Doctor of Nursing Practice , Case Western Reserve University, 2023, School of Nursing

Problem and aim: Authentic nurse leadership has the potential to enhance nurses' job satisfaction, healthy work environment, work engagement, nurse retention and organizational commitment. Medical-surgical nurses constitute the largest nursing specialty. The aim of this DNP project was to expand current knowledge regarding authentic nurse leadership by assessing medical-surgical nurses' perceptions of their nurse manager's authentic nurse leadership. Methods: This study was guided by the Authentic Nurse Leadership Conceptual Framework. A quantitative, descriptive, cross-sectional design was employed to collect data using electronic surveys from nurse members of the Academy of Medical Surgical Nurses. Authentic nurse leadership was measured using the Authentic Nurse Leadership Questionnaire encompassing five subscales of self-awareness, moral ethical courage, relational integrality, shared decision making and caring. Pertinent findings: The sample was 34 participants. The mean for overall Authentic Nurse Leadership was 3.08/4.0 (SD 0.7) and the means for the subscales ranged from 2.97/4.0 (SD 0.69) to 3.19/4.0 (SD 0.75). Conclusions: This was the first study to engage the ANLQ within the medical-surgical nurse population. As in previous studies regarding the ANLQ, the instrument was beneficial in discerning aspects of authentic nurse leadership exhibited by nursing managers. Overall, the participants perceive a moderately high level of authentic nurse leadership in their nurse manager.

Committee: Deborah Lindell (Committee Chair); Rosanne Raso (Committee Member); Joyce Fitzpatrick (Committee Member) Subjects: Nursing

DNP, Kent State University, 2021, College of Nursing

Advanced Practice Registered Nurses (APRN) are at the forefront of our current patient care systems. The APRN presence has brought questions involving the advanced practice community and their relationship to the medical staff, committees, and administration. Advanced practice registered nurse (APRN) includes the following practitioners: Certified Nurse Midwife (CNM), Certified Nurse Practitioner (CNP), Certified Nurse Specialist (CNS), and Certified Registered Nurse Anesthetist (CRNA). In 2012, the Center for Medicare/Medicaid Services (CMS) expanded the medical staff definition to include non-physician practitioners. This regulation change included advanced practice registered nurses and physician assistants. The Code of Title 42 C.F.R 482.22 allows hospitals and their medical staffs to take advantage of the expertise and skills of all types of practitioners who practice at the hospital when making decisions concerning medical staff privileges and membership. In 2014, Title 42 C.F.R. 482.22 Medicare Conditions of Participation clarified state laws would determine the eligibility for appointments by the governing body. The document does state the membership to the governing body is not a requirement but optional. (CMS, 2012). The DNP project “APRNs and Medical Executive Committee Membership: A Quality Improvement Proposal” highlights an environmental scan and a validation group input. Is there value of the APRN beyond the bedside? Multiple advanced practitioner journals, professional practice organizations, and textbooks direct APRNs toward positions in leadership as part of our professional responsibilities. However, few hospitals have positioned the APRN within the medical executive committee (MEC). The APRN membership on a MEC would reflect the diversity of our healthcare provider climate and is a natural progression of our hospital leadership. The s (open full item for complete abstract)

Committee: Lynn Gaddis Dr (Committee Chair); Kimberly Cleveland Dr (Committee Member); Marilyn Nibling Dr (Committee Member) Subjects: Nursing

Ph.D., Antioch University, 2019, Leadership and Change

The purpose of this study was to assess the degree to which servant leadership characteristics are exhibited in medical group practices, and the degree to which servant leadership characteristics correlated with measures of empathic care. This study featured an explanatory mixed methods research design embedded in appreciative inquiry. A total of 189 mid-level practitioners consisting of nurse practitioners, physician assistants, and practice mangers responded to a 32-item scale survey that featured a six-point Likert scale to measure servant leadership items and a 10-point continuous scale to assess measures of empathic care. The servant leadership items were based on the seven pillars of servant leadership. Data analyses included assessing means, standard deviations, and percentage distributions for servant leadership statements and empathic care statements. Additionally, bivariate correlation analysis and standard multiple regression analysis were conducted to assess the degree of influence of servant leadership characteristics on measures of empathic care. Findings from this study identified Pillar 1 (Persons of Character) as the servant leadership pillar most strongly exhibited in the medical group practices. Furthermore, Pillar 5 (Has Foresight) was the strongest correlate of reported empathic care within medical group practices as well as team members' proclivity to practice servant leadership behaviors with patients more than with each other. The study also found that clinicians and non-clinicians significantly differed in their endorsement of all of the servant leadership pillars except Pillar 1 (Persons of Character). The findings of this dissertation point to strategies for promoting an environment of empathic care, and team building and organizational development and training in the medical group practices. This dissertation is available in open access at AURA: Antioch University Repository and Archive, http://aura.antioch.edu/ and OhioLINK ETD Center, h (open full item for complete abstract)

