Digital Repository Masters Projects Spring 2023 Authentic Leadership and Nurse Retention Christopher Gibson Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Gibson, C. 2023. Authentic leadership and nurse retention. Weber State University Masters Projects. https://dc.weber.edu/collection/ATDSON This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact scua@weber.edu. WSU REPOSITORY MSN/DNP Authentic Leadership and Nurse Retention Project Title Christopher Gibson, BSN, RN, MSN Student Student’s Name A project submitted in partial fulfillment of the requirements for the degree of DOCTOR OF NURSING PRACTICE Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY Ogden, UT Christopher Gibson, BSN, RN, MSN Student April 2, 2023 Student Name, Credentials (electronic signature) Date 04/27/2023 DNP Project Faculty (electronic signature) Date 04/27/2023 Melissa NeVille (electronic signature) Norton DNP, APRN, CPNPPC, CNE Graduate Programs Director Note: The program director must submit this form and paper. Date 1 Authentic Leadership and Nurse Retention Christopher A. Gibson, BSN, RN, MSN Student Weber State University Annie Taylor Dee School of Nursing 2 Abstract This paper addresses the need for leadership to foster a healthy work environment and support staff in delivering high-quality, evidence-based, safe patient care. An organization’s leadership type can affect employee satisfaction and intention to leave due to a lack of resources, increased workloads, insufficient staffing, and poor working conditions. Relational leadership styles, such as authentic leadership, have been found to foster a positive work environment. Promoting job satisfaction among nurses and improving patient outcomes is vital to maintaining a sufficient workforce and reducing medical errors and healthcare costs. This project will assist in implementing authentic leadership training to promote a positive work environment and ensure nurse retention. Keywords: authentic leadership, relational leadership, nurse retention, job satisfaction. 3 Authentic Leadership and Nurse Retention Leadership and management influence job satisfaction at every stage of a nurse's career. The nurse leader is responsible for ensuring that high-quality, evidence-based care is provided to patients and supporting staff as needed. Specchia et al. (2021) demonstrate that leadership style significantly impacts nurses' job satisfaction and intent to leave. In their study, several leadership styles were discussed, and it was found that laissez-faire, passive-avoidant, and authoritarian styles led to employees feeling uncared for, unmotivated, and unappreciated. Authentic leadership has been shown to have many positive aspects, including a greater sense of job satisfaction and greater employee retention (Maziero et al., 2020; Mintz, 2019). Authentic leadership involves advocating for the nurse's well-being, empowering nurses to make decisions, promoting a team atmosphere, and fostering a culture of transparency and trust (Gigol, 2020). Additionally, nurses are more likely to feel empowered and respected if a team environment is promoted, and they are given the autonomy to make decisions regarding their work environment and appropriate workload (Maziero et al., 2020). As a result, they are more likely to feel a sense of purpose and meaning in their work, reducing burnout (Maziero et al., 2020). Overall, it has been shown that nurse leaders with relational leadership practices, such as authentic leadership skills, are more likely to achieve better outcomes in the workplace (Algeri et al., 2022). It has been found that positive leadership styles foster positive outcomes in the workplace (Eriksson et al., 2022). Furthermore, authentic leadership is correlated with an increase in trust in management and nurse engagement, which contributes to an increase in the quality of care provided (Bernardes et al., 2020). By demonstrating appreciation for their employees' work, leaders reduce stress levels as individuals can accurately evaluate their 4 progress toward achieving their goals (Moloney et al., 2020). Thus, a positive work climate and trust are developed within the organization (Moloney et al., 2020). According to Mrayyan et al. (2023), an authentic leadership style can be defined as a direct, honest style of leadership that fosters a safe work environment based on trust and relational transparency. Relational transparency involves clarity and a balanced evaluation of information contributing to a safe practice environment (Mrayyan, 2023). In addition, a thorough understanding of the relevant information, skills, and specialties is critical to maintaining a safe practice environment. Statement of Problem It is important to note that an ongoing global nursing shortage existed before the COVID19 pandemic (Turale & Nantsupawat, 2021). COVID-19 had an immense and far-reaching impact on the healthcare community, with nurses at the forefront of providing care. Due to the influx of patients, the healthcare system became overwhelmed, and it became clear how serious the situation was. Nurses faced unprecedented strains due to increasing demands, long working hours, virus exposure, and increased patient workload. Consequently, high levels of psychological distress led to burnout as they could not cope with the job demands (Turale & Nantspawat, 2021). As a result, the nursing shortage was further exacerbated by nurse burnout caused by chronic stress and decreased job satisfaction (Turale & Nantspawat, 2021). According to Rivaz et al. (2017), many stressors contribute to decreased job satisfaction, including inadequate resources, excessive workload, inadequate staffing, and an unpleasant work environment. Moreover, Sullivan et al. (2022) found that chronic stressors contributed to poor health, including sleep deprivation, hypertension, cardiovascular diseases, depression, and other illnesses leading to increased absenteeism. In a separate study, Filipova (2022) found a 5 correlation between poor management, bullying, burnout, and nurses' intent to leave. Zaghini et al. (2020) found that poor management and leadership styles are associated with decreased job satisfaction, ultimately leading to lower-quality patient care. The same study also found that relational leadership styles, including authentic leadership, enhance positive work environments and patient care (Zaghini et al., 2020). According to Rivaz et al. (2017), a lack of resources, increased workloads, inadequate staffing, and poor