Digital Repository Masters Projects Spring 2024 Leadership Styles and the Impact on Nurse’s Job Satisfaction Kim Steele Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Steele, K. 2024. Leadership Styles and the Impact on Nurse’s Job Satisfaction 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 Leadership Styles and the Impact on Nurse’s Job Sa sfac on 3URMHFW 7LWOH E\ Kim Steele, BSN, RN, CCRN, CNN, MSN Student 6WXGHQW¶V 1DPH $ SURMHFW VXEPLWWHG LQ SDUWLDO IXOILOOPHQW RI WKH UHTXLUHPHQWV IRU WKH GHJUHH RI 0$67(56 2) 1856,1* $QQLH 7D\ORU 'HH 6FKRRO RI 1XUVLQJ 'XPNH &ROOHJH RI +HDOWK 3URIHVVLRQV :(%(5 67$7( 81,9(56,7< 2JGHQ 87 Marh 31, 2024 'DWH Kim Steele, BSN, RN, CCRN, CNN, MSN Student March 31, 2024 6WXGHQW 1DPH &UHGHQWLDOV HOHFWURQLF VLJQDWXUH 'DWH April 26, 2024 061 3URMHFW )DFXOW\ HOHFWURQLF VLJQDWXUH 'DWH April 26, 2024 $QQH .HQGULFN HOHFWURQLF VLJQDWXUH '13 51 &1( 061 3URJUDP 'LUHFWRU 1RWH 7KH SURJUDP GLUHFWRU PXVW VXEPLW WKLV IRUP DQG SDSHU 'DWH 1 Leadership Styles and the Impact on Nurse's Job Satisfaction Kim Steele, BSN, RN, CCRN, CNN. MSN Student Annie Taylor Dee School of Nursing Weber State University MSN Project 2 Abstract Purposes/Aims: The project aims to educate current and future leaders in servant leadership to promote increased job satisfaction within the intensive care unit (ICU). Rationale/Background: Leadership (and organization) support fosters trust between the leader and follower, reducing burnout among nurses and increasing retention. Institutions experience improved patient outcomes and reduced hospital-acquired events when nurses report job satisfaction. Educating while simultaneously testing the correlation between variables provides information regarding the relationship between servant leadership and the impact on nurses' job satisfaction and patient outcomes. Methods: The project will be implemented in the ICU following written approval. Surveys will assess leaders' knowledge of servant leadership with assigned education modules. Both leaders and bedside nurses will be issued pre-, random, and post-surveys throughout the project. A diverse interprofessional team will review quality measures monthly and adjust target goals accordingly using the PDSA framework model. Results: The nurse survey will be administered to nurses in the ICU to determine desires and preferences for a leadership style. Education regarding servant leadership will take place after the survey results are finalized. If successful, this project will be implemented throughout the organization, unit by unit, after servant leadership is implemented within the ICU. Conclusions: Servant leadership and organizational support are relevant in the ICU. Trust in the leader and trust in the organization correlate directly with servant leadership, reduced job burnout, and bedside nurses¶ LQWHQW WR OHDYH. The implications of this project will directly impact the recruitment, retention, and job satisfaction of bedside nurses and improve leadership job 3 satisfaction. Appropriate and continuous nurse education in servant leadership is crucial to changing leadership styles and job satisfaction. Keywords: servant leadership, job satisfaction, nurse retention, burnout, intensive care unit 4 Leadership Styles and the Impact on Nurse's Job Satisfaction Historically, nursing turnover has been lower than the hospital average compared to other employees (Boston-Fleischhauer et al., 2023). As more nurses have left the profession over the last five years, the turnover rate has climbed to a high between 108.7% and 115.2%, demonstrating that this trend is worsening as more nurses continue to leave the profession (Boston- Fleischhauer et al., 2023). The cost to incur such high turnover ranges from $6.6 million to $10.5 million per hospital, with an estimated $52,350 for every nurse leaving the position (Boston-Fleischhauer et al., 2023). Many factors have contributed to the mass exodus the hospitals have experienced, including stress, burnout, moral fatigue, distrust of the organization, increased demands, and additional nursing duties. All of this equates to a loss of job satisfaction (Dimino et al., 2021). COVID-19 demonstrated the need for leaders to support nurses psychologically and physically. An integrative review of literature conducted by Boone et al. (2023) showed the direct impact leaders had through lack of visibility and the need for appropriate communication with their followers. The results provided the healthcare industry with undisputable data showing how this type of leadership isolated those followers, negatively impacting their mental health and job satisfaction, thus resulting in increased intent to leave the organization. Cummings et al. (2018) conducted a systematic review with quantitative findings supporting the relationship between leadership styles and nursing outcomes. Fifty-two of the 57 studies reported relational leadership having a higher association with job satisfaction than transactional leadership styles that dominate the healthcare industry. Another study within the systematic review by Cummings et al. positively correlates the relationship between ethical leadership and employee satisfaction with higher job satisfaction with leaders who discipline 5 wrongdoers, treat everyone fairly and considerately, and exhibit an ethical leadership style (Shafique et al., 2018). Undoubtedly, the literature shows a positive correlation between servant and ethical leadership and increased job satisfaction. This positive correlation should bring immediate attention to administrators and leaders on developing trust with their followers to improve job satisfaction, thus increasing retention of these valuable nurses. Failure to develop such vital relationships from leaders with their followers will allow this downward trend to continue impacting patient care and the financial losses for those who employ the nurse. This project aims to implement servant leadership that addresses the need for leaders to support a healthy work environment, resulting in the nurse's ability to find job satisfaction in a way that accommodates the nurse's needs and allows them to practice at their optimal level, bringing about positive changes that are desperately needed in nursing and resulting in retention and job satisfaction for all parties involved. The results will demonstrate an overall increase in job satisfaction for the nurse and a reduction of financial loss for the institution. As healthcare is still reeling from the COVID-19 pandemic, the landscape can be redesigned moving forward. The situation can be turned around for the 11% of nurses who intend to leave the profession (Gabele et al., 2023) by retaining that 11% and recruiting more through implementing servant leadership, creating a healthy work environment where nurses want to work and contribute their knowledge and skills. Statement of Problem A significant issue is plaguing the healthcare industry, with nursing turnover reaching unprecedented levels. According to the 2022 NSI National Health Care Retention and RN 6 Staffing Report (Ulrich et al., 2022), the registered nurse (RN) turnover rate increased to 27.1% in 2021. The rate is compared to the overall hospital turnover rate of 25.9%. For the first time, the RN turnover exceeds the hospital's overall staff turnover (Gabele et al., 2023). This trend will affect more RNs as the burden on those remaining will continue to increase as their job satisfaction continues to plummet. Data outlined previously demonstrates OHDGHUV¶ direct impact RQ DQ 51¶V LQWHQW WR OHDYH 7KLV SURMHFW ZLOO LPSOHPHQW and evaluate the servant leadership style to meet the needs of the bedside RNs in achieving their optimal performance and job satisfaction. Through servant leadership, the leader creates a healthy work environment where a nurse feels supported and heard (Boone et al., 2023). It also creates an environment where the RN can practice autonomy while having a unit function as a team (Restivo et al., 2022). Leadership styles have the single most impact on an 51¶V GHFLVLRQ WR OHDYH, demonstrating the need for leaders to be trained appropriately for their role (Halter et al., 2017). The style in which a leader practices leadership holds the most weight when discussing reasons for leaving with nurses; therefore, leaders must get it right. A study by Thacker et al. (2019) provided a positive correlation between servant leadership on followers and increased job satisfaction with the leader. The findings demonstrated that servant leadership fulfilled the IROORZHUV¶ and OHDGHUV¶ roles and inspired motivation and resilience. Significance of the Project The American Nurses Association (ANA) outlines the standards of practice for nurses (Nursing World, 2017). A nurse's primary commitment is to the patient and advocating on their behalf. They also recognize that their work is interdependent on all other disciplines to deliver the care the patient needs to become well. The combination of these two drivers describes what 7 nurses want to do and do daily. Servant leadership compliments this objective and standards (Booher et al., 2021). Emotional support from leaders to their followers, whether personal or professional, is also an essential characteristic of a leader and is found in servant