Digital Repository Masters Projects Spring 2023 Improving Job Satisfaction Among Breastfeeding Nurse Employees Hayley Gashler Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Gashler, H. 2023. Improving job satisfaction among breastfeeding nurse employees. 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 Improving Job Satisfaction Among Breastfeeding Nurse Employees Project Title by Hayley Gashler Student’s Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY Ogden, UT 04/11/2023 Date Hayley Gashler BSN, RN, MSN Student 04/11/2023 Student Name, Credentials Date (electronic signature) Jamie Wankier MSN, RN 04/11/2023 MSN Project Faculty Date (electronic signature) 05/25/2023 Melissa NeVille Norton (electronic signature) DNP, APRN, CPNP-PC, CNE Graduate Programs Director Note: The program director must submit this form and paper. Date 1 Improving Job Satisfaction Among Breastfeeding Nurse Employees Hayley Gashler, BSN, RN, MSN Student Weber State University Annie Taylor Dee School of Nursing 2 Abstract Breastfeeding nurse employees face unique challenges that require improved workplace lactation support from their organization, clinical leaders, and colleagues. Improving workplace lactation support can increase job satisfaction among breastfeeding nurse employees. This MSN project aims to explore and address the need for increased support for breastfeeding nurse employees. This project discussed many benefits to nursing job satisfaction by providing education and resources on workplace lactation to clinical leaders, staff, and breastfeeding nurse employees. The collaboration of interdisciplinary team members in this project ensures the creation of a comprehensive educational presentation and associated resources to provide breastfeeding nurse employees with increased workplace lactation support. Pre-and post-project surveys will be administered to assess the effectiveness of the project and its impact on job satisfaction. During this project’s implementation, breastfeeding nurse employees will receive lactation education and resources to provide support in balancing returning to work and breastfeeding. An additional benefit of the project is that clinical leaders and colleagues will be more equipped to support breastfeeding nurse employees by understanding workplace lactation policy and techniques to improve interventions in the workplace. Evidence-based research indicated that workplace lactation support could increase job satisfaction and improve patient outcomes. Keywords: Breastfeeding nurse employee, workplace lactation support, breastfeeding support, leader support, and job satisfaction 3 Improving Job Satisfaction Among Breastfeeding Nurse Employees In recent decades women have represented a larger share of the labor market and workforce (U.S. Department of Labor, 2021), and nearly 80% of the healthcare workforce is women (U.S. Bureau of Labor Statistics, 2022). Employees can experience increased job satisfaction and organizational commitment when they feel their employers support their worklife balance (Jantzer et al., 2017; Lisbona et al., 2020). Working mothers experience a variety of stressors when navigating work-life balance (Rajgariah et al., 2021). One stressor working mothers may face is combining breastfeeding and working. The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months and continued breastfeeding for one year or longer (WHO, 2022). Women are placed in a difficult position when breastfeeding goals are unattainable due to a lack of workplace breastfeeding support (Wallenborn et al., 2018). Additionally, breastfeeding nurse employees experience unique challenges when combining working and breastfeeding (Wambach & Britt, 2018). The work of a professional nurse is categorized by 12-hour shifts, limited flexibility, and mental and physical demands that are unlike other settings in which women work (Wambach & Britt, 2018). Breastfeeding nurse employees face distinct challenges when expressing breast milk or pumping at work. Expressing milk means removing breast milk from breasts other than when the baby is feeding and can be done with hand expression or with a manual or electric pump (CDC, 2021). When away from the baby, milk expression should be done every two to three hours and typically takes up to 20-30 minutes during each session (CDC, 2021). Breastfeeding nurse employees have difficulty stepping away from patient care responsibilities for long periods for breast milk expression (Froh & Spatz, 2016). Breastfeeding nurses have stated they feel discomfort asking for staff coverage for extended periods multiple times per shift, especially in 4 understaffed conditions (Froh & Spatz, 2016; Ramsey et al., 2021). Some breastfeeding nurse employees have difficulty finding adequate unoccupied spaces for milk expression in the hospital setting (Froh & Spatz, 2016; Wambach & Britt, 2018). Breastfeeding nurse employees often feel rushed and guilty leaving patient areas for milk expression breaks, and during breaks, they may worry about their patients (Ramsey et al., 2021; Wu et al., 2022). Breastfeeding nurse employees also have concerns about potential workplace pathogenic bacteria that could compromise their breastmilk or child’s health, making the lactation experience stressful (Wu et al., 2022). Nurses can experience improved workplace breastfeeding support through clinical leadership support and, in turn, experience increased quality of work life and job satisfaction (Li et al., 2021; Scott et al., 2019; Wambach & Britt, 2018). Statement of Problem Although research has demonstrated a positive association between workplace lactation support and employee job satisfaction, breastfeeding nurse employees continue to feel undersupported by leaders (Jantzer et al., 2017; Lisbona et al., 2020; Scott et al., 2019; Whitley et al., 2019). Furthermore, breastfeeding employees experience discomfort discussing breastfeeding support with employers, especially if the employer is male (Chang et al., 2021; Ramsey et al., 2021). According to Wu et al. (2022), staff nurses stated that although their hospital had lactation policies and procedures, they felt unsupported by their administration and peers in breastfeeding needs, making it very difficult to step away to pump while working. According to Ramsey et al. (2021), research demonstrated that the majority of healthcare professionals (88%) agreed that 2030 minutes every 2-3 hours should be necessary to express milk; however, only 18% felt comfortable asking for a schedule change to accommodate time to pump. To exacerbate the problem further, many employers and leaders have inaccurate information regarding lactation 5 support and its effect on their organization and view lactation benefits as discretionary (Chang et al., 2021; MacMillan Uribe et al., 2019). Many breastfeeding nurse employees are unaware of the already instituted workplace breastfeeding policies or programs to help support them in their breastfeeding goals (Froh & Spatz, 2016; Litwan et al., 2021). Therefore, this MSN project explores if lactation education and workplace support influence job satisfaction among breastfeeding nurse employees