practice environments can decrease job satisfaction. Additionally, the authors attribute an ethical environment to a safe working environment that promotes patient safety in the intensive care unit (Rivaz et al., 2017). Chronic stress contributes to poor health, including decreased immune response resulting in illness and increased absenteeism (Sullivan et al., 2022). Other adverse effects include sleep deprivation, hypertension, cardiovascular diseases, and depression (Sullivan et al., 2022). In the United States, 35% to 45% of new nurses are estimated to quit within the first year due to chronic stressors (Gayol & Lookingbill, 2022). Finally, although nurses are on the front lines of health care, they are often excluded from decision-making processes (Um-e-Rubbab et al., 2021). Promoting an environment of authentic leadership and recognizing nurses' valuable work makes them more likely to feel like valued partners and remain in the field. This will create trust and collaboration and ensure everyone strives for the same goal (Um-e-Rubbab et al., 2021). Therefore, organizations must provide adequate resources to help nurses cope with these chronic stressors, including effective leadership training (Eriksson et al., 2022). Ways Project Contributes to Intended Recipients Interestingly, organizations expend substantial time and money on training nurses, with an estimated cost per nurse of $50,000 (Kiel, 2020). It is estimated by Alshawush et al. (2020) 6 that nurse training costs between $10,000 and $88,000 for each new graduate nurse hired. However, according to Kelly et al. (2020), nurse turnover costs in the United States range from $11,000 to $92,000. According to Edmonson and Zelonka (2019), higher turnover rates could cost hospitals between $4 and $7 million annually. Evidence suggests that authentic leadership reduces nursing burnout by promoting a positive work environment that can positively impact the nurses' overall health, resulting in better patient care (Alilyyani, 2018). Additionally, increasing nurse engagement has improved job satisfaction, decreased turnover rates, and improved patient care quality (Frasier, 2019). It has been estimated that hospitals can save an additional $333,500 per percent change in nurse turnover based on these outcomes (Edmonson & Zolonka, 2019). These savings may lower healthcare costs. Thus, it would seem logical that organizations would benefit from retaining their current nursing staff, resulting in cost savings. Furthermore, more senior nursing staff are retained, and turnover rates are decreased; more experienced staff would be available to train newly hired nurses. Upon completing their onboarding training and mentoring, recent graduates have a greater chance of retaining their positions (Lindsay & Mathieson, 2022). Thus, this project aims to encourage organizational leaders and managers to adopt authentic leadership styles in their daily practice and to determine whether nurse retention relates to authentic leadership styles in a hospital's leadership structure. Rationale for the Importance of Project The nursing shortage continues to be a concern worldwide, and patient populations are growing and changing, as well as technological advancements changing the environment in which nurses practice (Haddad et al., 2022). It is essential to understand the impact of authentic leadership on nurse retention in light of factors contributing to job dissatisfaction and high nurse turnover rates. Burnout has been shown to decrease staff retention and productivity as overtime 7 levels increase. Therefore, leaders should better understand the nursing staff's stresses and foster a more positive working environment (Gayol & Lookingbill, 2022). According to the United States Bureau of Labor Statistics (BLS), nursing jobs will grow by 6% between 2021 and 2031, with approximately 203,200 positions available each year as nurses change occupations or retire (BLS, 2022). As nurses provide direct and indirect patient care, authentic leadership is essential for promoting a positive work environment (Suliman et al., 2020). Maintaining an adequate workforce, improving patient outcomes, reducing errors, and reducing healthcare costs cannot be overstated. Therefore, promoting job satisfaction among nurses and reducing the turnover rate is imperative. Literature Review and Framework Evidence-based change frameworks were reviewed to determine an appropriate model for this project. In addition, a literature review regarding authentic leadership and work environments was also conducted. The model applied to the project will be discussed in greater detail in the following section, including authentic leadership and work environments. Framework This MSN project will utilize the Stetler model to guide evidence-based change to support authentic leadership in acute care. According to the National Collaboration Centre for Methods and Tools (NCCMT), the Stetler model is a five-step process for developing and implementing evidence-based practice in healthcare organizations (NCCMT, n.d.). The model was developed to increase nurses' ability to design and implement effective and cost-effective interventions to improve patient outcomes and healthcare delivery. The Stetler model has five steps: preparation, validation, comparative evaluation, translation, and application (Huybrechts, 2021). The Stetler model examines work environments such as the Medical/Surgical department. 8 Based on the National Collaboration Centre for Methods and Tools [NCCMT] (n.d.), the Stetler Model examines "the relationship between research use and evidence-based practice" (para 1). The Stetler Model is not only designed for individual practitioners but can also facilitate organizational change. Overall, the Stetler model aligns with the purpose of this research project. Strengths and Limitations According to Indra (2018), the Stetler Model has some limitations; however, it provides expert consensus and data for operational evaluation and quality improvement, according to the NCCMT (n.d.). The Stetler Model facilitates the effective use of research findings by facilitating critical thinking and decision-making. Furthermore, it examines how research evidence can be applied to create patient-centered change. According to Christenbery (2017), practitioners can use the Stetler Model to assess how research findings and other relevant evidence are applied to clinical practice. Implementing a training program for management and leadership will