leadership. By providing emotional support to the follower, the follower becomes empowered, responsible, healthier, wiser, and autonomous, contributing to their satisfaction through well-being and decreased burnout and moral fatigue (Jit et al., 2016). Through this project, the leader can learn and create conditions that value the nurses as individuals in an atmosphere of trust, support, participation, and respect that will reduce burnout and increase job satisfaction. Learning and applying servant leadership would result in retaining current nursing staff and increase the desire for other nurses to return to this noble profession (Bobbio & Manganelli, 2015). The ability of the leader to place themselves at the bottom of the hierarchical pyramid allows them to lift the members of their team and even the organization to achieve personal growth and success. The leaders' lifting allows followers to feel valued and increases job satisfaction, increasing their ability to stay within the organization. Servant leadership considers the people first, fulfilling the follower's basic needs. If the basic needs (as LOOXVWUDWHG LQ 0DVORZ¶V KLHUDUFK\ DUH PHW WKH LQGLYLGXDO FDQ SUogress, and trust increases in the leader, fulfilling the leader's purpose as well (Thacker et al., 2019). Review of the Literature The literature review examines adopting and implementing a servant leadership approach WR LPSURYH QXUVHV¶ ZRUN HQJDJHPHQW and the factors influencing their job satisfaction. As outlined in the previous sections, nurse retention is a cause leaders must place at the forefront. Leadership is one of the most critical issues in every organization since it affects the attitudes and behavior of the employees and the perception of organizational justice, job performance, 8 patient care and outcomes, and intent to leave the profession. For this reason, it should be examined in-depth as the cost to remain stagnant in this high turnover environment costs more than should be tolerable to a healthcare system, employees, and patients in these organizations. Framework Servant leadership is based on trust, empathy, and caring, and the primary focus is on others. The unique position of the leader creates a unique opportunity for the leader to mentor and champion the followers (Melnyk & Fineout-Overholt, 2019). Therefore, the model selected for this problem would be most appropriate using the Plan-Do-Study-Act (PDSA) model framework to support the change in the Intensive Care Unit (ICU) (Melnyk & Fineout-Overholt, 2019). The transition for leaders to lead their followers using servant leadership will meet the needs of the followers more appropriately. An article by Squellati and Zangaro (2022) describes the millennial generation of nurses needing servant leadership within the organizations that employ them. Millennials are moving into these leadership roles and need organizations to support their preference for servant leadership. The PDSA model prepares the unit with a framework that will foster leadership development for all nurses to become servant leaders and develop the passion for helping others initiate the needed change (Gawlinski & Rutledge, 2008). This goal is achieved by addressing the three questions posed by the model that concentrate on what the group needs to accomplish, knowing how a change is an improvement, and examining the changes that will result in an improvement. The four areas in the model include plan, do, study, and act. The plan is the development of the quality improvement initiative. This phase should allow the development of a test to improve the process identified. The plan includes the involvement of the team members in selecting the quality improvement initiatives and 9 identifying barriers and baseline of the unit. During the planning, perspectives from both leaders and followers are essential for effective planning. When team members are involved, they develop a sense of ownership and are more likely to be involved in the solution to the identified problem. Surveys will be conducted to establish a baseline for leaders and followers based on their experiences and needs (Hall, 2016). The next area is titled do. Once the surveys are completed, training and education planning can be performed according to the survey results and needs. Defining expectations will guide the education and training material to ensure the successful execution of the project goal. Communicating the plan to the entire team and those who will carry out the plan is essential to WKH SURMHFW¶V VXFFHVV &ODULILFDWLRQ DQG DGMXVWPHQWV FDQ DQG ZLOO EH QHHGHG WKURXJKRXW WKH project. Specific, measurable, attainable, realistic, and time-bound (SMART) goals will facilitate this effort, comprising specific, measurable, achievable, relevant, and time goals (Hall, 2016). The third area is the study portion. The team utilizes the process or outcome measures developed during the study phase to evaluate the success of the changes implemented. Tracking the measurable outcomes is essential and can be done using many different charts or graphs for all members to view. During this phase, the team should ask whether the expected results were achieved and what adjustments need to occur to continue reaching the project goal (Hall, 2016). Act is the PDSA model's final stage and defines the cycle's completion. Adjustments needed are evident based on the results. Based on the results, the team will use this phase to decide whether to adopt, adapt, or abandon the project (Hall, 2016). The continuous PDSA cycle allows all members to learn and develop professionally, determine whether the implemented change shows the desired results, and adopt the needed changes for the next cycle (IHI, 2023). 10 Strengths and Limitations The PDSA model has proven safe, timely, effective, equitable, and cost-effective for implementing a desired change. It is specifically beneficial in a small healthcare setting with a complex social system, such as the ICU, where the project will be carried out. The PDSA model focuses on the most important issue: the desire for a needed change. It allows for translating ideas and intentions into action (Reed & Card, 2015). It is appropriate for this project because of the ability to have rapid change on a small scale before initiating it hospital-wide. One of the problems with the PDSA model is that it can uncover more significant cultural or organizational issues that need to be addressed at a higher level. It can also give the team the false impression that more than PDSA is needed, which may lead to a failure to investigate or conduct research before implementing the PDSA model. In addition, one must also carefully consider the scope and scale of change, amount of preparation prior to use, rigor of the evaluation, time, expertise, leadership support, and funding needed for the project. Understanding the possible need for additional organizational support may also be overlooked due to the simplicity of the PDSA model (Reed & Card, 2015). Careful consideration was given when selecting the model/ framework for this project. The PDSA model fits most appropriately when evaluating the project's aim and goal. Appropriate research is being conducted to ensure that all areas outlined within this section have been appropriately identified and addressed before implementation. Analysis of Literature Several sources were used to formulate this literature review. Qualitative, quantitative, and non-research findings provide information on the impact of servant leadership on the bedside nurse. The information gathered included job satisfaction, intent to leave, reduction of burnout 11 and moral fatigue, and the examination of task-oriented versus relational leadership and the impact of these leadership styles. Analysis was performed with an evidence table created to present the literature in an appropriate documented format. With the increase in job dissatisfaction, turnover, and burnout, evidence supports a leadership style that takes the traditional top-down hierarchy approach and reverses it to fit the needs of the healthcare system DQG IRVWHUV D EHOLHI WKDW ³HYHU\ QXUVH LV D OHDGHU´ (Booher et al., 2021, p. 1581) regardless of their official title. Search Strategies The literature search strategy included five electronic databases: CINAHL, PubMed, Medline, EBSCO, and OneSource. Searches included the following keywords- leadership, servant leadership, burnout, retention, job satisfaction, moral fatigue, quality measures, mental well-being, mental health, LMX (leader-member exchange), communication, positive precepting, positive mentoring, nurse, healthy work environments, job satisfaction, and job fulfillment. Various keyword combinations were conducted after a comprehensive search of available evidence. A literature search was conducted to identify current evidence using Google Scholar, Weber State University¶V 6WHZDUG /LEUDU\¶V 2QH6HDUFK DQG $GYDQFHG 6HDUFK ZKLFK VSDQ multiple databases), and CINAHL to direct initial exploration. Only articles from 2015 through 2023 were included in this literature review to keep information current. Synthesis of the Literature From September 2012 to January 2013, research shows that leadership characteristics are HVVHQWLDO LQ LPSURYLQJ QXUVHV¶ SV\FKRORJLFDO DQG SK\VLRORJLFDO