at a local hospital. This goal will be accomplished by examining current literature to determine the specifics of the problem and identify best practices to develop education and provide workplace support for the breastfeeding nurse population. Ways Project Contributes to Intended Recipients Recipients that benefit from this MSN project include the breastfeeding infant, breastfeeding nurse employees, coworkers, hospital administration, unit leaders, and patients. The proposed MSN project can benefit the breastfeeding infant by potentially increasing breastfeeding rates and duration. Breastfeeding infants can experience multiple health benefits, including a reduced risk of childhood medical conditions such as ear infections, sudden infant death syndrome (SIDS), allergic conditions, and respiratory tract infections (Bar et al., 2016). Research among breastfeeding infants has also shown a long-term risk reduction of obesity, inflammatory bowel disease, and celiac disease (Bar et al., 2016). Healthier children benefit the family and the parent’s employer because of reduced sick calls to tend to sick children (Bhattarai, 2022). This MSN project benefits breastfeeding nurse employees by providing education and support, which may increase job satisfaction. Increasing job satisfaction among breastfeeding nurse employees through lactation support also increases organizational commitment and vertical 6 trust among employees (Lisbona et al., 2020). Ross & Woszidlo (2022) found that employee perception of lactation support increased breastfeeding employees’ organizational commitment and job satisfaction and that of their coworkers. Employees want to be a part of an organization that supports all coworkers and supports employees in achieving work-life balance (Jantzer et al., 2017). Additionally, clinical leaders, unit managers, and human resource managers can benefit from the proposed MSN project by providing them with education and resources to support their employees, thus increasing job satisfaction (Scott et al., 2019). Hospital administration and the organization as a whole benefit from increased employee job satisfaction (Lisbona et al., 2020) Patients will also indirectly benefit from this MSN project because their nurses’ increased job satisfaction and investment will lead to better patient outcomes and positive patient experiences (Labrague, 2021). Increased job satisfaction also leads to increased nurse retention and improved quality of patient care (Gensimore et al., 2020). In summary, the intended recipients benefit significantly from the proposed MSN project, demonstrating the importance of this MSN project. Rationale for Importance of Project The proposed MSN project initiatives are valuable because they align with previous research highlighting the importance of workplace lactation support as it relates to job satisfaction (Jantzer et al., 2017; Li et al., 2021; Lisbona et al., 2020; Scott et al., 2019; Whitley et al., 2019). In 2010 the Fair Labor Standards Act (FLSA) was amended to require employers to provide basic accommodations, such as space and time, for breastfeeding mothers at work (U.S. Department of Health and Human Services, 2021). Despite the passage of the FLSA amendment, employees still face challenges such as time constraints or discomfort in asking for time to 7 express breast milk while at work (Chang et al., 2021; Ramsey et al., 2021), adequate amenities or resources (McCardel & Padilla, 2020), and lack of employer, managerial, or colleague support (MacMillan Uribe et al., 2019; Wu et al., 2022). Research has revealed several ways to improve or incorporate workplace lactation interventions and their positive association with job satisfaction (Jantzer et al., 2017; Scott et al., 2019; Whitley et al., 2019). According to Scott et al. (2019), the research demonstrated that job satisfaction among female healthcare employees was positively impacted by organizational and managerial support of workplace lactation interventions. However, minimal research has been conducted in healthcare settings; this MSN project will address a gap in practice and focus specifically on lactation support and education for nursing staff. This MSN project explores if lactation education and workplace support influence job satisfaction among breastfeeding nurse employees at a local hospital. It is crucial to address common workplace lactation support problems, such as a lack of employer and managerial support due to knowledge gaps (Chang, 2021; Froh & Spatz, 2016; MacMillan Uribe, 2019; Wu et al., 2022). Breastfeeding nurse employees must be aware of lactation resources and workplace-provided support (Froh & Spatz, 2016; Litwan et al., 2021). Bradford et al. (2017) highlighted the importance of creating a workplace breastfeeding policy and the need for systemwide education for leaders, administrators, and staff, especially in hospitals and clinics (Bradford et al., 2017). It is common for nursing staff to prioritize patient care before their own needs or experience discomfort in asking for time to pump at work (Froh & Spatz, 2016; Ramsey et al., 2021; Wu et al., 2022). Regarding job satisfaction, it is crucial to support the population of breastfeeding nurse employees (Wu et al., 2022). 8 Literature Review and Framework A literature review was performed to obtain the most relevant research, current evidence, and best practices regarding workplace lactation support and its effects on breastfeeding nurse employees’ job satisfaction. Various evidence sources were examined, explored, and evaluated for applicability to the proposed MSN project. Evidence-based frameworks were examined based on the MSN project problem and rationale. The Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Model was chosen because of its role in evidence-based practice changes within nursing (Melnyk & Fineout-Overholt, 2019). Framework The JHNEBP Model was chosen as the framework to implement this MSN project. The JHNEBP Model was created with bedside nurses in mind and seeks to embed evidence-based practice (EBP) into nursing practice (Melnyk & Fineout-Overholt, 2019). Nurses' evaluation and feedback were incorporated in creating the framework resulting in a method that includes a conceptual model, a process, and tools to guide nurses through the critical steps of the process (Newhouse et al., 2008). The JHNEBP Model begins with an inquiry that initiates the PET process (Practice question, Evidence, and Translation). The PET process is a systematic approach for nurses to develop a practice question, examine quality evidence, and translate that evidence into practice (Melnyk & Fineout-Overholt, 2019). Within the three phases of the PET process, there are 19 prescriptive steps. Though the steps appear linear, iterations are necessary, allowing the EBP initiative to evolve. During the practice question phase of the model, a PICOT question is formed, leaders and stakeholders are identified, and an interprofessional team is developed. In the evidence phase of the model, internal and external evidence are examined, and the evidence 9 is appraised, synthesized, and rated based on the quality of the