assist in convincing the leadership of this small hospital to adopt an authentic leadership style. Analysis of Literature A literature review examined the impact of authentic leadership on the work environment, job satisfaction, and nurse retention. Only literature published between 2017 and 2022 was considered. Below, each theme and how the literature supports them will be discussed in more detail. Search Strategies The literature search used Weber State University LibGuide, Google Scholar, CINAHL, PubMed, Ovid, and Cochrane Library. To broaden the search criteria, keywords and Boolean operators included: nurse retention, nurse burnout, nurse intention to leave, bullying in the nursing profession, authentic leadership, positive leadership styles, nursing shortage, nurse 9 turnover, retaining new graduates, effective leadership, and nurse retention. Inclusion criteria included studies that examined the relationship between leadership styles and nurses' job satisfaction and were also available in full text. Based on the literature review, three themes were identified, including factors that lead to job dissatisfaction and nurses' intent to leave, leadership styles and their impact on nurse retention, and nurses' health and well-being. Job Dissatisfaction and Intent to Leave According to Gayol and Lookingbill (2021), nurses' job dissatisfaction, burnout, and intention to leave are caused by various factors. Based on the Maslach Burnout InventoryHuman Services Survey, the authors found that improving nurses' well-being can significantly improve nurse retention; however, available resources are needed to be more effective. However, this study did not provide any information regarding leadership styles, but it did contribute to identifying factors that contribute to high nurse turnover rates. An additional study by Rivas et al. (2017) involved nurses, head nurses, and supervisors from five teaching hospitals in Iran. The authors examined the adequacy of staff numbers and resources needed to improve job satisfaction. It was determined through one-on-one interviews using open-ended questions that inadequate resources included equipment, staffing, and the physical environment (Rivas et al., 2017). Similarly, a systematic review was conducted by Sullivan et al. (2022), which identified contributing factors such as increased workload, moral distress, flawed support systems, limited resources, limited training, and bullying. The authors found that nurses in acute care settings reported mental, physical, and emotional exhaustion due to these factors. Additionally, burnout was associated with poor mental and physical health and low nurse retention (Sullivan et al., 2022). Finally, according to Olaleye et al. (2021), bullying has a detrimental effect on employee 10 performance and morale, and more research is needed to understand the organizational context. A study conducted by Lin et al. (2021) examined the challenges nurses faced daily during the COVID-19 pandemic. The authors found that many inequities, including a pressing nursing shortage, were exposed to the public. This study yielded an 86.2% response rate from (n=1,183) nursing students. In this sample of nursing students, 49.1% decided not to continue their studies, 45.4% said they would not enter the nursing profession, and 23.7% chose a position in healthcare that did not involve patient contact because they feared infection, death, or the risk of bringing illnesses home. Furthermore, Bartzik et al. (2021) found that nurses worldwide experienced an increased sense of appreciation from society; however, they also experienced a lack of support from management. The literature review also identified bullying as a common cause of job dissatisfaction and turnover. The most common sources of bullying were leadership and seasoned nurses (Alshawush et al., 2020; Edmonson, C., & Zelonka, 2019; Filipova, 2022). According to Edmonson & Zelonka (2019), bullying in nursing is an unfortunate reality, and many nurses refer to it as "eating their young." (para. 2). In addition, Filipova (2022) found that bullying and leadership styles are related to burnout and the intent to leave the organization. An analysis of a simple random sample of (n = 855) nurses was conducted from a pool of 4,306 nurses in a midwestern US state; a total of (n = 168) nurses were included in the study. A significant correlation was found between bullying (r = 0.47, p > 0.001) and nurses' intent to leave the organization (r = 0.45, p > 0.001). Aside from bullying, other variables contributed to nursing job dissatisfaction and intent to leave. According to Molina-Praena et al. (2018), in their systematic review of 38 articles and meta-analysis of 6,092 nurses, 31% experienced high emotional exhaustion, 24% had high 11 depersonalization, and 38% had decreased personal accomplishment. Additionally, hospitalbased nurses frequently reported increased workloads that resulted in stress and emotional exhaustion (Davey et al., 2019). Kelly et al. (2021) investigated resilience, burnout, and turnover in healthcare organizations. According to data collected from surveys of (N = 1,688) nurses, 54% were experiencing moderate burnout, while 28% were experiencing high burnout. According to the authors, burnout commonly influences nurses' intention to leave their positions. Furthermore, the authors concluded that leadership should take proactive steps to reduce nurse burnout and increase nurse retention. Despite this, the study needs to provide evidence of the electiveness of leadership styles. Authentic Leadership and its Impact on Nurse Retention Based on a review of (n=59) sources, Lu et al. (2019) found a statistically significant correlation between job satisfaction and authentic leadership (β = 0.16, p < 0.01). According to the authors, job satisfaction among nurses is related to the work environment, empowerment, professional commitment, patient satisfaction, and safe patient-to-nurse ratios. Additionally, Rivas et al. (2017) and Sullivan et al. (2022) suggest that addressing the factors associated with job dissatisfaction is necessary. Furthermore, the authors conclude that improving job satisfaction among nurses is vital to the success of today's healthcare, which can lead to improved patient outcomes. According to Cummings et al. (2018), a systematic review of 129 studies found that higher job satisfaction was related to authentic leadership and improved employee relationships. Similarly, Fiorini et al. (2020) found that the types of leadership nurses were directly exposed to influence their behavior. In their cross-sectional study of 479 nurses across 42 medical/surgical units, they concluded that leadership styles significantly impact burnout and job dissatisfaction. 