well-being. The leadership style in this survey, which included 217 employees (n=500) of Isfahan Health Center, reflected the OHDGHU¶V SHUVRQDO VW\OH rather than a traditional one. The research findings supported the 12 leadership styles, specifically ethical and servant leadership, and the direct impact RQ WKH QXUVH¶V performance, job satisfaction, and mental and physical well-being (Allameh et al., 2016). Using a regression model with latent variables using LISREL, the multi-sample procedure was conducted at two Italian hospitals (n=711) and reported that the psychological engagement of nurses with their job has the most significant impact on their job satisfaction and intent to leave, with a 34.4% correlation in the study conducted in 2012 by Carter and Tourangeau (as cited in Bobbio & Manganelli, 2015). Because of these significant findings, leaders must be able to address the psychological well-being of their followers to engage the nurse in a positive work environment that supports them and demonstrates their mental well-being to reduce turnover. The research shows that leaders who actively engage with their followers and are strong and visible in their SUHVHQFH GHYHORS PHQWDO UHVLOLHQFH WR VXVWDLQ WKH ZRUN¶V VWUHVVRUV DQG GHOLYHU H[FHSWLRQDO FDUH (Boone et al., 2023). The literature identified four outlined themes: positive leadership and its impact on mental well-being, positive leadership and job satisfaction, positive leadership its impact on the work environment, and positive leadership and intent to stay within an organization (retention). Positive Leadership and Impact on Mental Well-being COVID-19 demonstrated the need for leaders to support nurses psychologically and physically. An integrative review of literature conducted by Boone et al. (2023) demonstrates that leaders who are not visible and lack the appropriate communication with their followers isolate those followers, negatively impacting their mental health and job satisfaction, resulting in increased intent to leave the organization. The decreased job satisfaction and intent to leave also increased moral fatigue and burnout experienced during and post-pandemic by the bedside nurse. 13 Thirty studies in a systematic review conducted by Cummings et al. (2018) reported 13 outcomes related to staff health and wellness with emotional exhaustion and reduced job stress with transformational, empowerment, and resonant leadership as opposed to transactional, laissez-faire leadership styles. Lastly, a 10-item scale, adapted by Brown et al., was used to measure ethical and servant leadership on a 5-point Likert scale ranging from 1-strongly disagree to 5-strongly agree. An organization where employees feel valued for their contribution, care about their well-being, and reward their good performance will experience a decrease in job stress and, by default, a decrease in mental fatigue experienced by employees. This finding demonstrates the need for ethical/servant leadership to augment employee's well-being and overall job satisfaction (Shafique et al., 2018). A survey conducted by Ulrich et al. (2022) with a randomized survey of nurses from all 50 states showed less than 50% agreement with the statement, ³0\ RUJDQL]DWLRQ YDOXHV P\ health and safety ´ The surveys uncovered that nurses have experienced increased verbal abuse (65%), physical abuse (28%), sexual harassment (13%), and discrimination from patients (23%), patients' families, colleagues, and others since 2018. Emotional wellness and the incidence of moral distress are essential indicators of the nurse's well-being. Positive Leadership and Job Satisfaction A systematic review of 10 databases was conducted. The published quantitative study supports the relationship between leadership styles and nursing outcomes, with 52 of the 57 studies reporting relational leadership having a higher association with job satisfaction than transactional leadership styles (Cummings et al., 2018). Another study cited by Cummings et al. (2018) conducted by Brown et al. correlates the relationship between ethical leadership and employee job satisfaction to higher job satisfaction with leaders who discipline wrongdoers, treat 14 everyone fairly and considerately, and exhibit an ethical leadership style. These leaders establish acceptable behaviors that empower employees and foster learning, increasing work performance that compliments job satisfaction. In a cross-sectional survey by Bobbio and Manganelli (2015), results show that organizational trust positively correlates with several organizational variables, with job satisfaction at the top of the variable significance. Positive Leadership and the Impact on the Work Environment An integrative literature review conducted by Mabona et al. (2022) defined a healthy work environment (HWE) as a work environment that is caring and supportive to health professionals, including nurses, within their respective health organizations. A healthy work environment is a vital ingredient in WRGD\¶V healthcare setting. The literature review cited the important influence leadership plays in creating this environment. Effective nurse leadership and decision-making are essential to achieving an HWE. Creating an HWE through evidence-based transformational leadership develops the necessary and vital relationship of trust and respect between leaders and followers. A HWE includes leaders who strive to provide employees with a safe and positive environment. Franczukowska et al. (2021) study provided additional support demonstrating the need for a safe and positive workplace culture through leadership skills such as listening, assertiveness, and intellect. These are skills that are not easily taught and are complex. Understanding and developing these skills within leaders is crucial in promoting leadership that provides a workplace environment that is positive and safe for all staff. The effects of a leader can often be overlooked, especially during staff cuts and increased workloads. During this time, leadership training needs to be addressed to prevent a decline in workplace positivity and safety. Significant findings directly correlate with ethical leadership related to job satisfaction and 15 commitment. The results of the Franczukowska et al. (2021) study also demonstrated a correlation EHWZHHQ EXUQRXW DQG HPRWLRQDO VWDELOLW\ LQ OHDGHUV¶ DELOLW\ WR PHHW WKH QHHGV RI WKHLU followers. Unfortunately, a positive work environment can be affected by numerous factors. The Association of Critical Care Nurses (ACCN) surveyed (n=9862) nurses from all 50 states. The results showed a decline in the nurse's perception of a positive work environment from 2018 to 2021, with the most significant being inappropriate RN staffing, resulting in decreased work engagement (Ulrich et al., 2022). The survey also compared the data from 2006 to 2021 on the authentic leadership from nurse managers, which demonstrated a decline from 2.78% in 2006 to 2.50% in 2021 and a similar decline in the nurse managers ability to engage others in achieving a healthy work environment (2006= 2.70% to 2021=2.47%). The study demonstrated that nurses would continue to exit the workforce without appropriate interventions to improve the workplace environment in search of more meaningful and positive work environments. It also highlighted the work environment's impact LQ DOO DUHDV FRQFHUQLQJ WRGD\¶V KHDOWKFDUH HQYLURQPHQW 8OULFK HW al., 2022). Positive Leadership and Intent to Stay Within an Organization (Retention) The literature shows a positive correlation between servant and ethical leadership and increased job satisfaction. There is also a positive correlation between servant leaders and trust in their followers that reduces intent to leave the organization (Booher et al., 2021). The reviewed articles also found reduced burnout, moral fatigue, and mental well-being. In addition, the servant leadership style also positively correlated with leader-member exchange (LMX) and improved patient outcomes, including reduced mortality rates (Hanse et al., 2016). This review did show a negative correlation between the physician-nurse relationship and was thought to be 16 related to the traditional hierarchy of medicine (Booher et al., 2021). The literature on leadership within a healthcare organization has limitations. One of the most common is identifying the correct leadership style to address all employee's concerns, needs, and desires. The literature demonstrates that relational leadership (transformational, ethical, servant, or others) produces the highest rates of job satisfaction and reduces burnout and moral fatigue than task-oriented or transactional leadership styles (Booher et al., 2021). Another study conducted by Jit et al. (2016 shows that emotional support to employees, whether personal or professional, is one of the most important characteristics a servant leader must develop. By doing so, followers become empowered, responsible, healthier, wiser, and autonomous, which contributes to satisfaction through well-being and decreased burnout and moral fatigue. As a result, followers have a positive intent to remain with the organization, and delivery of care and meeting organizational goals is increased automatically. However, the literature needs to be more thorough on