evidence. In the final stage, labeled translation, an action plan is created, implemented, evaluated, and disseminated. The JHNEBP has provided ten tools to support the crucial steps in the PET process and guide nurses through the EBP process (Melnyk & Fineout-Overholt, 2019). The JHNEBP Model applies to this MSN project because it is nursing-centric and focused on the translation of research. The model emphasizes the importance of inquiry and developing a question out of curiosity (Melnyk & Fineout-Overholt, 2019). The PICOT question for this MSN project was triggered by interest and recognition of a needed change for breastfeeding nurse employees. The JHNEBP Model highlights the importance of creating an interdisciplinary team to coordinate, plan, and implement EBP. This MSN project requires various multidisciplinary team members, including nursing staff, clinical leadership, and human resource managers. The JHNEBP Model recognizes that sources of evidence are found outside of randomized control trials in non-research evidence and thus provides a rating system to assess the level and quality of non-research evidence to assist nurses in evidence appraisal (Melynk & Fineout-Overholt, 2019). This MSN project relies heavily on non-research evidence because measuring job satisfaction among breastfeeding employees requires qualitative research, systematic reviews, and quality improvement data. Strengths and Limitations Researchers must be aware of several strengths and limitations when using the JHNEBP Model. The strengths of the JHNEBP Model include the nursing-centric design, usability, and access to helpful tools (Johns Hopkins University, 2022). The JHNEBP was created for and evaluated by bedside nurses; this MSN project is nurse-driven and focuses on benefiting the bedside nurse. The JHNEBP is user-friendly, and the easy step-by-step process is spelled out, 10 providing users confidence as they navigate EBP changes (Schaffer et al., 2013). Another strength of the JHNEBP Model is the availability of ten tools to aid nurses in some of the most critical steps in the process. Some of the ten tools of the model guide developing PICOT questions, forming an interdisciplinary team, evidence appraisal, action planning, and dissemination (Melnyk & Fineout-Overholt, 2019). Additionally, the JHNEBP tools guide and prompt nurses throughout the change process and can be revamped and updated to match the ever-changing needs of healthcare and research (Johns Hopkins University, 2022). This MSN project relies upon multiple leaders and disciplines, requiring a streamlined framework and process to encourage the EBP change process to run smoothly. The JHNEBP Model and guidelines have been used successfully in numerous reviews and have been found to bolster nurses' involvement in EBP (Liu et al., 2021). Limitations of the JHNEBP Model include a lack of a system-wide context and that iterations are not explicitly encouraged (Schaffer et al., 2013). The JHNEBP Model is nursedriven and focused on the experience of the bedside nurse; however, in the process, many broader picture implications could be missed. The nursing-centric nature of the model lends itself to a lack of system-wide context that the bedside nurse may be unaware of, including instituting organizational policies and procedures, the interdependency of making changes, and budgetary implications (Schaffer et al., 2013). Another limitation of the JHNEBP Model is that the step-bystep process does not inherently allow for iterations or changes as the user follows the PET process (Schaffer et al., 2013). Users may unintentionally miss opportunities for a meaningful iteration or direction change because they fixate on completing each of the 19 steps in sequential order. Although the JHNEBP Model has some limitations, it remains a good fit for this MSN project. 11 Analysis of Literature Following the evidence appraisal steps of the JHNEBP Model, a thorough literature review was performed on implementing workplace breastfeeding support and its effects on breastfeeding nurse employees’ job satisfaction. The literature review utilized a robust and specific search strategy to obtain evidence-based information on the project topic. The strategies identified three themes common in the literature surrounding the topic of breastfeeding support and its effect on job satisfaction. Search Strategies A literature search was conducted to identify current evidence using Weber State University’s Stewart Library’s OneSearch and Advanced Search (spanning multiple databases), Google Scholar, CINAHL, MEDLINE, and PubMed. The search included keywords of breastfeeding, breastfeeding support, lactation support, lactation intervention, workplace support, leader support, job satisfaction, and nurse employees. Various keywords and Boolean operator combinations were used to create a broad search. Only articles from 2016 through 2022 were included in this literature review to keep the information current. Three major themes were identified in a literature search for the PICOT question: In breastfeeding nurse employees, does access to lactation education resources and workplace support result in increased job satisfaction? First, the unique challenges breastfeeding nurse employees face. The second theme identifies interventions the organization can implement to improve workplace breastfeeding support. The third theme explores how workplace lactation support affects job satisfaction. 12 The Unique Challenges Breastfeeding Nurse Employees Face Research has demonstrated the barriers working mothers face when navigating breastfeeding and employment (Chang et al., 2021; Hillard & Schneidermann, 2019; Snyder et al., 2018; Taylor et al., 2020). More specifically, breastfeeding nurse employees encounter barriers due to strenuous shifts, highly stressful and time-sensitive work environments, and emotional and physical demands (Wambach & Britt, 2018). Froh & Spatz (2016) analyzed responses from 410 participants working as full or part-time nurses at a large children’s hospital. The researchers found that nurse employees felt their work environment and culture were not conducive to breastfeeding (Froh & Spatz, 2016). Research demonstrated that understaffed conditions made stepping away from work responsibilities challenging to pump for 30-45 minutes multiple times per shift (Froh & Spatz, 2016). Wu et al. (2022) explored breastfeeding experiences among Intensive Care Unit (ICU) nurses. Researchers conducted semi-structured in-depth interviews with 10 ICU nurses to investigate difficulties in breastfeeding while at work. Within the Wu et al. (2022) study, multiple participants stated that “breastfeeding policies did not matter as much as having supportive unit leaders and colleagues” (p. 5). Other findings from Wu et al. (2022) determined that the pumping process could be stressful for the nurse employee. That stress is created by stepping away from critical patients, feelings of guilt for transferring care of patients to colleagues while pumping, and concerns about pathogenic bacteria in the ICU environment that would affect the safety of their breastmilk (Wu et al., 2022). Additionally, researchers found that nurses were unaware of workplace breastfeeding policies to help protect their rights and felt unsupported by colleagues to leave the unit when they needed to pump (Froh & Spatz, 2016). 