Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2016 Transformational Leadership as a Means of Improving Patient Care and Nursing Retention Carla D. Tomas Walden University Follow this and additional works at: htps://scholarworks.waldenu.edu/dissertations Part of the Nursing Commons Tis Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact Walden University College of Health Sciences This is to certify that the doctoral study by Carla Thomas has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Joan Moon, Committee Chairperson, Health Services Faculty Dr. Joanne Minnick, Committee Member, Health Services Faculty Dr. Mary Rodgers, University Reviewer, Health Services Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2016 Abstract Transformational Leadership as a Means of Improving Patient Care and Nursing Retention by Carla D. Thomas MNA, University of Illinois at Chicago, 2010 BS, University of Illinois at Chicago, 1990 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University June 2016 Abstract The Joint Commission (TJC) sets standards to assist healthcare organizations in improving performance. The hospital for which this project was developed did not meet national TJC benchmarks for patient satisfaction and nurse retention. Based on direct observation, discussion with staff, and results of the Multifactorial Leadership Questionnaire given to 39 staff nurses before this project was chosen, evidence suggested that the leadership style of the charge nurses was transactional, which is less effective than transformational leadership (TFL). Framed within the Plan, Do, Study, Act model, the purpose of this quality improvement project was to design an educational curriculum including didactic and competencies on TFL for unit charge nurses. A team approach was used for the project. Incorporating the American Organization of Nurse Executives recommendations on effective leadership, the curriculum encompassed the importance and management of TFL intertwined with the power, motivation, and characteristics of the transformational leader. Competencies governing TFL in practice were a significant part of the curriculum. The curriculum was evaluated by 4 content experts using a 12- item yes or no response for each of the criteria. One of the criteria was answered no in the learning objectives section and the design of the criteria was revised All other criteria were met. A recommendation was made for a change to the evaluation format for the leadership style identification portion of the curriculum. This project has important implications for social change as unit charge nurses strive to act on best practices in leadership, thus positively impacting the well-being and satisfaction of their patients and fellow nurses. Transformational Leadership as a Means of Improving Patient Care and Nursing Retentio n by Carla D. Tho mas MNA ,University of Illinois at C2h0ic1a0 go, BS, University of Illinois at, C19h9ic0 ago Projec Stubmitted in Partial Fulf illment of the Requirements for the D egree of Doctor of Nursing Pr actice Walden Unive rsity June2 016 Dedication I dedicate this project to my family, both those present and those who have passed on since its’ inception. I would not have been able to complete this project without the support and patience of those around me. I am blessed to have a team of support that allows me to continue my ministry in nursing. I have lost the most important man in my life during this process—my father, who has always supported me in whatever endeavors. To my children for the many, many hours in which they learned right along me with patience, love and keeping the end goal in sight. To my colleagues for their diligence and support to help guide me as I developed as a leader. To my Mother who encouraged me years’ ago to teach and nursing allows me the opportunity to provide a piece of me in every interaction with every student, patient, and team members that I am blessed to interact with while practicing nursing. Acknowledgments I wish to thank my parents, children, my mother, siblings, Great Aunt, my partner for life, and my friends both in and out of academia who helped me with this project. I would also like to express my deepest regards to all the faculty at Walden University who helped me grow—especially Dr. Moon for her patience, continued diligence, and support throughout this final process. Table of Contents Section 1: Nature of the Project ...........................................................................................1 Introduction ....................................................................................................................1 Background ....................................................................................................................2 Problem Statement .........................................................................................................4 Purpose Statement ..........................................................................................................4 Project Goal/Outcomes ..................................................................................................4 Goal…. ...........................................................................................................................4 Outcomes .......................................................................................................................5 Framework/Theory ........................................................................................................5 Nature of the Project ......................................................................................................5 Definition of Terms........................................................................................................7 Assumptions/Limitations ...............................................................................................9 Significance....................................................................................................................9 Summary ........................................................................................................................9 Section 2: Review of the Literature ...................................................................................11 Introduction ..................................................................................................................11 Literature Search Strategy............................................................................................12 Concepts, Models, and Theories ..................................................................................13 Transformational Leadership Theory ..........................................................................13 Plan, Do, Study, Act Model .........................................................................................17 Transformational Relevance to Nursing Practice ........................................................21 i Nursing Leadership ......................................................................................................22 Nurse Retention ...........................................................................................................26 Patient Satisfaction.......................................................................................................28 Patient Care Days .........................................................................................................29 Curriculum Development.............................................................................................30 Local Background and Context ...................................................................................33 Summary ......................................................................................................................35 Section 3: Project Plan .......................................................................................................37 Introduction ..................................................................................................................37 Role of the DNP Student..............................................................................................37 Role of the Project Team .............................................................................................37 Methods and Approach ................................................................................................38 Outcomes .....................................................................................................................42 Outcome 1 Educational Curriculum ............................................................................42 Outcome 2 Content Expert Evaluation of the Curriculum...........................................42 Outcome 3 Implementation Plan .................................................................................43 Outcome 4 Evaluation of the Implementation Plan .....................................................43 Outcome 5 Summative Evaluation of the Project and My Role ..................................44 Population ....................................................................................................................45 Ethics…........................................................................................................................45 Data Analysis ...............................................................................................................45 Outcome 1 Curriculum Content Evaluation ................................................................45 ii Outcome 2 Summative Evaluation ..............................................................................45 Summary ......................................................................................................................46 Section 4: Findings and Recommendations .......................................................................47 Introduction ..................................................................................................................47 Evaluation, Findings and Discussion ...........................................................................47 Outcome 1. Educational Curriculum and Outcome 4. Content Expert Evaluation .......................................................................................................48 Outcome 2. Implementation Plan and Outcome 3. Plan for Evaluation ......................49 Outcome 5. Summative Evaluation of Project and My Role .......................................50 Implications..................................................................................................................52 Policy... ........................................................................................................................53 Practice .........................................................................................................................54 Impact on Social Change .............................................................................................55 Strengths and Limitations ............................................................................................56 Strengths ......................................................................................................................56 Limitations ...................................................................................................................56 Recommendation for Future Projects ..........................................................................57 Analysis of Self ............................................................................................................57 Analysis of Self as Scholar ..........................................................................................57 Analysis of Self as Practitioner ....................................................................................58 Analysis of Self as Project Developer .........................................................................58 Contribution to Professional Development ..................................................................59 iii