which leadership style could address the needs of all nurses at all facilities and units. Literature supports servant leadership as the appropriate style to meet this need most effectively. It has been shown to be the most closely related OHDGHUVKLS VW\OH WR WKH QXUVH¶V VHOI-reporting perception of a leader (Bobbio & Manganelli, 2015). This association could be due to the close relationship between the definition of servant leadership and the code of ethics outlined in the ANNA code of conduct (Bobbio & Manganelli, 2015). In addition, the bottom-up approach described by Thacker et al. (2019) describes how the servant leadership bottom-up hierarchy pyramid supports the followers by leaders serving their followers first. This reversal of the traditional hierarchy pyramid familiar throughout healthcare allows the follower to develop the trust and relationship necessary for trust to develop with the 17 organization. Holding followers up to their potential versus pulling them up demonstrates the shift needed to encourage and promote the followers instead of the organization. Through support (instead of pull), the follower automatically desires to perform at their peak level and stay within the organization, making them feel seen, heard, and supported within the role (Thacker et al., 2019). While similarities exist between transformational, ethical, and servant leadership, further research is still needed to show the preference for one over the other. However, nurses¶ selfreporting of preference for servant leadership over all others should be noted and sufficient to implement this style within hospital settings. Findings also demonstrate that empowering bedside nurses as leaders needs to be implemented from the beginning of their careers and training of existing nurses to accommodate servant leadership should also be sought (Cummings et al., 2018). Leaders have the fiduciary responsibility to lead followers in their preferred style to reduce the healthcare system¶V FULVLV LVVXHV. Suppose nurses want to stay within the organization but need more leaders who enable a desire to stay. In that case, servant leadership must become the highest priority It must be done to support, train, and empower the bedside nurses to be leaders and to find job satisfaction and gratification in their work and organization. Leaders must also address the mental health of employees to demonstrate concern and support. Successful leadership can and will revolutionize healthcare and address the high cost of turnover that is now being experienced (Halter et al., 2017). Project Plan and Implementation The project plan requires presenting the proposed plan for the change to the administration, management, and review committee. Once presented, the amount of buy-in to the 18 change from administrators will directly affect the project's success and should be, at most, a 30day decision period. There are no required participatory statements or documentation of participant consent as it is a proposed change within the organization's leadership styles. Once approved, the change in leadership style to accommodate the healthy work environment will, in WKHRU\ LPSDFW QXUVHV¶ MRE VDWLVIDFWLRQ. This proposed plan will be carried out within the ICU and, if successful, can be implemented throughout the organization (Hall, 2016). Implementation will consist of all members of the ICU unit on which this plan will be introduced and implemented. Utilizing concepts and deliverables obtained from the American Association of Critical Care Nurses provides a free toolkit for creating and implementing a healthy work environment (AACN, n.d.). It contains information on the topics within this paper, which will provide deliverables and utilization of education modules through Workday, the learning platform utilized through the organization. As discussed throughout this paper, a healthy work environment is needed for nurses to find job satisfaction that will result in an increased desire to remain within the unit and organization. It will promote mental well-being, decrease burnout and moral fatigue (Cummings et al., 2018), and encourage bedside learning, growth, and autonomy. Once the administration's official approval letter for this project is received, the ICU has demonstrated a readiness to change. Therefore, it is prepared to carry out the needed tasks to succeed. Before implementing the leadership style (servant leadership) change, a collective consensus was obtained on increasing caregivers' job satisfaction to improve nurse retention. A collective team of stakeholders will be selected and assembled to advance into the PDSA and SMART (Hall, 2016). 19 A pre-assessment will be conducted with leaders on their knowledge and skillset of servant leadership as well as a pre-assessment of the floor staff to include an assessment of 1) current job satisfaction, 2) current level of burnout, 3) degree of self-reported moral fatigue, 4) intention to leave the organization/ role, 5) current satisfaction with leadership, 6) other items that impact job satisfaction that are not listed as well as the six non-negotiable standards outlined in the HWE toolkit (AACN, n.d.). The pre-assessment will establish a baseline for both groups before initiating the plan. When the leaders complete the pre-assessments, educational materials will be presented for servant leadership training. This education is provided through the organization learning platform Workday as an assigned task with modules to be completed in succession, with a test at the end of each module. Completing these modules will provide the leader with a completion certificate to be part of the employee training record. The education of current leaders will be assessed through the successful completion of the modules, discussions within meetings, and post-assessment knowledge assessment will be performed. Once the previous steps are completed, a PDSA model will be constructed to guide the project rollout and setting of goals. SMART tool will also be utilized in the project's planning to promote the project's success and the overarching goals. Once the team has developed the PDSA, the project will be implemented with oversight from the team members. The PDSA cycle is a continuous feedback loop that will be reviewed every thirty days to ensure the goals are achievable yet continually promote learning, growth, and improvement (Hall, 2016). Once the plan preparation is underway, the plan will be presented to the unit staff members with an adequate question-and-answer forum. The start date will also be announced, and goals will be shared with input and suggestions from all levels of staff. Allowance for staff to participate in the rollout with sufficient answers to the why will increase staff PHPEHU¶V 20 willingness to be open to the change, embrace the change, and identify areas that would facilitate increased job satisfaction for the entire unit as well as the development of servant leadership with each bedside nurse. Once the plan has been rolled out, with the leaders utilizing their knowledge and training, the PDSA cycle will be reviewed every 30 days. At the end of the sixth and twelfth month, a post-assessment survey will be conducted for the staff to assess the plan's success and allow for needed changes in identified areas (AACN, n.d.). In addition, other resources that may be beneficial in utilizing for plan implementation and effectiveness include 1) caregiver survey results that are conducted quarterly, 2) Safety event reports to monitor a decrease in trends, 3) Employee Assistance Program to provide support to staff and allow for collaboration of open discussions on what is working and what is not and any gaps within the initiative, and 4) monthly staff meetings with open Q & A discussions to allow all team members to have input. Plan and Implementation Process This plan will be implemented within the ICU after a readiness assessment utilizing the HWE toolkit through the AACN website. The leaders will receive education and training on servant leadership styles through leadership modules through Workday. Completing these modules will be mandatory for all shared leaders, and successful completion will be verified through recorded completion competency certificates. Nursing staff will be presented with the proposed change, a reason for the change, and input from staff will be encouraged. Question and answer sessions will be scheduled to ensure the staff understands the reason for the change in leadership styles and can express their needs to the leaders. An open-door policy for leadership encourages individuals to meet with the nurse manager and leaders to discuss concerns, clarify information, and discuss any other issues the 21 staff may need to discuss. Pre- and post-assessments for both parties will be conducted to measure the outcomes and success of the plan. Interdisciplinary Team The PDSA toolkit (Hall, 2016) outlines assembling a successful team for the PDSA cycle. The team should consist of at most ten individuals. It should include various stakeholders to ensure all disciplines are included and represented. The members should include physician(s), leaders, nursing staff, critical care tech(s), administrator(s), and nurse manager. Ideally, discussing the healthcare