RN engagement. It is therefore my recommendation that an RN Engagement Program be
implemented in order to demonstrate the commitment to respecting, supporting and
acknowledging the significant role of the RN in health care changes and organizational success.
Strengths and Limitations of the Project
The strength of such a project will be based upon the efforts put forth to develop and
sustain such a program. The commitment to this relationship between the organization and its
19
RN staff will have numerous benefits including RN loyalty, decreased burnout, decreased
turnover rates, increased RN satisfaction, increased patient satisfaction, and a positive return on
investment for the organization. While and RN engagement program may not incur a high bill, it
would indeed require time and commitment on behalf of nursing and hospital administration.
The lack of such commitment may lead to disengaged RN staff and the potential for increased
turnover rates (Atkins, et al., 1996). Ongoing assessment of the established goals, and the
creation of new goals guided by the needs of the RN staff would prove fundamental to the
sustainment of the program.
20

Section 5: Dissemination Plan

The inclusion of key stakeholders is vital to the success of the RN engagement program.
While the proposal of an RN Engagement Program was presented to nursing leadership earlier
this year, the concept was not shared with upper administration. In consideration of recent
administrative changes and the obvious need for relationship building, the recent NDNQI RN
survey results from June 2016, the employee engagement survey held from September 7th to
September 28th, and the recent Magnet Survey conducted October 19th through the 21st, it is the
perfect time to implement an RN engagement program.
I would like to prepare a poster board presentation highlighting literature that emphasizes
the importance of RN Engagement as well as the scores of the NDNQI RN survey from 2013 to
2015. I would eventually like to be able to conduct one on one surveys, as well as group
sessions with the RN staff in order to have some qualitative data, demonstrating the emotional
context of RN engagement, tracking trends and connecting those trends with the responses to the
NDNQI RN survey. I am optimistic that presenting these finding at nursing leadership and the
management meeting would sustain the buy in for the RN engagement program.
The RN engagement program would be a quarterly forum in which nurse leaders would
present and get feedback from the RN staff on matters such as:
• Employer of choice
• Best service/growth
• Quality indicators
• Growth/Financial Viability
These pillars are all significant to the viability of the organization, hence important areas
of concern requiring the necessary involvement of the RN staff (IOM, 2010). Guest speakers
21
such as the CFO, the president and even outside experts would be invited to speak to and with
the RN staff. Team building activities, leadership sessions, and open discussions would be part
of the design of the RN engagement program. An open and interactive style session to be held
quarterly for one and a half to two hours in which RN staff would participate in a program that is
solely about them, their significance within the organization and the importance of their voices
and expertise in the growth and change necessary for the organization to succeed. In
consideration of the workload and dedication of the RN staff who rarely leave the unit, this
quarterly forum would sometimes be an on the road program, meeting the RN staff on their units
and even at the bedside.

Analysis of Self

I see myself as the facilitator of the RN engagement program, however more importantly
part of a greater team that acknowledges the importance of the RN role in the health care system.
I would like to present this concept at larger venues such as the regional town hall meetings with
nurse leaders who are seeking Magnet Designation. While the focus is to present those stories
and data that support them as part of the Magnet document application, it is more important that
an organization present a nursing team that can speak to the document in a manner that
demonstrates pride in what they have done and an attitude content with their organizational
relationship.
I began this DNP journey in 2012. Despite the small pauses in my studies due to family
matters, my focus remained steady. I have a plethora of experience having worked within health
care organizations that remain focused on numbers instead of people. I have been more
determined in my research to demonstrate the correlation of organizational culture and RN
engagement. If indeed this is a positive relationship, it will be demonstrated in the success of
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any healthcare organization and sustained by a well-developed and dynamic RN engagement
program (Collins, et al., 2008).
The post graduate plan to implement an RN engagement program is not a matter I take
for granted. The challenges faced during this scholarly journey offered many insights that have
helped me grow personally and professionally. With the initial acceptance of my DNP Project
being from a prior administrative team that knew and trusted my intentions, the sudden change in
administrative teams did not initially appear concerning. Considering the topic, my thoughts
were that a new administrative team, attempting to build new relationships would see my project
as the perfect measure to put into place. Trust seemed to be a factor in getting the buy in, as I
perceived the intentions of the project being the main area of concern.
It became important to clarify my intentions with the RN engagement program were to
benefit the organization, not my personal or academic agenda. I still believe there are some
concerns, despite the letter of cooperation from the CNO. I can only be optimistic that once I
present the program to the senior administrative team, the purpose and intent will be clear
without question, including the ROI. My plan to better support buy in from the CNO is to
demonstrate an emphasis and respect of her opinions and ideas.

Summary

The concept of an RN engagement program may have actually begun several years into
my being a nurse leader. I especially note several years, as it certainly took me some time to
learn and grow in this important role. In the process of practicing, learning, listening, and
observing, my professional nursing path has afforded me the opportunity to impact the lives of
others in a way that no other healthcare professional can. Although healthcare continues to
change, the essence of the human connection made between healthcare consumers and the RN
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staff that care for them never changes. It is the RN staff that makes themselves vulnerable and
available to address the physical, emotional, psychological, and spiritual needs of patients and
families. These frontline stakeholders are the everyday heroes that change lives, even when
death is imminent. Any healthcare organization that values the worth of an RN, knows that these
RN’s need just as much support as the patients they serve. Healthcare organizations willing to
invest in an RN engagement program, will demonstrate a commitment to their RN staff and
ultimately the communities they serve. This win-win approach affords a healthcare organization
a competitive edge in safe, quality, effective care that is rendered by present and engaged RN
staff who are committed and loyal to their healthcare organizations.