NUR5094 Module 5 leadership project evaluation example

From Fifty-Seven to Seventy-Six Percent Planning to Stay: Evaluating the Stay Interview Project Against Baseline and Targets, Read Through Structure, Process and Outcome

Student Name

American College of Education

NUR5094: Capstone Practicum Experience for Role of the Nurse Administrator

Module 5 Assignment

Instructor Name

April 10, 2029

The Evaluation Framework

Donabedian (1988) set out three sources of evidence for judging quality: structure, meaning the settings, resources and organization in which care is provided; process, meaning what is actually done; and outcome, meaning the effects on those served. The framework applies equally well to a leadership intervention. For this project, structure is the policies, time and resources put in place; process is whether the stay interviews and follow-through happened; and outcome is whether nurses' intent to stay, their experience of their managers and, eventually, turnover changed. Reading the results in this order matters, because an outcome cannot be attributed to a process that did not occur, and a process cannot occur without the structure to support it.

Structure and Process

The structural changes were all in place by week twelve. All three managers completed the preparation session. A single schedule request policy, built with staff nurses, was in force on all three units from week eleven. The managers' rotation for meeting night-shift nurses was scheduled through the end of the year. The director's budget line for certification review courses and examination fees was approved, and stay interviews were added to each manager's annual goals and to the new manager orientation.

The process targets were met. Forty-six of 49 eligible nurses, 94%, had a stay interview, against a target of 90%. Managers recorded 71 commitments and reported back on 58, 82%, against a target of 80%. After the schedule policy took effect, every schedule request in the audited period received a written answer within five days, compared with no consistent practice before. The managers held 14 of the 16 planned early-morning or late-evening contacts with night-shift nurses in the four weeks after the rotation began.

Outcomes

Intent to stay. On an anonymous survey of early-career nurses at week six, before the interviews, 28 of 49, or 57%, said they intended to stay on their unit at least another year. At week twelve, 34 of 45 respondents, 76%, said so. Among night-shift nurses, the proportion who agreed that they saw their manager regularly rose from 12% to 59%.

Early turnover. In the twelve weeks from the start of the interviews, three registered nurses left the three units, compared with eight in the same twelve weeks of the previous year. One of the three who left had declined an interview. Because turnover varies from month to month and year to year, twelve weeks is far too short to judge it, and the project's target for turnover is set for twelve months.

Practice environment. The manager support subscale will be remeasured in the hospital's next survey in the autumn, and cannot yet be evaluated. Every measure that could move in twelve weeks moved in the intended direction; the measures that matter most to the budget have not yet had time to move.

Costs and Potential Return

The project's direct costs were about 1,350 dollars to pay nurses for interview time, 600 dollars for the preparation session and materials and about 500 dollars to pay six staff nurses for the schedule policy session, a total of about 2,450 dollars, with the certification support adding 7,200 dollars a year from the next budget cycle. Managers' time was absorbed within their roles, with the mentor's covered call shifts. Using the finance department's estimate of about 61,000 dollars per registered nurse departure, derived with an inflation-adjustment approach of the kind Jones (2008) describes, preventing one departure would return roughly six times the project's first-year costs including the certification line. If the service line reached the hospital's average turnover of 15%, about 12 fewer departures a year, the saving would approach 730,000 dollars, although the project alone is unlikely to achieve that and other factors, including pay, will influence the result.

How the Findings Compare With Other Reports

The themes the interviews produced were close to those reported elsewhere, which gives some confidence that they reflect common features of nurses' work rather than local quirks. In the published report of 75 stay interviews on two cardiothoracic units, nurses said unit culture, their team and their schedules kept them, and pay, development and travel opportunities pulled them away (Snyder et al., 2023). The medical units' nurses named the same pulls, particularly pay and development, and the same anchors, with scheduling appearing as both an anchor where it was fair and a push where it was not. Two differences stand out. First, night-shift isolation, which dominated the medical units' interviews, did not appear as a separate theme in the published report, perhaps because the cardiothoracic units had different leadership coverage at night. Second, the medical units' nurses spoke more about recognition, consistent with their low score on the manager support subscale. The comparison also suggests where the project's effect may be limited. Pay and travel opportunities, which both reports identify as reasons to leave, lie outside the unit managers' authority, so stay interviews can reduce the push factors managers control but cannot remove the pull of higher wages elsewhere. That is one reason the recommendations below ask for twelve-month turnover to be interpreted alongside the system's compensation decisions rather than attributed to the project alone. It is also why the director sent the pooled comments about pay on to the human resources team, so that what the interviews uncovered reaches the people with authority over it. The project's value, in other words, depends partly on whether the organization listens beyond the unit level, and the executive presentation in Module 6 will make that point directly.

Limits and Recommendations

The evaluation has important limits. There was no comparison group; all three medical units took part, and other hospital units were not surveyed. The intent to stay survey could reflect nurses' appreciation of being asked as much as a lasting change in plans, and nurses may have answered more favorably after a personal conversation with their manager. The twelve-week turnover comparison is too short and too small to support a conclusion, and seasonal patterns differ between years. The practice environment effect is not yet measurable. Finally, the author was both the evaluator and a staff nurse on one of the units, which may have influenced how colleagues answered and how the results were read, despite the anonymous survey.

The author recommends four things, which the mentor has presented to the chief nursing officer. Continue stay interviews at the first and second anniversaries of every registered nurse on the three units, as already built into managers' goals. Extend the schedule request policy to the hospital's surgical units, whose managers have asked for it. Track twelve-month turnover and intent to stay quarterly, with the same survey, and report both to the nursing executive team. And, if twelve-month turnover on the medical units falls meaningfully, pilot stay interviews on one surgical unit with a comparison unit, to give the hospital stronger evidence before system-wide adoption. Module 6 presents the project to the hospital's executives.

References

Donabedian, A. (1988). The quality of care: How can it be assessed? JAMA, 260(12), 1743-1748. https://doi.org/10.1001/jama.1988.03410120089033

Jones, C. B. (2008). Revisiting nurse turnover costs: Adjusting for inflation. Journal of Nursing Administration, 38(1), 11-18. https://doi.org/10.1097/01.NNA.0000295636.03216.6f

Snyder, A., Whiteman, K., DiCuccio, M., Swanson-Biearman, B., & Stephens, K. (2023). Why they stay and why they leave: Stay interviews with registered nurses to hear what matters the most. Journal of Nursing Administration, 53(3), 154-160. https://doi.org/10.1097/NNA.0000000000001261