professionals contributing to the project and describing how teamwork impacts patient care and outcomes would be beneficial. This type of teamwork (healthcare professionals) includes working with all staff to share expertise, knowledge, and skills that impact patient care and outcomes (Hall, 2016). Description and Development of Project Deliverables The deliverables for this project will be obtained mainly via Workday. Intermountain Health has partnered with Udemy and has multiple learning videos and modules readily available through Workday for training leaders and managers. This site will be the source of learning modules to educate the leaders on servant leadership and mental health support for followers. The pre-and post-assessments are created using the AACN HWE assessment toolkit 2.0 as a guide and will be delivered via Workday email. An informatics specialist will be needed to maintain anonymity so employees and leaders can express their feelings without fear of retaliation or penalization from leaders and management. The education modules for the leaders to educate (regardless of whether the leader is a beginner or a novice) will be assigned via Workday as required learning modules. Successful completion will be recorded, and the successful obtainment of the competency certificate will be 22 added to the leader employee file. Yearly refresher of these or other similar courses will be required. Four deliverables will be utilized for this MSN project. Each will be discussed individually and described in terms of their use in the project's implementation and success. The deliverables will be addressed chronologically as they are implemented into the project. Benefits of Servant Leadership PowerPoint The first deliverable will be a PowerPoint presentation to the administration and stakeholders. Through this presentation, benefits to the individual employee as well as the organization will be presented. Through servant leadership, the traditional hierarchy pyramid is flipped, positively impacting mental well-being, job satisfaction, the work environment, and the intent to stay within the organization (see Appendix A). This flip of the pyramid will demonstrate the ability to meet the basic needs of the followers to have them feel seen and heard (Boone et al., 2023). This presentation will be shown in anticipation of written approval from the intended audience within Intermountain Health. The intent is to build an understanding of the need for change in leadership styles and promote an interest in understanding the need for this change. It will also demonstrate the financial impact of retention issues on the unit(s) and how this project will positively impact the financial loss. With hospitals experiencing approximately $10.5 million in losses and approximately $52,350 per RN who leaves the organization, there is a significant opportunity to positively impact these losses by changing the leadership pyramid (Boston-Fleischhauer et al., 2023). This same PowerPoint presentation will be utilized to introduce servant leadership to the staff as it requires very little change for the bedside nurse and more of an observation and feedback of satisfaction. It will allow the bedside nurse to understand servant leadership and gain insight so they, too, can build a servant-oriented culture with each 23 other and become servant leaders themselves. This PowerPoint presentation will be presented during the monthly staff meeting to allow for an adequate question-and-answer session. The PowerPoint presentation will also highlight how implementing this plan into a highintensity unit like the ICU will demonstrate the ability of other units to succeed. This PowerPoint will outline the plan to create leaders who lift their followers instead of pulling them along. It will develop a work environment where everyone wants to serve one another because they understand that serving brings success (Burg & Mann, 2019). Through implementing positive leadership, more nurses will remain within the organization, as leadership has been demonstrated to have the most significant impact RQ D QXUVH¶V intent to leave an organization (Halter et al., 2017). Nursing Assessments Before implementing the project, assessments will be conducted to establish a baseline to measure the project's success (see Appendix B). Pre-assessments will be conducted with leaders and followers. The pre-assessment for the leaders will help management understand the leader's knowledge of servant leadership and the ability to implement this type of leadership to their followers. The pre-assessment for the followers is to obtain a baseline of their current satisfaction within the role and what everyone would like from their leaders to promote a healthy work environment where they feel seen and heard. This information will allow leaders to customize their servant leadership in a way that will be meaningful to those they lead. The surveys will be conducted prior to the start of the project being implemented as well as after its completion. Random surveys can and should be conducted to obtain real-time data to implement during the PDSA cycle to make the change more impactful. Utilizing the random survey (see Appendix C) would allow the team to gauge the project's success from baseline and 24 serve as a guide to areas that need focus within the project. Guidance for implementing this project can be supported using the HWE 2.0 toolkit, which is free and accessible on the AACN website (AACN, n.d.). Servant Leadership Educational Modules Leader training will use Workday, an Intermountain Health learning platform (see Appendix D). Intermountain has thousands of leadership training modules that can be utilized to train current (and future) leaders in servant leadership and support for nurses. Individuals perform the modules found within the deliverables for this project, and competency is assessed by completing the test at the end of the modules and obtaining the completion certificate. The certification will be renewed yearly to ensure all leaders obtain adequate training and refreshers. New or additional modules may be added depending on feedback from leaders and surveys. All modules will be obtained from Intermountain Health and its affiliates. The cost associated with leaders completing these modules will be minor. It will demonstrate significant reimbursement to the organization through the leader's ability to improve the work environment, decreasing the bedside nurses' intent to leave the organization. Intermountain Health encourages its employees to utilize these learning modules, so approval of the cost should prove equitable to both parties. Timeline A detailed timeline will help guide the implementation of this project and keep the project organized (see Appendix E). Administration, management, and review committee approval will be completed within 30 days after the project presentation. The assembly of the team and interdisciplinary teams will be completed within one week after receiving the approval letter. Pre-assessment surveys will then be conducted for leaders to assess their knowledge and 25 servant leadership skills. Education through Workday will then be assigned the required completion dates. A competency certification will be issued upon completing the modules and electronically filed in the leader employee file. Nursing staff will be issued a pre-assessment survey to assess their job satisfaction, which the assigned team will review for the project. This assessment survey will be confidential and allow the nursing staff to share their feelings freely. The manager and charge nurse will evaluate the implementation of servant leadership during daily leader rounding, and any concerns or uplifting feedback will be noted on the daily report sheet. It will track the project's success. The timeline will take approximately six months to demonstrate the proposed project's success. Project Evaluation The evaluation of this change initiative will be determined through post-evaluation surveys utilizing the AACN toolkit with modifications. Higher job satisfaction ratings and other areas will indicate the project's success. Effective training of leaders for servant leadership will be evaluated through the completion of the education modules with completion certificates uploaded into their employee files. In their post-assessment surveys, leaders will also be able to express their satisfaction with servant leadership and their active role in conducting this type of leadership within the unit. Training of leaders and the organization's success depends predominately on the adequacy and management of training leaders effectively (Cakir & Adiguzel, 2020). The team will meet every 30 days to evaluate the feedback received. Caregiver surveys, including pre-, random, and post-surveys, will also be beneficial tools to evaluate the servant leadership style's success from the bedside nurse's perspective. The random survey allows bedside nurses to write in concerns and suggestions to improve the project during the project timeline and for future project continuation. It can be used as a guide for the team to meet 26 the needs and goals of the project effectively. Safety event reports will also be reviewed every 30 days to monitor trends and