Committee: Laura Morgan Roberts PhD (Committee Chair); Carol Baron PhD (Committee Member); Reginald Silver Dr. PH (Committee Member) Subjects: Behavioral Psychology; Business Administration; Communication; Education; Health; Health Care; Health Care Management; Health Education; Higher Education Administration; Management; Medical Ethics; Occupational Psychology; Organization Theory; Organizational Behavior; Personal Relationships; Personality; Personality Psychology; Philosophy; Psychology; Public Health; Public Health Education

Ph.D., Antioch University, 2017, Leadership and Change

This research examined one large health system that has, through a stated mission outcome that every encounter is a sacred encounter, sought to enhance relationships occurring within the health care environment. Seeking to understand the lived experience of sacred encounters through the lens of nurse leaders in one acute care hospital settings this study examined how nurse leaders experienced their leadership role in realizing sacred encounters. Participants were defined as nurse leaders from one hospital setting and included nurse managers, directors and one vice president. A narrative thematic analysis framed by situational analysis was the method of inquiry. Data was gathered through an intensive interview process eliciting an in-depth exploration of the experience of the participants, along with their personal interpretation of that experience. Two questions were asked to each participant, the first to gain an understanding about their personal experience with sacred encounters and the second to allow the nurse leader to reflect on his or her personal leadership behavior as it related to the realization of sacred encounters within their primary area(s) of responsibility. A review of research of current literature focused on relational leadership, spiritual leadership and nursing leadership theory. The major finding was that organizational culture can be defined from the top of the organization and, through well-defined and purposeful leadership behaviors, be realized at the point of bedside care. This study was limited to a one-faith-based hospital. Future research should focus on broadening the scope of inquiry about organizational culture and how espoused culture can be translated into action through purposeful leadership behaviors. This dissertation is available in open access at AURA, https://aura.antioch.edu/ and OhioLINK ETD Center, https://etd.ohiolink.edu/etd

Committee: Jon Wergin Ph.D. (Committee Chair); Elizabeth Hollaway Ph.D. (Committee Member); Peter Vaill D.B.A. (Other) Subjects: Health Care Management; Nursing; Organization Theory; Organizational Behavior

DNP, Walsh University, 2014, Nursing

This study described the leadership style of nurse managers in a Magnet designated organization and determined the relationship between their self-perceptions of their leadership style and the perceptions of their respective directors, and direct report registered nurses. The study used a descriptive design. A convenience sample of eight nurse managers and their immediate supervisors (four directors), and direct reports (68 staff nurses) from select units at a Magnet designated healthcare facility in Northeast Ohio completed the Multifactor Leadership Questionnaire (MLQ) (5X short) Leader Form and Rater Form (Bass & Avolio, 2004). The MLQ measures leadership style (Transformational, Transactional, and Passive Avoidant) and leadership outcomes (Extra effort, Effectiveness, and Satisfaction) based on raters perceptions of the leaders behavior. Descriptive statistics described the sample demographic data (gender, age, nursing education, number of years as an RN, number of years in current position, and number of years as a nurse manager). Statistical Package for Social Sciences (SPSS) analyzed MLQ data. The means, standard deviations, and ranges were calculated for all scales items. Reliability for subscales was calculated using Cronbachs alpha (Cronbach, 1970). The directors overall mean scores on the MLQ items indicated perceived leadership characteristics of the nurse managers as more Transformational with a mean of 3.6/4. The nurse managers rated themselves lower than the directors but higher than the staff nurses for Transformational leadership style with a mean of 3.3/4. Conversely, the staff nurses rated the nurse managers to be almost the same in Transformational and Transactional leadership styles with means of 2.7/4 and 2.65/4 respectively. The Pearson product-moment correlation coefficient showed a positive correlation between Transformational leadership style and the outcomes extra effort, effectiveness, and satisfaction. Knowledge gained from (open full item for complete abstract)

Committee: Sharon Oetker - Black PhD, RN, JD (Advisor) Subjects: Management; Nursing