12 Additionally, nurses dissatisfied with their leadership are more likely to engage in counterproductive behaviors, negatively affecting patient outcomes (Fiorini et al., 2020). Similar conclusions were reached by Specchia et al. (2021), who reported that the least effective leadership styles include transactional, laissez-faire, and passive-avoidance styles that resulted in lower job satisfaction and lower nurse retention. As a result, nurses may feel under pressure to achieve their goals without guidance or emotional support. Nevertheless, they also observed a positive correlation between job satisfaction and authentic leadership (Speccia et al., 2021). Additionally, Maziero et al. (2020) found that authentic leadership motivated nurses to perform better than expected based on attitudes, behaviors, engagement, and job satisfaction. Furthermore, these results were associated with customer satisfaction, cost reductions, and reduced turnover and absenteeism. A cross-sectional observational study conducted by Bernardes et al. (2020) demonstrated that mentoring, coaching, and learning programs contribute to the development of leadership skills in participants. They assessed the ability of leaders to employ authentic leadership styles in their current practice using the Authentic Leadership Questionnaire (ALQ). In another study by Kim and Lim (2022), a quasi-experimental study called "High-Up" was developed. After five weeks, a program for strengthening nursing management competency was developed, implemented, and evaluated among experienced hospital nurses. The experimental group consisted of 22 nurses, while the control group consisted of 20 nurses. This study's intervention (High-Up) effectively improved management competency (pre-intervention score: 3.48 + 0.36; post-intervention score: 3.71 + 0.49; Z = 1.99, p = 0.046). To maintain competence, the authors also concluded that continuing education is necessary. This study demonstrates the effectiveness of educational programs designed to train leaders in authentic 13 leadership practices. Nurse Well-Being and Patient Outcomes Burnout is a real and common problem that affects nurses' well-being in various ways. Burnout is caused by high-stress levels, a lack of resources, and constantly changing demands at work (Molina-Praena et al., 2018). It leads to a significant decrease in motivation, fatigue, and feel of isolation, leading to serious physical and mental health problems. It has become an important health and safety issue in nursing careers, affecting quality care and patient outcomes (Molina- Praena et al., 2018). A systematic review of the literature conducted by Alilyyani et al. (2018) found a significant relationship between nurses' well-being and authentic leadership. Ultimately, the authors conclude that organizations benefit significantly from authentic leadership and that current and future leaders should be educated and trained. However, the authors suggest that more research and testing be conducted to determine whether authentic leadership affects patient outcomes. Similarly, Edmonson and Zelonka (2019) found that bullying can profoundly affect a nurse's physical and mental health. The authors found a strong correlation between bullying and high-stress and high-stakes work environments with heavy workloads and limited autonomy. Additionally, Edmonson and Zelonka (2019) report that 60% of nurses leave their jobs because of bullying by their coworkers within the first six months of employment. Additionally, bullying may create situations that compromise the safety of patients. Overall, an effective leadership style can mitigate a culture of bullying among nurses, an imbalance of workloads, dangerous nurse-to-patient ratios, and inadequate resources that negatively affect the work environment. Finally, part of the leadership's job is to ensure that nurses care for themselves. Setting an example, helping nurses achieve a work-life balance, and focusing on self-care 14 initiatives effectively support and manage burnout. By addressing these issues, it may be possible to retain appropriate nursing staff and improve the quality of patient care (Kelly et al., 2020). Summary of Literature Review Findings and Application to the Project. These findings suggest that negative workplace factors influence nurses' intent to leave, and leadership can positively or negatively impact the workplace. As a result, organizations risk losing competent and talented healthcare professionals without a more positive work environment. Moreover, organizations face an increased risk of medical errors, poor patient outcomes, negatively perceived facilities, and revenue loss. Nursing leadership and management have an opportunity to recruit, train, or encourage new or existing staff to adopt positive leadership styles. Overall, the negative trends throughout the healthcare system must be fixed, and change must begin with leadership. Project Methodology This project aims to determine if an authentic leadership style is associated with nurse retention and job satisfaction. The following section discusses data collection and presentation methods, as well as the implementation and dissemination of this project. Description and Development of Project Deliverables First, a visual timeline has been included to guide the implementation process (Appendix A). Next, during the preparation phase, a leadership questionnaire (Appendix B) will be distributed to the stakeholders to assess how they relate to having an authentic leadership style. The authentic leadership questionnaire (ALQ) was adapted from one Walumbwa and Associates developed in 2008 (Farid et al., 2020). The sixteen questions assess leadership characteristics, including self-awareness, moral perspective, balanced processing, and relational transparency The responses are rated on a Likert scale ranging from one to five, where one represents "strongly disagree," and five represents "strongly agree." They are tallied at the end and provide insight into those likely to possess authentic leadership styles. 