13 Multiple research studies highlighted breastfeeding nurse employees' discomfort in requesting time to step off the unit to express breast milk (Froh & Spatz, 2016; Ramsey et al., 2021; Wu et al., 2022). Breastfeeding nurse employees also experienced difficulty finding adequate unoccupied spaces for milk expression in the hospital setting (Froh & Spatz, 2016; Wambach & Britt, 2018). The research showed that breastfeeding nurse employees experienced unique barriers and challenges regarding workplace lactation and felt a lack of support from their leaders and colleagues (Froh & Spatz, 2016; Ramsey et al., 2021; Wu et al., 2022). The Interventions the Organization can Implement to Improve Workplace Breastfeeding Support Multiple studies explored the most effective interventions for workplace breastfeeding support (Kim et al., 2018; Lennon et al., 2017; Litwan et al., 2021; Vilar-Compte et al., 2021). In a thorough systematic review, Litwan et al. (2021) analyzed 39 publications examining the effectiveness of workplace breastfeeding interventions. The researchers found that increasing awareness of the interventions and resources, changing the workplace culture among managers and coworkers regarding breastfeeding, and providing time and space for lactation proved effective (Litwan et al., 2021). In another focused, systematic review, Vilar-Compte et al. (2021) extracted data from 28 quantitative and nine qualitative studies to examine the most and least common lactation interventions, highlighting a need for a combination of interventions such as designated lactation spaces, adequate break times, and written organizational policies as key strategies. Furthermore, multiple studies examined interventions more broadly, such as policy development in creating breastfeeding-friendly organizations (Bradford et al., 2017) or state and legislative laws regarding breastfeeding (Hilliard & Schneidermann, 2019). Additional research assessed potential gaps in workplace breastfeeding support (McCardel & Padilla, 2020; Reat et 14 al., 2019). Bradford et al. (2017) highlighted the importance of creating a workplace breastfeeding policy and the need for system-wide education for leaders, administrators, and staff, especially in hospitals and clinics. Organizational and managerial support are crucial aspects of workplace breastfeeding support for breastfeeding nurse employees (Scott et al., 2019). MacMillan Uribe et al. (2019) explored the decision-making process of Human Resource Managers (HRMs) through 16 semistructured interviews. The researchers discovered three themes; first, HRMs want to meet the needs of their employees; second, HRMs view lactation benefits as discretionary; and third, providing lactation benefits is strongly influenced by the HRMs’ perception of employee needs (MacMillan Uribe et al., 2019). In a quantitative study, Lisbona et al. (2020) also analyzed how managers’ support in lactation predicts trust and organizational identity for working mothers (n=1,028). They found that perceived manager support for breastfeeding is significant (p < .05) for increasing organizational identification and vertical trust (Lisbona et al., 2020). Chang et al. (2021) examined employers’ perceptions and experiences in workplace lactation support and highlighted gaps in knowledge or education about breastfeeding, concerns about the adverse effects of breastfeeding employees on the workplace, and awareness of employees’ discomfort in discussing breastfeeding, especially with male employers. The literature examined demonstrated effective interventions employers and organizations can implement to improve workplace breastfeeding support (Bradford et al., 2017; Litwan et al., 2021). Additionally, the literature highlighted the essential role of leaders and managers in supporting breastfeeding employees. However, evidence also highlighted leaders’ knowledge gaps or inaccurate perceptions of workplace lactation support (Chang et al., 2021; Lisbona et al., 2020; MacMillan Uribe et al., 2019). 15 Workplace Lactation Support Affects Job Satisfaction Several studies found a positive relationship between workplace breastfeeding support and job satisfaction (Jantzer et al., 2017; Ross & Woszidlo, 2022; Taylor et al., 2020; Whitley et al., 2019). Whitley et al. (2019) assessed responses from women (n = 488) examining workplace breastfeeding concerns. The researchers found a statistically significant (p <.05) relationship between workplace breastfeeding problems and low job satisfaction, namely that the higher the workplace breastfeeding problems, the lower the job satisfaction at 3, 9, and 12 months postpartum (Whitley et al., 2019). Multiple studies highlighted the importance of workplace support to counteract potential staff breastfeeding issues (Litwan et al., 2021; Vilar Compete et al., 2021). Scott et al. (2019) surveyed breastfeeding female employees in a healthcare system. Research determined that organizational and managerial support for breastfeeding significantly (p < 0.001) increased job satisfaction and exclusive breastfeeding (Scott et al., 2019). Similarly, in a quantitative cross-sectional study among nurses in a hospital setting, the support of clinical leadership was positively associated with the score of quality of work life (p < .001) (Li et al., 2021). Additionally, Ross & Woszidlo (2022) found that employee perceptions of breastfeeding support lead to increased job satisfaction and employee investment and commitment to the organization. The research findings highlighted that workplace breastfeeding support increases breastfeeding nurse employees’ job satisfaction and that of their coworkers (Ross & Woszidlo, 2022; Scott et al., 2019; Whitley et al., 2019). Summary of Literature Review Findings and Application to the Project A detailed review of current literature on workplace breastfeeding support and nurse employee job satisfaction demonstrated the unique challenges breastfeeding nurse employees encounter, the interventions to increase workplace breastfeeding support, and its effects on job 16 satisfaction. The literature emphasized the problem and the importance of addressing workplace breastfeeding support for breastfeeding nurse employees. The literature review information emphasized that breastfeeding nurse employees face unique challenges, such as a lack of time and amenities to express breastmilk, discomfort in requesting time to pump, heightened levels of stress about the pumping process, and a lack of support from clinical leaders and colleagues (Froh & Spatz, 2016; Ramsey et al., 2021; Wu et al., 2022). Additionally, research suggested that the role of organizational leaders and human resource managers is critical; however, many lack accurate knowledge and understanding of workplace lactation support (Lisbona et al., 2020; MacMillan Uribe et al., 2019; Scott et al., 2019). The literature examined other interventions that could be implemented to