PhD, University of Cincinnati, 2013, Nursing: Nursing - Doctoral Program

Shared governance models have been implemented in health care organizations throughout the world over the past three decades. Moving from a vertical governance structure to a shared leadership organizational model requires significant changes in the culture of an organization, and in the behaviors, beliefs and values of its members. The purpose of this study was to discover, describe and systematically analyze the expressions, meanings, lifeways, beliefs, and values of selected clinical nurse shared governance council leaders in a pediatric health care organization. The aims of this study were to: 1) gain new knowledge from the participants through interviews, focus group sessions and field work that may prepare nurses as leaders; 2) discover barriers that may exist in the development of the caring lifeways that are needed to prepare nurses as leaders; and 3) analyze how caring relationships develop to promote nursing leadership. Ethnonursing research methods (Leininger, 1997) were used to discover previously unknown knowledge about the participants' experiences. The findings illustrated how caring relationships assisted clinical nurse council leaders to discover leadership within themselves, find their own voice, give voice to other nurses, accept personal and professional accountability for nursing practice, and advocate for patients and families. Caring leadership practices were all levels of nurses equally sharing their beliefs and values about nursing practice. However, the values and beliefs that nurses experienced in a hierarchical organizational culture could sometimes be in opposition to a nursing culture with the values and beliefs of shared governance. Mutuality in shared governance was clinical nurse council leaders engaged in equitable, reciprocal communication with managers to share leadership and decision making about nursing practice, and grow professionally to become nursing leaders.

Committee: Edith Morris Ph.D. (Committee Chair); Marilyn Ray Ph.D. (Committee Member); Denise Gormley Ph.D. (Committee Member); Rebecca Lee Ph.D. (Committee Member) Subjects: Nursing

Doctor of Nursing Practice, Mount St. Joseph University , 2024, Department of Nursing

In 2022, an engagement survey showed that a local organization's regional float pool was low. This quality improvement project examines whether implementing a unit-based council for the regional float pool will affect nurse engagement scores and improve patient satisfaction. A pre-and post-survey, prior to implementation of the unit-based council and after implementation, was given, and it had a 4-point Likert scale. Additionally, patient satisfaction scores regarding nurses' communication were evaluated pre- and post-implementation using results from an established patient survey routinely used by the hospital system. This project contributes to the existing literature that supports the implementation of unit-based councils and improved nurse engagement and patient satisfaction.

Committee: Dr. Sandra Curtis (Advisor) Subjects: Nursing

PhD, University of Cincinnati, 2023, Nursing: Nursing - Doctoral Program

Background: Nurse leaders need to pay attention to their own wellbeing by understanding what leads to burnout. The aims of this dissertation are to: (a) review the evidence and determine how transformational leadership (TFL) characteristics are associated with burnout among nurse leaders; (b) identify the differences in burnout between male and female nurse leaders while considering work-life balance and COVID-19 impact; and (c) investigate the relationship between TFL and burnout by examining the mediating effect of stress, role overload, peer support, and work-life balance. Methods: Using PRISMA guidelines, an integrative review and critique of 11 articles was conducted. Personal burnout, work-related burnout, client burnout, work-life balance, and COVID-19 impact were assessed through a gender lens in a sample of 210 nurse leaders using ANCOVA testing. The relationship between TFL and burnout was investigated while examining the mediating effect of stress, role overload, peer support, and work-life balance in a sample of 210 nurse leaders using multiple regression analysis. Results: Findings from the integrative review aid in developing a better understanding of the general construct of TFL and burnout among nurse leaders; however, studies exhibited several limitations warranting further research in this area. Females had significantly higher personal burnout than males (Mean 56.2 vs. 49.3, F= 5.853, p = 0.019). Males had significantly higher client related burnout than females (Mean 45.3 vs. 34.8, F= 7.014, p = 0.008). Quantitative data derived from the multiple regression analysis revealed that among transformational nurse leaders, inspirational motivation skills (p <.000, 95% CI [6.8, 2.6]), work-life balance (p = 0.022, 95% CI [5.7, 0.4]), stress (p <.000, 95% CI [4.1, 11.0]), role overload (p <.000, 95% CI [2.2, 5.7]), and peer support (p = 0.001, 95% CI [4.6, 1.2]) were all retained as significant predictors of the burnout score. Concl (open full item for complete abstract)

Committee: Gordon Gillespie Ph.D. (Committee Chair); Carolyn Smith Ph.D. (Committee Member); Kermit Davis Ph.D. (Committee Member) Subjects: Nursing