15 Next, a PowerPoint presentation (Appendix C) about this project will be presented to stakeholders. The PowerPoint presentation will include an overview of the problem statement, the impact of the global nursing shortage, factors contributing to nursing burnout, the average cost of turnover and training, and the effects of leadership on nurse retention and departure intent. Additionally, this PowerPoint presentation will be presented to the faculty overseeing this project and to student peers. Next, a disclosure form (Appendix D) will accompany the questionnaire (Appendix E) to assess the RN staff’s perception of their current leadership and overall job satisfaction. Inclusion criteria include demographics, job satisfaction, perceptions of leadership styles, the nursing staff’s intent to remain in their current positions, and factors influencing their decisions. The candidates for inclusion are registered nurses (RNs) or licensed practical nurses (LPNs) who have served in their current position for at least 70% of the time under their current leadership in the Medical/Surgical department. Finally, the RN staff questionnaire will remain open for four weeks, and a reminder e-mail will be sent each week. Finally, to evaluate any changes in stakeholders' perceptions of authentic leadership styles, the leadership questionnaire (Appendix B) will be reissued at the end of phase two to be included in phase three's data analysis. Finally, a formal leadership training program is outlined (Appendix F). The leadership training program will occur at the end of the evaluation and dissemination phase, pending approval by stakeholders. Plan and Implementation Process Following the conclusion and presentation, the stakeholders will decide if implementing a formal leadership training program is feasible based on the evidence presented. Based on the overall feedback from the stakeholders, a formal leadership training program should be researched and revised. One leadership training program was developed by Frasier et al. (2019) and is provided 16 in Appendix F. Alternatively, it may be possible to hire consultants to help design an authentic leadership program. Planning and implementation will occur upon approval, and each phase is projected to occur over nine weeks and relies on volunteer participation. Interdisciplinary Teamwork Developing this project requires interdisciplinary teamwork, and stakeholders whose interests are affected can influence its adoption or rejection (Lobiondo-Wood & Haber, 2018). Furthermore, stakeholders should be aware of how leadership styles impact workplace environments and how they ultimately affect patient care. Additionally, the importance of teamwork between nursing staff members whose work environment is directly affected cannot be overstated. To ensure the success of this project, the following individuals are essential. Chief Nursing Officer (CNO): The CNO is responsible for many organizational changes that affect nursing staff. Ultimately, the CNO must approve this project before it can be adopted and implemented. Director of Clinical Operations: This individual oversees the Medical/Surgical Unit and the Emergency Department. Their approval is also required to implement this MSN project and comply with the leadership training program. Nurse Leaders: Clinical coordinators and charge nurses primarily oversee the unit's daily activities and assign tasks to the nursing staff. Their leadership roles are crucial in influencing others and creating a cohesive and safe environment. Therefore, the unit will benefit from their cooperation with authentic leadership training. Nursing Staff: For successful implementation, it is also essential that the nursing staff directly affected by leadership styles work together. Employees should be made aware of what authentic leadership style is and what it means for the work environment. 17 Timeline The planned implementation process is illustrated in a visual/graphic timeline (Appendix A). This project is expected to take nine weeks to complete. As part of the preparation phase of this project, stakeholders will be identified, and their knowledge of authentic leadership styles will be evaluated. Next, a PowerPoint presentation will be developed and presented to the stakeholders. Then, the questionnaire will be sent to the recipients along with the disclosure/consent form. The online questionnaire phase will be open for four weeks, and each week a reminder email will be sent to potential participants about their voluntary responses. Then, at the end of the questionnaire phase, the analysis phase will be conducted for two weeks. Next, the leadership knowledge concerning their understanding of authentic leadership style will be reevaluated, and the findings will be analyzed and reported. The project's feasibility will be determined based on the evidence obtained during the evaluation and dissemination phases. Finally, submission for the final poster presentation will mark the end of this project. Plan for Evaluation of Project The fourth phase of this project involves evaluating and disseminating the results and is estimated to occur over one week. Stakeholders will be presented with the findings of the previous phases at this time, and the feasibility of implementing formal leadership training will be assessed. In addition, stakeholders will assess the appropriateness, cost-electiveness, and sustainability of the proposed evidence-based change (Nelson-Brantley et al., 2021). In addition, leadership will be evaluated on their knowledge of authentic leadership styles at the beginning of phase one and again at the end of phase two before data collection and analysis takes place. Finally, the results of this phase will be shared with the project faculty, the content expert, and 18 student peers before the creation of the final poster presentation. Ethical Considerations The ethical considerations for this project have been taken into account. Permission must be obtained from the intended organization to implement this project. Therefore, all dissemination purposes must be clearly defined. The online questionnaire's disclosure and informed consent form will explain participants' rights. Anonymity will be maintained by removing all identifying information from the data. Each item will be fair, unbalanced, nondiscriminatory, honest, and diverse. Compensation will not be provided to reduce the influence of the participant's opinions or decisions. Contributing factors are factual determinants based on the literature used to support this project. This project will make its results available to all interested parties, and participant confidentiality