ensure a healthy work environment. EAP may also be utilized to explore the staff's mental well-being. The exploration of mental well-being could include consent to voluntarily disclose certain portions of their meetings with EAP or a generalized summary report of areas that need to be addressed more adequately. Mentorship forms will also be used as a resource to gauge the needs and concerns of the staff and whether they are reporting an increase in job satisfaction with the new leadership style. At the end of the project trial period, a thorough report will be produced that provides data supporting significant findings. The report will be used for future project planning and can serve as a guide for other units to use in conjunction with the HWE toolkit 2.0 from the AACN website. This combination of data can improve nurses' job satisfaction, decrease the financial burden of intent to leave places in the organization, and improve the ability to appropriately compensate current and future nurses. Ethical Considerations In healthcare, management and leaders must not focus on more than just tasks and performance. Ethical considerations must include building and maintaining meaningful relationships that facilitate cooperation while respecting the rights of others. Leaders' empathetic responses to personal and professional conflict are also necessary to help support nurses in their roles and create a unified team to achieve success (Cummings et al., 2018). Factors influencing a nurse's job satisfaction must be examined and identified appropriately, as poor job satisfaction directly correlates with quality care issues. Clarifying appropriate leadership style(s) has a greater potential to influence patient outcomes than any other measure (Cummings et al., 2018). This project specifically addresses and implements 27 servant leadership. Each unit that implements this project should assess its readiness and the leadership style preferred for the unit before utilizing this project. Understanding internal biases and measuring honest service within the LMX dynamic will also be imperative to successfully implementing leadership change. The lead for this MSN project could inadvertently inflict personal bias on the project due to extensive involvement in its research, development, implementation, and evaluation throughout. This project will also consider the learning styles of its leaders, the abilities of leaders and followers, language preferences for all individuals, cultural sensitivities that may be encountered, and the preferences of each individual when addressing ethical considerations for this project. All information obtained throughout this project about patients, families, employees, leaders, managers, and any other individual will be kept anonymous and private, and this project will comply with all security and HIPAA laws and regulations. Any data obtained for review and use during this project will have all identifiers removed to protect pertinent information. In addition, this project will elicit the help of information technology and informatics to assist in maintaining the integrity of all sensitive and confidential information throughout the project. These considerations will be addressed to ensure ethical implementation throughout this project. Discussion Positive leadership has a significant impact on the ability of the bedside nurse to achieve job satisfaction. The work environment is among the most influential factors in the decision to stay or leave a current position. With hospitals incurring a deficit of $52,350 per nurse that leaves the organization, it is imperative to address the issue by promoting positive leadership (Boston-Fleischhauer et al., 2023). According to the National Nurse Work Environments (AACN, n.d.) status report by the American Association of Critical Care Nurses released in 28 2023, the intent to leave escalates at unparalleled rates because of unhealthy work environments (AACN, n.d.). Nurses have made their need to be supported and heard known (Boone et al., 2023). The toxic work environment instigated by poor leadership erodes the trust between team members and results in poor patient outcomes, including mortality, adverse hospital-acquired events, poor safety outcomes, and the nurse's psychological and mental well-being (Bobbio & Manganelli, 2015). This project aims to implement positive leadership to improve nurses' job satisfaction through the education of leaders, implementation of the HWE assessment toolkit 2.0 (AACN, n.d.) and implementation of servant leadership that will be measured through pre, random, and post-surveys to identify effectiveness and areas that lag and need intervening. The following sections discuss disseminating the project's results, significance, strengths, limitations, and recommendations. Evidence-based Solutions for Dissemination The project's results will be disseminated in various ways after its implementation. First, after all leaders are educated and pre-assessments are conducted (both leader and employee), this information will be shared with stakeholders and administrators during the monthly meeting for discussion and evaluation. Adjustments will be made following the results of the document and feedback from the team. Second, after a review of the information, outcomes for the project will be outlined following the utilization of the PDSA and SMART model. The outline will be presented in a flow chart to identify each step. A PowerPoint presentation can also be created for utilization within the meeting to ease discussion of the strengths, limitations, and recommendations based on the evaluation to identify barriers and areas needing improvement and adjustment of goals. Finally, a poster presentation will be created to share this project¶V 29 success with the course students and faculty at Weber State University and other platforms that may be appropriate to showcase the project's success in the final semester. If the project is successful within the ICU where it will be implemented, future dissemination within the hospital units would be beneficial to mitigate burnout, moral fatigue, psychological distress, and intent to leave the organization, resulting in improved job satisfaction across the organization. Significance to Advance Nursing Practice This project can benefit the nursing profession through the deliverables outlined within this project. Implementing positive leadership creates an environment where the nurse can practice autonomy while having the unit function as a team (Restivo et al., 2022). Leadership VW\OHV KDYH WKH VLQJOH PRVW LPSDFW RQ DQ 51¶V GHFLVLRQ WR OHDYH, demonstrating the need to appropriately train the current leaders (Halter et al., 2017). Thacker et al. (2019) provided a positive correlation between servant leadership on followers and increased job satisfaction with the leader. The findings demonstrate that VHUYDQW OHDGHUVKLS IXOILOOHG WKH IROORZHU¶V QHHGV DQG OHDGHUV¶ UROHV DQG LQVSLUHG PRWLYDWLRQ DQG UHVLOLHQFH IRU DOO SDUWLHV Furthermore, data has demonstrated a negative trend that has been occurring with more nurses leaving the profession over the last five years than at any other time (Boston-Fleischhauer et al., 2023). The cost incurred to the organization for this frightening trend ranges from $6.6 million to $10.5 million per hospital, with an estimated $52,350 for every nurse leaving the position (Boston-Fleischhauer et al., 2023). Organizations need to invest in training current and future leaders to accommodate the needs of the nurse. The healthcare landscape can be redesigned moving forward. More nurses can be retained and recruited by implementing servant leadership and creating healthy work environments where nurses want to work and contribute because of the satisfaction they receive from their work. 30 Implications The strengths of this project were the implementation of quantitative, qualitative, and literature review evidence. This project pulled information from across the globe to represent the nursing body. This project utilized assessment tools and educational material from reputable sources. The learning material consisted of modules created by Udemy, an online learning marketplace covering a broad range of topics created by top experts. Additional deliverables included surveys and the HWE assessment toolkit 2.0 created by the AACN. All deliverables have online access to the assessments, timeline, and PowerPoint slides, which are available for print. This project utilizes the PDSA and SMART framework to support the change in the ICU (Melnyk & Fineout-Overholt, 2019). The PDSA framework prepares the unit to implement this project by addressing three questions posed by this model: what the group needs to accomplish, how the change is an improvement, and examining the change that will result in an improvement. This project does have some limitations. First, there is a limited study of servant leadership specifically. Second, there may be bias in one preferred leadership style over another. The attempt to mitigate this bias has been acknowledged, but whether it is mitigated is still being determined. The author of this project has acknowledged their preferred leadership style that may impact the outcome of the project data. Third is the inability to fully execute the project within the designated unit to address possible issues and barriers. As of today, this project is hypothetical and prevents appropriate identification of strengths and limitations. Appropriate implementation would give real-time data and allow a more comprehensive understanding of servant leadership and its implications on nursing. 