PhD, University of Cincinnati, 2018, Nursing: Nursing - Doctoral Program

Background: Changes in the United States (US) health care delivery system require more advanced nursing education and training to prepare nursing graduates for their leading role. Acute care nurse practitioners (ACNP) play a vital role in hospitals and critical care settings. ACNPs require special training and educational preparation to meet their role expectations such as leading a cardiovascular resuscitation team. Using high fidelity simulation (HFS) with debriefing modalities is considered one of the innovative learning strategies in graduate nursing which provide the opportunity to practice their leadership capabilities within safe, nonthreatening learning environment. Purposes: The purpose of this study was to examine the difference in ACNP students' knowledge, team leader skills and self-efficacy using two debriefing modalities: verbal debriefing (VD) vs. video-assisted debriefing (VAD) guided by Kolb's experiential learning theory (ELT). Additionally, this study explored ACNP students' evaluation and perceptions of the debriefing experience and how this experience impacts the transferability of simulation-based learning into clinical settings. Method: A two group, pretest-posttest quasi-experimental design was used. This study was conducted in two phases. Phase I was quantitative and Phase II included qualitative data collection using two focus group interviews. A total 28 ACNP students were recruited from an acute care nurse practitioner program or post master's acute care certificate program at a university in the Midwest United States during the fall of 2017. ACNP students participated in HFS scenario managing emergency dysrhythmias during a code experience. Then the students were evaluated using many tools followed by two focus group interviews. Results: There were no significant differences between the two groups in knowledge acquisition/retention, leadership skills, and self-efficacy, but there was a significant difference in self-efficacy in both (open full item for complete abstract)

Committee: Elaine Miller Ph.D. (Committee Chair); Tamilyn Bakas (Committee Member); Kathleen Ballman (Committee Member); Gary Geis (Committee Member); Jun Ying Ph.D. (Committee Member) Subjects: Nursing

Doctor of Nursing Practice , Case Western Reserve University, 2016, School of Nursing

Abstract This study describes the clinical nurse leadership skills of operating room nurses. Despite intense focus on patient safety cultures, two of the top ten reported sentinel events to the Joint Commission from 2012 – 2014 occurred in the surgical environment: unintended retention of foreign objects and wrong patient, wrong site, wrong procedure surgery. With leadership identified as a significant root cause for operating room error, no research exists to support evidence based practice specific to clinical nurse leadership at the bedside of the patient. This descriptive, correlational study will provide information regarding clinical nurse leadership within the operating room environment. This study will draw on the conceptual model of staff nurse clinical leadership by Chavez and Yoder to hypothesize the relationship amongst the variables of interest: (1) clinical nurse leadership competency, (2) certification in operating room specialty, (3) organizational culture, and (4) years of operating room experience. The hypothesis for this study is that clinical nurse leadership competency will be greater in operating room nurses within Magnet accredited institutions or specialty certification or greater than ten years of operating room experience. The Leadership Practice Inventory® tool will be used to evaluate clinical nurse leadership in operating room nurses. This is the first study to examine clinical nurse leadership skills of nurses in the operating room environment. Findings may provide evidence to support leadership training for operating room nurses making safety decisions that are essential to preventing patient errors.

Committee: Gayle Petty DNP, RN (Committee Chair); Ronald Hickman PhD, RN (Committee Member); Rebecca Patton MSN, RN (Committee Member) Subjects: Health Care; Nursing

PhD, University of Cincinnati, 2011, Nursing: Nursing - Doctoral Program

Strong nursing leadership is needed to create and maintain a healthy and safe practice environment for both nurses and patients. Acute care hospitals are fundamentally complicated organizations where nurse leaders must answer to numerous stakeholders and meet performance goals across multiple levels of achievement such as quality, cost, and satisfaction. Furthermore, in a recent study of chief nursing officers it was found that 62% of nurse leaders plan to retire, leave the profession, or change jobs within the next five years (Jones, Havens, & Thompson, 2009). This scenario of change requires an in-depth look at options for optimizing the development of highly skilled nurse leaders. Transformational leadership is identified as an empowering leadership style that can be used within today's hospital and nursing environment to improve organizational outcomes (McGuire & Kennerly, 2006). Coaching is believed to encompass several key characteristics of transformational transactional leadership and may be an effective means of developing and/or expanding the leader's skills and of guiding leader development of followers (Humphreys & Einstein, 2003; Kowalski & Casper, 2007). Using a correlated, non-experimental design, this research study explored the relationships between transformational and transactional leadership, coaching, and the impact of the leader-follower coaching relationship on followers' work performance, job satisfaction, work relationships, and job commitment. The sample consisted of 53 chief nurse leaders in hospital organizations and 301 of their direct nurse reports. The Multifactor Leadership Questionnaire (5X – Short) developed by Bass and Avolio (1999), a researcher-developed Coaching Behavior Measure (Ellinger, Ellinger, & Keller, 2003), and four researcher-developed visual analogue surveys of work-related outcomes were used to measure the variables of interest. Data analysis revealed the nurse leaders were dominantly transformational and used coa (open full item for complete abstract)

Committee: Susan Kennerly PhD (Committee Chair); Cheryl Hoying , (Committee Member); Nancy Evers PhD (Committee Member); Denise Gormley PhD (Committee Member) Subjects: Nursing