will be fully maintained. Discussion This MSN project aims to determine whether an authentic leadership training program can be implemented to foster a more positive workplace environment. It has been shown that nurse leaders with relational leadership practices are more likely to achieve better outcomes in the workplace (Algeri et al., 2022). The following sections will discuss solutions for dissemination from evidence-based research, the significance of advancing nursing practice, the implications involved, and subsequent recommendations for translation into practice. Evidence-based Solutions for Dissemination Information gathered from this MSN project and intervention materials will be presented to stakeholders, peers, and faculty via a poster presentation. The objective is to disseminate information about the evidence-based intervention associated with this project to increase motivation for continual and sustainable implementation. Additionally, public awareness may be 19 achieved through social media platforms and interpersonal outreach (NHMRC, 2021). Furthermore, using several opinion leaders and social networks may also increase motivation to implement this evidence-based intervention (Flodgren et al., 2019). In addition, opinion leaders are influential users of online social networks developed to share and exchange information (Riquelme et al., 2019). Opinion leaders are generally identified as individuals capable of motivating community movements through social media postings, responses, and mentions (Riquelme et al., 2019). Significance to Advance Nursing Practice Studies that examined the relationship between authentic leadership in nursing align with this MSN project. According to these studies, authentic leadership contributed significantly to creating a positive work environment essential for nurse retention (Aliyyani et al., 2018; Cummings et al., 2018; Iqbal et al., 2019). As such, demonstrating honesty and truthfulness may encourage nurses to adopt this behavior as a norm, building an environment of trust within organizations (Iqbal, 2019). As such, nurses who trust their leaders are more likely to be engaged and satisfied in their work, resulting in a positive impact on the health of their patients (Alilyyani, 2022). Leaders must allow nurses to be creative, take ownership of their tasks, express their ideas, suggest initiatives to improve practices and celebrate individual accomplishments (Alilyyani, 2022). Generally, hospitals consider themselves to be providing a valuable service to their patients, and many patients consider themselves healthcare consumers (Akinleye et al., 2019). Patients are likely to return and recommend their care if they are satisfied with their care (Akinleye et al., 2019). In a business context, customer loyalty is determined by customer satisfaction. In turn, customer referrals generate more revenue for the organization (Akinleye et 20 al., 2019). Thus, authentic leadership can benefit the organization by fostering a healthy, positive work environment where patients feel safe and valued. In addition, authentic leadership can influence organizational goals and culture. By creating an atmosphere of trust, authentic leadership creates a sense of empowerment among nurses, inspiring them to remain part of the team and contribute to achieving the organization's goals. Implications and Limitations There is a strong correlation between psychological well-being and self-efficacy, availability of resources, and clearly defined goals for team members (Marques-Quinteiro et al., 2021). Additionally, team members may be less likely to react negatively to stressors when leaders provide clear objectives, responsibilities, and explanations of performance strategies. Funding this leadership training program for one year and evaluating its effectiveness and benefits would be necessary. However, budgetary constraints may hinder the development of the leadership training program and jeopardize its continuation. Furthermore, budgetary constraints could eliminate some leadership positions, potentially resulting in a lack of credible leadership. Therefore, organizations must see authentic leadership training as a long-term investment. Additional limitations related to the workplace environment. exist, such as bed occupancy, infection, and mortality rates. Moreover, the study would be conducted in one setting, which may affect the generalizability of the findings. Finally, the sample size would be small, and the results may be biased. Recommendations The development of authentic leadership and retention of nurses is imperative in today's multifaceted healthcare environment (Cummings et al., 2018). Therefore, it is imperative to emphasize the value of authentic leadership and its efficacy in gaining stakeholder support. Additional research and testing may be required to examine the effects of authentic leadership on 21 managers and employees (Marques-Quinteiro et al., 2021). As such, modifications may be necessary to ensure the success of future studies. For example, a multilevel or longitudinal design may help examine how context affects leadership behavior in the workplace (MarquesQuinteiro et al., 2021). The use of a longitudinal study may provide insight into the influence of context on leadership and outcomes. Utilizing a multilevel research design may provide insight into how contextual factors affect individual outcomes of team leadership behaviors (Marques-Quinteiro et al., 2021). Maximo et al. (2019) suggest that longitudinal designs should be used to determine causal relationships between similar projects and studies. As such, it would be beneficial to examine other related, positive leadership styles, such as transformational leadership, to eliminate potential outcomes associated with them (Maximo et al., 2019). Next, by increasing the sample size, obtaining more reliable results regarding the relationship between authentic leadership and work environments may be possible. Further, it would be beneficial to expand the scope of the project to include larger departments and organizations. Therefore, obtaining information from additional sources within the organization, a medical/surgical unit with more registered nurses, a higher patient population with a higher acuity level, and leadership positions could alleviate some of these problems (Maximo et al., 2019). Conclusion The literature has demonstrated that relational leadership styles, such as authentic leadership, contribute to