NUR5094 Module 4 leadership project implementation report example

Forty-Six Conversations and the Decisions They Forced: Implementing Stay Interviews on Three Medical Units, From Themes to Schedule Rules, Night Rounds and a Budget Line

Student Name

American College of Education

NUR5094: Capstone Practicum Experience for Role of the Nurse Administrator

Module 4 Assignment

Instructor Name

March 27, 2029

Implementation Against the Plan

The managers' preparation session took place in week six. Between weeks seven and eleven, the three managers held stay interviews with 46 of the 49 eligible nurses, 94% against a target of 90%. Two of the three not interviewed were on leave and one declined. Seventeen of the 46 worked mainly nights; managers met them at 0630 or 0700, before or after their shifts, as planned. Interviews averaged 24 minutes. The managers recorded 71 commitments in total, and by week twelve had reported back to the nurse on 58 of them, 82% against a target of 80%. The author met each manager weekly and led three meetings of the managers, and the mentor covered the planned weekend call shifts.

What the Nurses Said

The author and the managers coded the interview notes into themes, using the nurses' own words where possible. Four themes dominated. Inconsistent handling of schedule requests was raised by 29 of 46 nurses, who described approvals that seemed to depend on who asked and when. Feeling invisible on nights was raised by 16 of the 17 night-shift nurses, who said they saw their manager only when something went wrong. Lack of recognition, the item the practice environment survey had flagged, was raised by 18. Workload peaks from late-afternoon admissions were raised by 15. Twelve nurses, most in their second or third year, asked about support for specialty certification, and eight said a competing hospital's higher pay had tempted them.

The themes largely confirmed the exit interview reasons from Module 2, but the conversations added what the exit data could not: specific, fixable detail. The practical value lay in the specificity that Wang et al. (2023) identify as the method's purpose: learning what, concretely, would keep a particular nurse engaged. An exit interview tells a manager that scheduling was a problem; a stay interview tells the manager which three requests were denied and why the nurse thought it was unfair.

The Decisions

The themes required decisions at two levels. At the unit level, the managers agreed in the second managers' meeting on a single written policy for schedule requests across the three units, with a request window, a rule for competing requests based on a rotating priority list and a standard reply within five days. They also agreed that each manager would be on the unit at the start of the night shift or the end of it at least one day a week, rotating so that every night nurse would see a manager at least twice a month, and that each unit would hold a monthly recognition huddle at shift change, with nominations from staff.

At the service line level, the director made two decisions. She approved funding for a specialty certification review course and the examination fee for up to 12 nurses a year, about 7,200 dollars, arguing to the chief nursing officer that it cost less than one-eighth of a single departure. She declined to pursue unit-level pay adjustments, which are set by the system's compensation team, but forwarded the aggregate pay concerns to human resources with the turnover data, and told the managers to say so honestly when nurses raised pay. The late-afternoon admission peaks were referred to the patient flow committee, since they arise from emergency department and bed management processes beyond the units' control.

How the Schedule Policy Was Built

Because scheduling was the most common theme, the way the new policy was built deserves a closer look. The managers' first instinct, in the second meeting, was to write the policy themselves over a weekend. The author suggested instead that each manager bring a pair of staff nurses, a day worker and a night worker, with at least one of the pair still in their first three years, to a 90-minute working session. The mentor approved paying the six nurses for the time. The session began with the anonymized interview quotes about scheduling projected on the wall, which made the problem concrete without singling anyone out. The nurses then described how requests actually worked on each unit, and the group discovered that the three units used three different request windows and that one unit had no rule at all for competing requests, so that approval depended on who emailed first. The group drafted a single policy in the session: requests open eight weeks before a schedule posts and close at six, holidays rotate on a published list, competing requests for the same weekend are settled by a rotating priority order that resets each quarter, and every request receives a written answer within five days. The managers agreed to post each schedule with the requests approved and denied, without names, so that nurses could see the rules being applied. The policy took effect for the schedule posted in week eleven. Involving staff nurses took more time than the managers' weekend plan would have, but it produced a policy nurses had helped write, and two of the six took on explaining it at their units' staff meetings, which the managers could not have done as credibly.

Difficulties and How They Were Handled

Three difficulties arose. In four interviews, nurses raised concerns about their own manager. The managers had been prepared for this, and three of the four conversations went well; in the fourth, the manager became defensive, and the nurse raised the matter with the director afterward. The director met with the manager, and the manager later described the conversation as the most useful feedback received in years. Second, a manager fell two weeks behind in week eight because of a staffing crisis; the mentor joined that manager's interviews for a week, as planned, and the manager caught up. Third, several nurses asked whether their comments would be shared. The managers explained that themes, never names, would go to the managers' meeting, and the author confirmed that the notes shared with the group contained no identifying details.

Lessons for the Administrator's Role

The implementation corresponds to the moving stage of the change model the project used. Lewin (1947) emphasized that change requires not only new behavior but a new equilibrium, and the managers' practice shifted once the first commitments were kept and nurses began to mention them to colleagues. Three lessons stand out. First, the administrator's contribution was less in the interviews than in making the managers' follow-through possible: protected time, a shared policy and a budget line that turned a conversation into an action. Second, relational leadership, which research links with better outcomes for nurses (Cummings et al., 2018), requires structural support; the managers were not unwilling to lead relationally, they had no time or routine for it. Third, honesty about what cannot be changed, such as pay, did not undermine trust; nurses said they valued hearing it directly. Module 5 reports what the project achieved against its objectives.

References

Cummings, G. G., Tate, K., Lee, S., Wong, C. A., Paananen, T., Micaroni, S. P. M., & Chatterjee, G. E. (2018). Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review. International Journal of Nursing Studies, 85, 19-60. https://doi.org/10.1016/j.ijnurstu.2018.04.016

Lewin, K. (1947). Frontiers in group dynamics: Concept, method and reality in social science; social equilibria and social change. Human Relations, 1(1), 5-41. https://doi.org/10.1177/001872674700100103

Wang, A., Devine, C., Hamilton, L., & Layton, M. (2023). Do not wait until it is too late: Using stay interviews to engage and retain nursing staff. Nursing Leadership, 36(1), 46-56. https://doi.org/10.12927/cjnl.2023.27124