31 Recommendations This MSN project utilized robust resources to create a highly detailed and effective plan. Weber State University faculty, content experts, peers, and colleagues were utilized to create an ideal project and to minimize gaps that may exist. Although the project goals were thoroughly analyzed with various sources of review, recommendations are indicated for improvement to address areas that have been overlooked or gaps that may exist in the project. The literature review provides extensive research on the impact of leadership styles on job satisfaction and the leader's impact on the bedside nurse to practice autonomy within a unified team to achieve the highest job satisfaction (Restivo et al., 2022). It also demonstrated that leadership styles have the single most impact RQ DQ 51¶V GHFLVLRQ WR OHDYH (Halter et al., 2017). Therefore, additional research should be sought to determine different leadership styles and their impact within different units of an organization. This additional research would improve and expand the project. This project specifically addresses servant leadership within the ICU, and it would be necessary to determine whether ethical or authentic leadership would be more appropriate within a specified unit outside of the ICU setting. Utilizing the interprofessional team would add depth to the project and give different perspectives and insights into the limitations of servant leadership. Halter et al. (2017) identified collaboration and teamwork as part of the six domains of a healthy work environment. To exclude interprofessional and barrierless communication to enrich this project would be negligent of the author and perpetuate the decrease in job satisfaction. Research has demonstrated that nurses recognize that their work is interdependent on all other disciplines to deliver the care the patient needs to become well and can be best accomplished utilizing servant leadership, which is most closely related to the nursing standards practice they exemplify 32 (Booher et al., 2021). This project focuses on educating current leaders in servant leadership to improve bedside nurses' job satisfaction. Therefore, expanding the same education to bedside nurses would prepare them to become future leaders well before stepping into the official role and serve to benefit the patients cared for by the current and future leaders, resulting in improved outcomes (Halter et al., 2017). Many current leaders have been placed into leadership roles without the appropriate training. Educating leaders within the interprofessional team would promote trust, support, participation, and respect among colleagues, thus reducing burnout and improving nurse retention through increased job satisfaction (Bobbio & Manganelli, 2015). This project supports this goal through education, collaboration, and implementation across unit(s) professionals. Conclusions Nurses and patient outcomes depend on strong, supportive, and highly visible leadership. Providing the appropriate education on servant leadership will support this and significantly impact the nurse's job satisfaction and future retention of these trained and competent nurses (Restivo et al., 2022). Servant leadership creates conditions that value the nurse as an individual while promoting trust, support, participation, and respect, significantly reducing burnout and increasing job satisfaction. This knowledge allows for the implementation of servant leadership education for current leaders within the ICU, resulting in retention and return to the nursing profession (Bobbio & Manganelli, 2015). The organization can retain current nurses Through increased job satisfaction while redesigning the healthcare landscape. More nurses can be retained and recruited by implementing servant leadership and creating healthy work environments for the nurse to achieve the highest level of job satisfaction. This project aims to educate current and future leaders in servant leadership. As leaders implement the deliverables, 33 bedside nurses can feel more fully supported, resulting in better job satisfaction and exceptional patient outcomes. 34 References Allameh, S. M., Salimiyan, S., Aboofazeli, M., & Mircholi, A. (2016). The relationship between the leadership style of administrators and the mental health of employees of healthcare centers of Isfahan University, Iran. Journal of Fundamentals of Mental Health, 156-160. American Association of Critical Care Nurses (AACN). (n.d.). AACN Healthy Work Environment Assessment Tool 2.0. AACN. https://www.aacn.org/nursingexcellence/healthy-work-environments/aacn-healthy-work-environment-assessment-tool BREELR $ 0DQJDQHOOL $ 0 $QWHFHGHQWV RI KRVSLWDO QXUVHV¶ LQWHQWLRQ WR OHDYH WKH organization: A cross sectional survey. International Journal of Nursing Studies, 52(7), 1180±1192. https://doi.org/10.1016/j.ijnurstu.2015.03.009 Booher, L., YaWHV ( &ODXV 6 +DLJKW . %XUFKLOO & 1 /HDGHUVKLS VHOIဨSHUFHSWLRQ of clinical nurses at the bedside: A qualitative descriptive study. Journal of Clinical Nursing, 30(11±12), 1573±1583. https://doi.org/10.1111/jocn.15705 Boone, L. D., Rodgers, M. M., Baur, A., Vitek, E., & Epstein, C. (2023). An integrative review RI IDFWRUV DQG LQWHUYHQWLRQV DIIHFWLQJ WKH ZHOOဨEHLQJ DQG VDIHW\ RI QXUVHV GXULQJ D JOREDO pandemic. Worldviews on Evidence-Based Nursing, 20(2), 107±115. https://doi.org/10.1111/wvn.12630 Boston-Fleischhauer, C., Malott, D., & Bierhoff, J. (2023, April 11). Charted: The impact of nurse turnover in 2022. http://www.advisory.com/daily-briefing/2023/04/11/rn-turnover Burg, B., & Mann, J. D. (2019). The go-giver: A little story about a powerful business idea. Portfolio Penguin. 35 Cakir, F. S., & Adiguzel, Z. (2020). Analysis of leader effectiveness in organization and knowledge sharing behavior on employees and organization. SAGE Open, 10(1), 215824402091463. https://doi.org/10.1177/2158244020914634 Cummings, G. G., Tate, K., Lee, S., Wong, C. A., Paananen, T., Micaroni, S. P. M., & Chatterjee, G. E. (2018). Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review. International Journal of Nursing Studies, 85, 19±60. https://doi.org/10.1016/j.ijnurstu.2018.04.016 Dimino, K., Learmonth, A. E., & Fajardo, C. C. (2021). Nurse managers leading the way: Reenvisioning stress to maintain healthy work environments. Critical Care Nurse, 41(5), 52±58. https://doi.org/10.4037/ccn2021463 Franczukowska, A.A., Krczal, E., Knapp, C., & Baumgartner, M. (2021). Examining ethical leadership in health care organizations and its impacts on employee work attitudes: An empirical analysis from Austria. Leadership in Health Services, 34(3), 229-247. https://doi.org/10.1108/lhs-06-2020-0034 Gabele, D., Cartwright, T., Christen, F., Martinez, E., McKenzie, L., Murray, R., Peavler, S., & Blake, N. (2023). Authentic leadership: Pearls of wisdom. AACN Advanced Critical Care, 34(1), 59±62. https://doi.org/10.4037/aacnacc2023422 Gawlinski, A., & Rutledge, D. (2008). Selecting a model for evidence-based practice changes. AACN Advanced Critical Care, 19(3), 291±300. https://doi.org/10.4037/15597768-20083007 Hall, L.L. (2016, April 27). Plan-Do-Study-Act (PDSA)Accelerated Quality Improvement in Your Practice. Home. https://edhub.ama.assn.org/steps-forward/module/2702507 Institute for Healthcare Improvement. (n.d.). Quality Improvement Essential toolkit | 36 IHI-Institute for Healthcare«Institute for Healthcare Improvement. https://www.ihi.org/resources/Pages/Tools/Quaity-Improvement-Essentials-Toolkit.aspx Halter, M., Boiko, O., Pelone, F., Beighton, C., Harris, R., Gale, J., Gourlay, S., & Drennan, V. (2017). The determinants and consequences of adult nursing staff turnover: A systematic review of systematic reviews. BMC Health Services Research, 17(1). https://doi.org/10.1186/s12913-017-2707-0 Hanse, J. J., Harlin, U., Jarebrant, C., Ulin, K., & Winkel, J. (2016). The impact of servant leadership dimensions on leader-member exchange among healthcare professionals. Journal of Nursing Management, 24(2), 228-234. https://doi.org/10.1111?jonm.12304 Jit, R., Sharma, C. S., & Kawatra, M. (2016). Servant leadership and conflict resolution: A qualitative study. International Journal of Conflict Management, 27(4), 591±612. https://doi.org/10.1108/ijcma-12-2015-0086 Mabona, J. F., van Rooyen, D., & ten Ham-Baloyi, W. (2022). Best practice recommendations for healthy work environments for nurses: An integrative literature review. Health SA Gesondheid, 27, 1±11. https://doi.org/10.4102/hsag.v27i0.1788 Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and Healthcare: A guide to best practice (4th ed). Wolters Kluwer. Reed, J. E., & Card, A. J. (2015). The problem with plan-do-study-act cycles. BMJ Quality & Safety, 25(3), 147±152. https://doi.org/10.1136/bmjqs-2015-005076 Restivo, V., Minutolo, G., Battaglini, A., Carli, A., Capraro, M., Gaeta, M., Odone, A., Trucchi, C., Favaretti, C., Vitale, F., & Casuccio, A. (2022). Leadership effectiveness in healthcare settings: A systematic review and meta-analysis of cross-sectional and before±after studies. 