positive outcomes for staff and patients (Cummings et al., 2018; Maziero et al., 2020). Individuals with good relational skills and a genuine concern for their staff must be placed in leadership positions (Schwepker & Dimitriou, 2021). Evidence-based 22 leadership training, interventions, continuing education, and a supportive work environment are essential for promoting authentic leadership behaviors among nurse managers (Labrague et al., 2021). According to Marquis and Huston (2021), implementing authentic leadership can be challenging for existing staff members and new leaders. There is often a period of adjustment during the initial transition as staff adjust to the change in leadership style and organizational structure. The response to a change in leadership styles should be met with transparency and acceptance of the feelings felt by nursing staff. To this end, it will be essential to encourage subordinates to openly express their views regarding the proposed change in leadership style, as demonstrated by authentic leadership. Further, the planning process should include those directly affected by the changes. Also, according to Marquis and Huston (2021), it will be beneficial to identify change agents and empower them to encourage others to accept the proposed changes in leadership. Nevertheless, once incorporated into the health system, these changes can be of long-term benefit. By demonstrating respect, trust, and encouragement, nurses can achieve a greater sense of job satisfaction and belonging on the job. As a result of improved team collaboration and coordination, patient satisfaction is improved. In addition, through authentic leadership, nurses tend to remain in their positions for an extended period, demonstrating that nurse retention is improved through authentic leadership (Marquis & Huston, 2021). In conclusion, by utilizing authentic leadership, healthcare organizations may build a cohesive team loyal to the organization and embed a culture of collaboration and trust. (Giordano-Mulligan, & Eckardt, 2019). A healthy work environment, employee engagement, and nurse empowerment can improve patient outcomes. In addition to improving patient outcomes, 23 healthcare costs can be reduced by reducing errors that lead to adverse events and costly litigation (Rodziewicz et al., 2022). Furthermore, an authentic leadership style must differ from traditional hierarchical and transactional leadership styles to impact nurse retention effectively. Developing self-awareness in leaders, promoting ethical or moral perspectives, and developing balanced processing benefit a hospital’s success (Cummings et al., 2018). 24 References Alilyyani, B. (2022) The effect of authentic leadership on nurses’ trust in managers and job performance: A cross-sectional study. Nursing Reports, 12(4), 993-1003. https://doi.org/10.3390/nursrep12040095 Aliyyani, B., Wong, C., & Cummings, G. (2018). Antecedents, mediators, and outcomes of authentic leadership in healthcare: A systematic review. 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Questionnaire Phase (4 weeks) Disseminate disclosure form and questionnaire online Questionnaire is open e-mail questionnaire to clinical nursing staff e-mail reminders at the beginning of each week Reevaluate leadership knowlege on authentic leadership 3. Analysis Phase (2 weeks) Collect and organize data Data analysis Interpretation of the results 4. Evaluation and dissemination phase (1 week) Conclusion Evaluation of the results Present findings Submit for final poster presentation 33 Appendix B Questionnaire to evaluate leadership knowledge about authentic leadership. Authentic leadership questionnaire (ALQ) Self-Assessment for Authentic Leadership Styles Instructions Elements of authentic leadership styles are provided in this questionnaire. Answer the following questions honestly according to how you feel about each element of authentic leadership. Scoring instructions are provided below. There are no right or wrong answers. 1. I am aware of my most significant weaknesses. 1. Strongly disagree 2. Disagree 3. Neutral 4. Agree 5. Strongly agree 2. My core values are reflected in my actions. 1. Strongly disagree 2. Disagree 3. Neutral 4. Agree 5. Strongly agree 3. I am comfortable with seeking others’ opinions before making decisions. 1. Strongly disagree 2. Disagree 3. Neutral 4. Agree 5. Strongly agree 4. I am open and comfortable sharing how I feel with others. 1. Strongly disagree 2. Disagree 3. Neutral 4. Agree 5. Strongly agree 5. I am aware of my greatest strengths. 1. Strongly disagree 2. Disagree 3. Neutral 4. Agree 5. Strongly agree 6. I am not controlled by group pressure. 1. Strongly disagree 2. Disagree 3. Neutral 4. Agree 34 5. 5. Strongly agree 7. I am able to listen to others’ ideas, even if they contradict my own. 1. Strongly disagree 2. Disagree 3. Neutral 4. Agree 5. Strongly agree 8. Who I am as a person is clearly known by others 1. Strongly disagree 2. Disagree 3. Neutral 4. Agree 5. Strongly agree 9. Feedback from others about who I am as a person is essential to me 1. Strongly disagree 2. Disagree 3. Neutral 4. Agree 5. Strongly agree 10. I am transparent about where I stand on controversial topics 1. Strongly disagree 2. Disagree 3. Neutral 4. Agree 5. Strongly agree 11. My personal point of view is not used at others’ expense 1. Strongly disagree 2. Disagree 3. Neutral 4. Agree 5. Strongly agree 12. How I present myself is honest and accurate. 1. Strongly disagree 2. Disagree 3. Neutral 4. Agree 5. Strongly agree 13. My feelings about myself are strongly accepted 1. Strongly disagree 2. Disagree 3. Neutral 4. Agree 5. Strongly agree 14. What I do as a leader is strongly influenced by my moral character. 1. Strongly disagree 2. Disagree 35 3. Neutral 4. Agree 5. Strongly agree 15. Before I make decisions, it is important to me that I listen to the ideas of others. 1. Strongly disagree 2. Disagree 3. Neutral 4. Agree 5. Strongly agree 16. I am able to admit my mistakes to others 1. Strongly disagree 2. Disagree 3. Neutral 4. Agree 5. Strongly agree Scoring Self-awareness is represented in 1, 5, 9, 13. • Add your totals here _____ 2. Moral perspective is represented in 2, 6, 10, 14. • Add your totals here _____ 3. Balanced processing is represented in 3, 7, 11, 15 • Add your totals here _____ 4. Relational transparency is represented in 4, 8, 12, 16 • Add your totals here _____ Total scores: Self-Awareness ___ Moral/Ethical Perspective ___ Balanced Processing ___ Relational Transparency Interpretation___ 16-20 indicates stronger authentic leadership 36 15 and lower indicate weaker authentic leadership. Note. This authentic leadership questionnaire (ALQ) is based on one Walumbwa & Associates (2008) developed. It will be used to assess the knowledge of authentic leadership. It will be given to the stakeholders at the beginning of the preparation phase and again at the conclusion during the evaluation and dissemination phase. 