improve workplace lactation support (Bradford et al., 2017; Litwan et al., 2021; Vilar Compete et al., 2021). These included increasing staff awareness of lactation resources, enhancing a breastfeeding-friendly work environment, ensuring adequate time, space, and amenities for breastfeeding employees, and system-wide education for clinical leaders, administrators, and staff (Bradford et al., 2017; Litwan et al., 2021; Vilar Compete et al., 2021). Additional evidence demonstrated a positive relationship between workplace lactation support and employee job satisfaction (Ross & Woszidlo, 2022; Scott et al., 2019; Whitley et al., 2019). Researchers found that immediate and long-term job satisfaction is increased with workplace breastfeeding support (Li et al., 2021; Ross & Woszidlo, 2022; Scott et al., 2019; Whitley et al., 2019). Additionally, information showed that clinical leadership plays a critical role in employee quality of work life and that workplace breastfeeding support can lead to increased job satisfaction (Li et al., 2021; Ross & Woszidlo, 2022; Scott et al., 2019; Whitley et al., 2019). 17 The literature review conducted supports the potential problem for breastfeeding nurse employees. Furthermore, the findings suggested possible solutions for educating clinical healthcare leaders and staff regarding workplace breastfeeding policies. Project Methodology This MSN project addresses the need for increased support for breastfeeding nurse employees. The project accomplishes this by providing education and resources to clinical leaders, staff, and breastfeeding nurse employees. Deliverables were created to promote this project’s introduction, implementation, and evaluation within the University of Utah Health inpatient hospital system. Some of these deliverables include (a) a PowerPoint presentation with resources for clinical leaders regarding workplace breastfeeding support, (b) a customizable welcome-back brochure with lactation resources and policies for nurses returning from maternity leave, (c) a pre- and post-presentation survey to assess knowledge gaps and effectiveness of education among clinical leaders, and (d) a pre- and post-project survey assessing job satisfaction among breastfeeding nurse employees. The plan for change and implementation will be discussed with an emphasis on the interdisciplinary team, the timeline, and the evaluation process, and additional ethical considerations will be covered. Description and Development of Project Deliverables Four project deliverables were developed to aid in the implementation of this project. In this section, the deliverables are described, along with an explanation of the importance and function of each deliverable. PowerPoint Presentation for Clinical Unit Leaders The first deliverable is a PowerPoint presentation for clinical leaders (see Appendix A). This presentation will demonstrate the need for and the importance of increased workplace 18 breastfeeding support for nurse employees by highlighting their unique challenges and the relationship between workplace breastfeeding support and job satisfaction (Froh & Spatz, 2016; Li et al., 2021; Ramsey et al., 2021; Ross & Woszidlo, 2022; Scott et al., 2019; Wambach &Britt, 2018; Whitley et al., 2019; Wu et al., 2022). The PowerPoint presentation will also provide varied resources for administrative staff and leaders on how to improve workplace breastfeeding support for breastfeeding nurse employees (Bradford et al., 2017; Chang et al., 2021; Lisbona et al., 2020; Litwan et al., 2021; U.S. Department of Health and Human Services, 2021). The presentation delivery allows time for a discussion about concerns leaders have and an opportunity for questions and answers regarding implementing workplace lactation support. The goal will be disseminating the PowerPoint presentation and associated resources to the clinical leaders’ unit nursing staff. Welcome-back Brochure with Resources for Nurses Returning from Maternity Leave The second deliverable is a welcome-back brochure for nurses returning from maternity leave (see Appendix B). The brochure addresses knowledge gaps that breastfeeding nurse employees have regarding their employer’s lactation policies, provides the employee with lactation education resources, and demonstrates employer and clinical leader support toward the breastfeeding nurse employee. Another purpose of this welcome-back resource is to remind the returning employee to discuss any potential issues they may encounter navigating their return to work and breastfeeding with their direct manager. The brochure includes logistical information such as the nearest lactation room, federally mandated break times, and other support measures. (U.S. Department of Health and Human Services, 2021). Other information includes lactation education resources for maintaining milk supply upon return to work, cleaning a breast pump and equipment, and breast milk storage. (CDC, 2021). The breastfeeding nurse employee should 19 feel more equipped with lactation education and resources and feel supported by their clinical leaders in navigating their return to work. A Pre-and Post-Presentation Survey The third deliverable is a pre-and post-presentation survey to assess stakeholder knowledge and the effectiveness of education among clinical leaders (see Appendix C). Before the presentation, a brief anonymous survey will be distributed to clinical leaders in attendance. The pre-presentation survey will determine knowledge gaps regarding the workplace breastfeeding policy and lactation support resources. Upon completion of the presentation, a short anonymous post-presentation survey will be administered to the clinical leaders and will be used to measure the effectiveness of the education provided. The post-presentation survey will include a Likert scale for attendees to rate the effectiveness of the educational information provided. A Pre-and Post-Project Survey The final deliverable created for the evaluation of this project is an adaptive pre-and postproject survey to specifically assess job satisfaction among breastfeeding nurse employees (see Appendix D). The survey will be administered before the project implementation and six months after project implementation to examine the effectiveness of the project on breastfeeding nurse employee job satisfaction. The pre-and post-survey will be given to all staff members and will address knowledge of workplace lactation policies and job satisfaction. This survey will include breastfeeding and breastfeeding support-related questions specifically for the nurse who is breastfeeding or has breastfed within the last three years. 