37 Appendix C PowerPoint Presentation Slide 1 Slide 2 38 Slide 3 39 Slide 4 Slide 5 40 Slide 6 41 Slide 7 42 Appendix D Disclosure and Informed Consent I wish to invite you to participate in a study about leadership styles and how they influence job satisfaction, nurse turnover rates, and workplace safety. This questionnaire determines your understanding of leadership roles in your hospital unit. This study is being conducted by Christopher A. Gibson, BSN, RN, MSN student. Funding for this project has not been provided. Participation is strictly voluntary. Participants must meet two criteria: Must be registered nurses or licensed practical nurses and have been in their current position for 70 percent of the time under their current leadership. It is implied that consent has been given by completing this survey. Participating in this survey may not benefit you directly; however, the information obtained will help determine what leadership qualifications are needed in the healthcare field in the future. You may skip any questions you do not want to answer, and you may end at any time. If you choose to participate, your information will be kept strictly confidential to the fullest extent permitted by law. A unique code will be assigned to your information for this study. Your name will be kept in a locked file. The information you provide will only be visible to other researchers attached to this study and me. Following completion and analysis of the data, participant names and links to study numbers will be destroyed. Study results will be presented only as summaries, and your name will not appear in any report. Despite your information being kept confidential, your information can be compromised when sent over the Internet. 43 Appendix E Participant questionnaire Demographics Hospital Unit: Job title: a) Registered Nurse b) Licensed Practical Nurse Experience 0-5 years 5-10 years 10- 20 years 20+ years How satisfied are you with your current position? 1. Extremely satisfied 2. Somewhat Satisfied 3. Neutral 4. Somewhat dissatisfied 5. Extremely dissatisfied How much do you agree with each of the following statements? 1) “My manager always provides a clear goal for our unit.” 1. Strongly disagree 2. Disagree 44 3. Neutral 4. Agree 5. Strongly agree 2) “My manager is a role model on how to work with others effectively 1. Strongly disagree 2. Disagree 3. Neutral 4. Agree 5. Strongly agree 3) “My ideas and input are valued by my manager 1 Strongly disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly agree 4) “My manager encourages me to do my job to the best of my ability.” 1. Strongly disagree 2. Disagree 3. Neutral 4. Agree 5. Strongly agree 5) “I am confident that my manager has the technical knowledge to lead the unit.” 1. Strongly disagree 45 2. Disagree 3. Neutral 4. Agree 5. Strongly agree 6) “My manager is consistent with effective decisions” 1. Strongly disagree 2. Disagree 3. Neutral 4. Agree 5. Strongly agree 7) “My manager is a highly effective in leading the unit” 1 Strongly disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly agree 8) “My manager encourages me to learn and grow” 1 Strongly disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly agree 9) “My manager is a highly effective in leading the unit” 46 1 Strongly disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly agree 10) “My manager encourages me to learn and grow” 1. Strongly disagree 2. Disagree 3. Neutral 4. Agree 5. Strongly agree 11) “My manager provides useful feedback on a regular basis” 1 Strongly disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly agree 12) “My manager consistently holds 1 on 1 meetings with each team member” 1 Strongly disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly agree 47 13) “My manager cares about each team member as individuals” 1 Strongly disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly agree 14) “My manager consistently shares valuable and important information with me.” 1 Strongly disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly agree 15) How likely are you to remain in your current role? 1. Extremely unlikely 2. Unlikely 3. Undecided 4. Likely 5. Extremely likely Note. This questionnaire will be emailed to the Medical/Surgical Unit RN staff at the end of the preparation phase and will be open for four weeks. A weekly reminder will also be sent to each RN staff. At the beginning of the analysis phase, the data will be collected, analyzed, and interpreted before the beginning of the evaluation and dissemination phase. 48 Appendix F Proposal for leadership training structure Didactic learning structure for leadership training (Frasier et al., 2019) v Introduction and overview of the following are characteristics of being an authentic leader. Ø Self-Awareness § Being able to understand your own strengths, weaknesses, and the impact they have on others. Know your own values and know what you stand for. Ø Balanced processing § Being able to process and accept differing viewpoints and opinions before making decisions. Ø Relational transparency § Being able to admit your mistakes, having the ability to be open and honest about the information, and the opinions that you share with your team. Ø Moral perspective § Being able to do the right thing, self-regulation of your own behavior and practicing with high standards of ethical and moral behaviors. Ø Inspire And Empower Those Around You. § Being an inspiration your team and empower them for high achievements that adds personal value and greater assets to your unit (Frasier et al., 2019). v Mastering the five components outlined in the introduction. Ø Attendees will attend and learn more in depth the five components of authentic 49 leadership outlined in the introduction. v Practicing the five components Ø Attendees will attend this one-day seminar where they will put into practice what they have learned from session one. v Biweekly check-in. Ø Attendees will keep a journal, discuss their experiences, and offer encouragement and constructive feedback.