20 Plan and Implementation Process Based on the implementation framework outlined in the JHNEBP model, the first step is creating an action plan, followed by implementation, evaluation, and dissemination (Melnyk & Fineout-Overholt, 2019). Part of the action plan involves getting buy-in from the stakeholders, including hospital administration, clinical leaders, and human resource representatives. Implementation of this project will occur once the hospital administration grants clearance. A pre-project survey will be administered to hospital nursing staff. The survey data will be analyzed and incorporated into the presentation and may guide resources based on knowledge gaps. The respective unit clinical leaders, Human Resource (HR) managers, and administrative staff will be invited to a scheduled presentation. The presentation will be held in a large conference room at the University of Utah Main Hospital. Individuals will have the opportunity to attend virtually, but in-person attendance will be recommended and preferred. The attendees will be asked to complete a brief pre-presentation survey before the presentation. An explanation of the project and the deliverables will be given during the presentation. Following the presentation, the project lead will lead a discussion addressing clinical leaders’ questions or concerns about the project or workplace lactation support. Following the discussion, the attendees will receive a brief post-presentation survey. The presentation and resources will be distributed to all attendees and those who cannot attend. Attendees will be encouraged to disseminate and forward the presentation and resources to all staff members. Immediately following the presentation meeting, the project brochure will be disseminated to all nurses returning from maternity leave and any current breastfeeding nurse employees (determined based on the pre-project survey). The post-project survey will be administered to hospital nursing staff six months following implementation. All staff will be 21 surveyed to examine pre-project knowledge gaps among employees and that those gaps have been addressed post-project. It is imperative to survey all staff to explore any confounding factors for job satisfaction. Interdisciplinary Teamwork The interdisciplinary team members involved in this project will collaborate by sharing expertise, knowledge, and skills to implement the MSN project. The interdisciplinary team members include a project lead, hospital administration, clinical nurse managers, HR representatives, an Internationally Board Certified Lactation Consultant, a charge nurse, and a breastfeeding nurse employee. The collaboration of interdisciplinary team members will ensure the creation of a comprehensive educational presentation and associated resources and provide breastfeeding nurse employees with increased workplace lactation support. Project Lead. The project lead will coordinate all meetings with the interdisciplinary team members. The project lead will present the PowerPoint presentation to the hospital administration and clinical leaders and lead the discussion following the presentation. The project lead will compile and analyze results and will then present results to hospital administration and stakeholders. The project lead will work collaboratively to ensure the deliverables are created, disseminated, and modified as needed. Hospital Administration. The hospital administration includes the Chief Nursing Officer (CNO) and hospital-wide policy committee team members. Hospital administration leaders will grant permission and clearance on the project’s plan and provide input on systemwide implementation and strategies for dissemination. The hospital administration will also assist in communicating and coordinating the presentation's date, time, and location. 22 Clinical Nurse Managers and Management Teams. The clinical leaders include unit nurse managers, unit nurse educators, unit administrative assistants, and schedulers. This management team will directly interact with the staff nurses and will be their point of contact for lactation support and resources. Additionally, this management group will be the presentation’s audience and participate in pre-and post-presentation surveys. The clinical leaders will disseminate the presentation and resources to their staff members and familiarize themselves with the content to support and assist their breastfeeding nurse employees. HR Representatives. The HR representatives will provide feedback and insight into the workplace lactation policies, procedures, and nurse employee leave resources to benefit the breastfeeding nurse employee. The HR representatives will attend or receive the administration presentation and work alongside unit clinical leadership to distribute the welcome-back brochure and resources for returning nurse employees. International Board Certified Lactation Consultant (IBCLC). The IBCLC will provide insight into the MSN project presentation and brochure materials by providing evidencebased lactation education resources. The IBCLC will work collaboratively with team members to ensure best practices and answer lactation-specific concerns or questions. In addition, the IBCLC will connect breastfeeding nurse employees with community and hospital resources as requested. Charge Nurse. The role of the charge nurse varies depending on the specific inpatient unit. The charge nurse's role involves ensuring an effective staff-to-patient ratio, making assignment adjustments based on staff needs or patient acuity, coordinating admissions, transfers, and discharges, and generally overseeing the unit's and staff's safety. A specific charge nurse from an inpatient unit will participate on the MSN project team by providing insight into the charge nurse's role in supporting workplace lactation policies. The charge nurse will have 23 relevant hands-on experience managing the unique challenges of balancing unit and patient safety and supporting breastfeeding nurse employees. Breastfeeding Nurse Employee. The breastfeeding nurse employee can highlight the challenges and benefits of breastfeeding in the workplace. The breastfeeding nurse employee will contribute by providing experiential insights about balancing breastfeeding and working. Timeline Once the hospital administration grants permission and clearance to implement this MSN project, the first step will be to determine and schedule the date and time of the presentation with clinical leaders, giving participants a month’s notice to address schedule conflicts. The presentation and discussion with clinical leaders will take one hour, including pre-and postpresentation surveys. When the date, time, and place are secured, the next step will be administering the pre-project survey to the nursing staff. Two weeks will be allotted to collect survey data and one week to analyze survey data and adjust the presentation and resources accordingly. Employees returning from maternity leave will receive the welcome back brochure and resources during the next six months. After six months, the post-project survey will be administered over two weeks, with one week allotted to analyze and create results for stakeholders and plan any modifications to the project based on the post-survey results. This timeline suggests a time allotment of nearly eight months to conduct and analyze surveys and to implement and evaluate this project (see Appendix E). Plan for Evaluation of Project The success of the project will be determined by the effectiveness of the education, the dissemination of the resources, and any improvements to job satisfaction among breastfeeding nurse employees following the project implementation. A pre-project survey will be 24 administered to nursing staff before the implementation of the project to assess knowledge gaps regarding lactation resources and job satisfaction. A pre-presentation survey will demonstrate any knowledge gaps regarding workplace lactation support among clinical leaders. A postpresentation survey will be administered to the clinical leaders immediately following the presentation. The post-presentation survey will also include a Likert scale to rate the effectiveness of the educational information they received. After a six-month interval, a postproject survey will be administered to nursing staff. This survey will assess the effectiveness of the information, the use of resources, and whether the leaders sent and disseminated the presentation and resources to their staff members. The survey will examine job satisfaction for all staff members but will have additional breastfeeding-related job satisfaction questions for breastfeeding nurse employees. Ethical Considerations Several ethical considerations must be addressed in this MSN project. First, hospital administration and clinical leaders must follow federally mandated workplace lactation policies and procedures (U.S. Department of Health and Human Services, 2021). Any areas that are not abiding by the 2010 FLSA amendment for working breastfeeding mothers must address these concerns accordingly. This MSN project must also consider that all nurse employees returning from maternity leave may not be receptive to receiving lactation education resources. The project should also be sensitive to individuals who are not biologically female but will be participating in maternity leave. Additionally, receiving lactation education resources may be uncomfortable for some nurse employees who could not or chose not to breastfeed for various reasons. It is essential to maintain privacy and sensitivity for all population groups experiencing the information and 25 education from this MSN project. All staff must recognize that breastfeeding resources are available to them as desired and understand that staff are not mandated to read or utilize them. The verbiage in pre- and post-project surveys will be respectful, transparent, and inclusive. Another ethical consideration is the need to protect the privacy of the clinical leaders and employees participating in the surveys. Participation is not mandatory. The survey responses are anonymous and have no bearing on employment. The project lead analyzing and compiling results may also have potential biases. To counteract any potential ethical issues the project lead poses, survey participants will be anonymous, and the interdisciplinary team will review all results analyses. This MSN project must abide by ethical standards to protect all nurse employees' privacy and psychological safety. Discussion Breastfeeding nurse employees face unique challenges requiring increased workplace lactation support (Froh & Spatz, 2016; Ramsey et al., 2021; Wu et al., 2022). Clinical leaders can improve workplace lactation support, thus improving job satisfaction among breastfeeding nurse employees (Litwan et al., 2021; Ross & Woszidlo, 2022; Scott et al., 2019; Vilar Compete et al., 2021; Whitley et al., 2019). This MSN project addresses the need for increased support for breastfeeding nurse employees. This project will accomplish this by providing education and resources to clinical leaders, staff, and breastfeeding nurse employees. This section will discuss the project’s dissemination, strengths and weaknesses, and recommendations for future nursing research. Evidence-based Solutions for Dissemination Dissemination is a crucial step within the JHNEBP model to embed evidence-based practice into nursing practice (Melnyk & Fineout-Overholt, 2019). Successful implementation 26 involves disseminating workplace lactation educational resources to clinical leaders and all staff members. After the implementation of the project, the results will be disseminated in several ways. All pre- and post-project survey results will be presented via PowerPoint to hospital administration, clinical leaders, and HR representatives for review. Any necessary modifications can be implemented at this time, and the decision to continue the project will be made. If the project results demonstrate a beneficial and successful implementation, the data can be compiled and sent via email to the University of Utah Health organization leadership for further dissemination to all University hospitals and clinics. Once the information is disseminated through emails and presentations to stakeholders, similar projects can be implemented throughout the state to benefit all breastfeeding nurse employees. With multiple data sources from varying hospitals and clinics, publication may be considered. Additionally, the project will be presented to Annie Taylor Dee School of Nursing peers and faculty in a poster format. Significance to Advance Nursing Practice This MSN project benefits all nurses but specifically breastfeeding nurse employees. It is important to note that breastfeeding nurse employees are a large demographic of registered nurses (RN); according to the national workforce survey, women comprise nearly 90% of the RN workforce, and of that 90%, the majority are of childbearing age (Smiley et al., 2021). Additionally, improving workplace lactation support for nurse employees can increase all employees’ job satisfaction (Ross & Woszidlo, 2022; Scott et al., 2019; Whitley et al., 2019). Increased job satisfaction leads to less nurse turnover and improved patient outcomes (Gensimore et al., 2020; Labrague, 2021). 27 Implications This project addresses the need for increased workplace lactation support by educating clinical leaders, staff, and breastfeeding nurse employees. Improving workplace lactation support will increase breastfeeding nurse employees’ job satisfaction and work-life balance (Jantzer et al., 2017; Li et al., 2021; Lisbona et al., 2020). This project allows collective and individualized workplace lactation interventions to improve the breastfeeding nurse employee’s experience. Increasing workplace lactation support increases breastfeeding nurse employees’ job satisfaction and that of their coworkers (Jantzer et al., 2017; Ross & Woszidlo, 2022). Utilizing the JHNEBP model as a framework for implementing this MSN project will ensure that the nursing perspective is heard and valued, the evidence is adequately appraised, and modifications to the project are applied as needed (Melnyk & Fineout-Overholt, 2019). The project’s limitations include the sample size due to a limited time frame, equitable reception of workplace lactation education resources, and confounding factors to job satisfaction. The project allows only six months for implementation before evaluation, which may not be enough time to collect meaningful data about breastfeeding nurse employees. With a limited time frame, capturing the experiences of breastfeeding nurse employees may be difficult due to a small sample size. Ideally, the project will continue after the implementation timeline has been met. Evaluating the results will provide supporting data to continue implementing the project and disseminating results to other stakeholders. Other hospitals and clinics will then implement the project and provide more data to analyze. Another project limitation is ensuring equitable reception of educational resources regarding workplace lactation support. Clinical leaders and staff may receive the information but not read it or apply it to their unit. The presentation to clinical leaders will be interactive with 28 discussion, surveys, and incentives for disseminating educational resources to reduce this obstacle. The educational resources for all staff should be disseminated through email, physical copies on the unit bulletin board, or a learning module. The welcome-back lactation resources for nurse employees returning from maternity leave could be sent at the beginning and end of their leave to increase visibility and motivate employees to attempt breastfeeding, knowing they have a supportive workplace. A final limitation of the project is ruling out potential confounding factors for job satisfaction. It may be challenging to ascertain if project implementation is the sole cause of increased job satisfaction. A potential solution may include more specific questions in the survey regarding employee perception of job satisfaction, allowing the employees to determine possible causes and or explicitly asking whether or not the improved workplace lactation support increased job satisfaction. Recommendations The literature review conducted for this project indicated multiple potential interventions for improving workplace lactation support, including mentor programs, improving equipment and facilities, and educational classes for breastfeeding employees (Kim et al., 2018; Lennon et al., 2017; Litwan et al., 2021; Vilar-Compte et al., 2021). Focusing on improving multiple aspects of the workplace lactation policy or incorporating a variety of interventions may be an area of focus for the future. There was also ample evidence supporting the relationship between workplace breastfeeding support and job satisfaction; however, the literature review highlighted the need for further research on breastfeeding nurse employees (Jantzer et al., 2017; Ross & Woszidlo, 2022; Wambach & Britt, 2018; Whitley et al., 2019). In summary, the literature review demonstrated the numerous ways to improve workplace breastfeeding support and its 29 associated effect on job satisfaction, although further research on healthcare employees is needed. Conclusion The literature review conducted with this MSN project supports that breastfeeding nurse employees face distinct challenges and require increased workplace lactation support (Froh & Spatz, 2016; Ramsey et al., 2021; Wu et al., 2022). Offering a variety of interventions can increase lactation support (Bradford et al., 2017; Chang et al., 2021; Litwan et al., 2021; VilarCompte et al., 2021). The literature emphasized the crucial role of organizational and managerial support for breastfeeding nurse employees, the importance of creating a workplace breastfeeding policy, and the need for system-wide education for leaders, administrators, and staff (Bradford et al., 2017; Scott et al., 2019). Additional evidence demonstrated a positive relationship between workplace lactation support and employee job satisfaction (Ross & Woszidlo, 2022; Scott et al., 2019; Whitley et al., 2019). This MSN project addresses the need for increased support for breastfeeding nurse employees. It will accomplish this by providing education and resources to clinical leaders, staff, and breastfeeding nurse employees. Clinical leaders and colleagues will become more equipped to support breastfeeding nurse employees by understanding workplace lactation policy and techniques to improve interventions in the workplace. Breastfeeding nurse employees will also receive lactation education and resources to provide support balancing returning to work and breastfeeding. Improved workplace lactation support will increase job satisfaction and improve patient outcomes. 30 References Bar, S., Milanaik, R., & Adesman, A. (2016). Long-term neurodevelopmental benefits of breastfeeding. 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No c. Unknown, N/A 3. I know where to access workplace lactation education resources for myself and my employees. a. Yes b. No c. Unknown, N/A 4. I can list three evidence-based interventions to better support breastfeeding nurse employees. a. Yes b. No c. Unknown, N/A 5. On a scale of 1-5, please rate how you feel about this statement: I feel confident in my ability to counsel and support breastfeeding nurse employees. a. 1- Strongly disagree b. 2- Disagree c. 3- Neither agree nor disagree d. 4- Agree e. 5- Strongly agree Post-presentation Survey This survey will include the five pre-presentation survey questions with one additional question: 6. On a scale of 1-5, please rate the effectiveness of the educational information provided. a. 1- Very poor b. 2- Poor c. 3- Acceptable d. 4- Good e. 5- Very good 44 Appendix D Pre-and Post-Project Survey Pre-project Survey 1. Do you know where to access your employer's lactation policy? a. Yes b. No c. Unknown, N/A 2. On a scale of 1-5, please rate how you feel about this statement: “I know what is in the lactation policy and abide by it to support all breastfeeding nurse employees.” a. 1- Strongly disagree b. 2- Disagree c. 3- Neither agree nor disagree d. 4- Agree e. 5- Strongly agree 3. Please rate your current job satisfaction on a scale of 1-5. a. 1- Very unsatisfied b. 2- Unsatisfied c. 3- Neutral d. 4- Satisfied e. 5- Very satisfied 4. Are you currently breastfeeding, or have you breastfed within the last three years? a. Yes [continue to question #5] b. No [conclude survey] c. Unknown, N/A [conclude survey] 5. On a scale of 1-5, how supported do you feel by your clinical leaders in your efforts to express breastmilk while at work? a. 1- Very unsupported b. 2- Unsupported c. 3- Neutral d. 4- Supported e. 5- Very supported 6. On a scale of 1-5, how supported do you feel by your colleagues in your efforts to express breastmilk while at work? a. 1- Very unsupported b. 2- Unsupported c. 3- Neutral d. 4- Supported e. 5- Very supported Post-project Survey This survey will include the pre-project survey questions with one additional question for all staff: 45 1. Did you receive and find helpful the workplace breastfeeding presentation and resources? f. Yes g. No h. Unknown, N/A The post-project survey will also include two additional questions for breastfeeding nurse employees or nurse employees who were breastfeeding recently: 1. On a scale of 1-5, how helpful were the welcome-back brochure and resources? a. 1- Very much not helpful b. 2- Not helpful c. 3- Neutral d. 4- Helpful e. 5- Very helpful 2. On a scale of 1-5, please rate how you feel about this statement: “I have experienced increased job satisfaction because I felt supported in my efforts to express breastmilk while at work.” a. 1- Strongly disagree b. 2- Disagree c. 3- Neither agree nor disagree d. 4- Agree e. 5- Strongly agree 46 Appendix E Timeline