37 International Journal of Environmental Research and Public Health, 19(17), 10995. https://doi.org/10.3390/ijerph191710995 Shafique, I., N. Kalyar, M., & Ahmad, B. (2018). The nexus of ethical leadership, job performance, and turnover intention: The mediating role of job satisfaction. Interdisciplinary Description of Complex Systems, 16(1), 71±87. https://doi.org/10.7906/indecs.16.1.5 Squellati, R., & Zangaro, G. A. (2022). Eight ways nurses can manage a burnt-out leader. Nursing Clinics of North America, 57(1), 67±78. https://doi.org/10.1016/j.cnur.2021.11.005 Thacker, C., Sullivan, G., & Self, S. (2019). How servant leadership principles affect employee turnover at a solid waste management firm. Journal of Leadership, Accountability and Ethics, 16(2). https://doi.org/10.33423/jlae.v16i2.2023 Ulrich, B., Cassidy, L., Barden, C., Varn-Davis, N., & Delgado, S. A. (2022). National nurse work environments - October 2021: A status report. Critical Care Nurse, 42(5), 58±70. https://doi.org/10.4037/ccn2022798 38 Appendix A PowerPoint Presentation Servant Leadership Presentation Assignment.pptx Why leadershipmatters? PositiveLeadership ‡ KimSteeleBSN, RN, CNN MSNStudent Instructor: DianeLeggett-Fife, Ph.D., RN ‡ ‡ ‡ ‡ ‡ ‡ Leadershipisthenumber onereasonanursedemonstratesanintent toleavean organization 10.5millioncost toahospital (27.1% increaseinRNturnover in 2021 withhospitals at 25.9%) (Ulrichet al., 2022) 52.350per RN(Boston-Fleischhaueret al., 2023) Nurseswant tobesupportedandheard (Booneet al., 2023) Servant leadershipsupportsautonomy andteamunity (Restivoet al., 2022) Maslow’sHierarchy demonstrateshumanneedstoreachthefull potential (Thacker et al., 2019) Traditional medicinehierarchy isoutdated ( Booheret al., 2021) Mental Well-Being Visibility andcommunicationmatter Ļjobsatisfaction=moral fatigue/ burnout (Booneet al., 2023) empowerment Servant leaders= ↑well-beingandjob satisfaction (Booneet al., 2023) JobSatisfaction WorkEnvironment Numerousstudiessupport servant leadership Disciplinewrongdoers Treat everyonefairly andconsiderately Fosterlearningandempowerfollowers Increaseworkperformanceandjob satisfaction Safeandpositiveenvironment foremployees Leaders: Listen, assertive, intelligent Emotional intelligence TRUST RNstaffingratios, safecommunication 6domainsinHWEtoolkit (Cummingset al., 2018) (Cummingset al., 2018) (Bobbio&Manganelli, 2015) Trust theirleader= Ĺ intent tostay ĹLMXandimprovedpatient outcomes Ļmortality rates Negatetheoldmedical hierarchy toimprove RN/MDrelations Emotional support (personal &professional) (Booheret al., 2021) (Booheret al., 2021)) (Jit et al., 2016) (Bobbio&Manganelli, 2015) (AACN, 2023) (AACN, 2023) Servant Leadership-BottomUpApproach Intent toStay (Hanseet al., 2016) (Franczukowska et al., 2021) (Cummingset al., 2018) - Serve your followers first: supports the follower - Develop the trust/ rela onship - Encourages and promotes follower instead of the organiza on= ↑ trust in organiza on (Thacker et al., 2019) (Thacker et al., 2019) - RN self repor ng of servant leadership preferred (Bobbio & Manganelli, 2015) 39 Key Takeaways -Trust -Bottomup -Retention -Psychosocial safety (Thackeret al., 2019) (AACN, 2023) -Empower -HWEassessment (AACN, 2023) -Well-being -Teamwork -Collaboration -Improvesoutcomes -Patient prioritized -Overall experience This Photo by Unknown Author is licensed under CC BY References $PHULFDQ $VVRFLDWLRQ RI &ULWLFDO &DUH 1XUVHV Q G $$&1 +HDOWK\ :RUN (QYLURQPHQW $VVHVVPHQW 7RRO $$&1 KWWSV ZZZ DDFQ RUJ QXUVLQJ H[FHOOHQFH KHDOWK\ ZRUN HQYLURQPHQWV DDFQ KHDOWK\ ZRUN HQYLURQPHQW DVVHVVPHQW WRRO %REELR $ 0DQJDQHOOL $ 0 $QWHFHGHQWV RI KRVSLWDO QXUVHV¶ LQWHQWLRQ WR OHDYH WKH RUJDQL]DWLRQ $ FURVV VHFWLRQDO VXUYH\ ,QWHUQDWLRQDO -RXUQDO RI 1XUVLQJ 6WXGLHV ± KWWSV GRL RUJ M LMQXUVWX %RRKHU / <DWHV ( &ODXV 6 +DLJKW . %XUFKLOO & 1 /HDGHUVKLS VHOIဨSHUFHSWLRQ RI FOLQLFDO QXUVHV DW WKH EHGVLGH $ TXDOLWDWLYH GHVFULSWLYH VWXG\ -RXUQDO RI &OLQLFDO 1XUVLQJ ± ± KWWSV GRL RUJ MRFQ %RRQH / ' 5RGJHUV 0 0 %DXU $ 9LWHN ( (SVWHLQ & $Q LQWHJUDWLYH UHYLHZ RI IDFWRUV DQG LQWHUYHQWLRQV DIIHFWLQJ WKH ZHOOဨEHLQJ DQG VDIHW\ RI QXUVHV GXULQJ D JOREDO SDQGHPLF :RUOGYLHZV RQ (YLGHQFH %DVHG 1XUVLQJ ± KWWSV GRL RUJ ZYQ %RVWRQ )OHLVFKKDXHU & 0DORWW ' %LHUKRII - $SULO &KDUWHG 7KH LPSDFW RI QXUVH WXUQRYHU LQ KWWS ZZZ DGYLVRU\ FRP GDLO\ EULHILQJ UQ WXUQRYHU Burg, B., & Mann, J. D. (2019). The go-giver: A li le story about a powerful business idea . Penguin Business. References Servant-leadership . (2016). photograph, Retrieved January 8, 2024, from h ps://leadershipfreak.files.wordpress.com/2016/12/servant-leaders-serve-others-so -others-are-free-to-serve-others.jpg?w=578. 7KDFNHU & 6XOOLYDQ * 6HOI 6 +RZ VHUYDQW OHDGHUVKLS SULQFLSOHV DIIHFW HPSOR\HH WXUQRYHU DW D VROLG ZDVWH PDQDJHPHQW ILUP -RXUQDO RI /HDGHUVKLS $FFRXQWDELOLW\ DQG (WKLFV KWWSV GRL RUJ MODH Y L 8OULFK % &DVVLG\ / %DUGHQ & 9DUQ 'DYLV 1 'HOJDGR 6 $ 1DWLRQDO QXUVH ZRUN HQYLURQPHQWV 2FWREHU $ VWDWXV UHSRUW &ULWLFDO &DUH 1XUVH ± KWWSV GRL RUJ FFQ <RX7XEH 6HSWHPEHU 7KDW¶V DOO IRONV +' <RX7XEH KWWSV ZZZ \RXWXEH FRP ZDWFK"Y E %R*N14 References &XPPLQJV * * 7DWH . /HH 6 :RQJ & $ 3DDQDQHQ 7 0LFDURQL 6 3 0 &KDWWHUMHH * ( /HDGHUVKLS VW\OHV DQG RXWFRPH SDWWHUQV IRU WKH QXUVLQJ ZRUNIRUFH DQG ZRUN HQYLURQPHQW $ V\VWHPDWLF UHYLHZ ,QWHUQDWLRQDO -RXUQDO RI 1XUVLQJ 6WXGLHV ±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± KWWSV GRL RUJ LMFPD 5HVWLYR 9 0LQXWROR * %DWWDJOLQL $ &DUOL $ &DSUDUR 0 *DHWD 0 2GRQH $ 7UXFFKL & )DYDUHWWL & 9LWDOH ) &DVXFFLR $ /HDGHUVKLS HIIHFWLYHQHVV LQ KHDOWKFDUH VHWWLQJV $ V\VWHPDWLF UHYLHZ DQG PHWD DQDO\VLV RI FURVV VHFWLRQDO DQG EHIRUH ±DIWHU VWXGLHV ,QWHUQDWLRQDO -RXUQDO RI (QYLURQPHQWDO 5HVHDUFK DQG 3XEOLF +HDOWK KWWSV GRL RUJ LMHUSK 40 Appendix B Pre-and Post Survey Questionnaire for Leaders and Staff Healthy Work Environment Survey.docx 41 Appendix C Random Survey for Bedside Nurses Random HWE Survey.docx 42 Appendix D Servant Leadership Educational Modules Servant Leadership Training for Leaders Talking To Your Employees About Stress At Work https://intermountain.udemy.com/course/talking-to-your-employees-about-stress-atwork/learn/lecture/27436850#overview Description: Deborah Grayson Riegel, the keynote speaker and a leadership communication consultant, created this course. This course is designed to educate and instruct leaders on the ability to help colleagues with stress, burnout, and anxiety within the work environment without backing away or overstepping. It educates leaders on creating an open, inclusive, and safe environment that allows every team member to bring their whole self to work, including their mental well-being. This is done through teaching methods that promote an ability to share openly at work, facilitate the employee's ability to perform better, engage more fully, and retain staff by creating a better work environment. It was created to assist leaders through education to help others around them. This course educated leaders on the need for support to improve mental well-being in the work environment, which is significant in this project. Length: 1:40 Scoring: 4 questions are asked and recorded throughout the presentation. The responses to the questions are recorded through Workday, and documentation of successful completion is recorded within the employee (leader) Workday required education. Physical records can be printed from the employee's Workday completion history. 43 Updates: Updates to the modules are completed through a third party (Udemy) and automatically updated into Workday. Notification of updates is issued to shared leaders as well as Intermountain IT. This service is paid for through Intermountain Health Corporation. Note: The link is available to those employed by Intermountain Health Corporation. Visionary Servant Leadership https://intermountain.udemy.com/course/visionary-servantleadership/learn/lecture/15814118#overview Description: Matthew Strohhacker, MPH, MBA, CPH is a healthcare leader and wellness guru who created this series to help each viewer become the best leader within healthcare. This education module is designed to help leaders become the best leaders they can be. It teaches the viewer how to transform the workplace into a family/community. It also educates the leader on how to lead effective and efficient teams that develop a love of working with you, the leader. It also delves into ways to build relationships built on trust and loyalty that enhance all aspects of life. It teaches viewers how to optimize their leadership style to connect with their colleagues, family, friends, and strangers to build political capital and enact positive change. This course applies to the project because it directly influences the OHDGHU¶V ability to lead effective teams built on unity and trust, which are essential components of servant leadership and promote overall job satisfaction with increased intent to stay. Length: 1:50 Scoring: 6 questions are asked and recorded throughout the presentation. The responses to the questions are recorded through Workday, and documentation of successful completion is 44 recorded within the employee (leader) Workday required education. Physical records can be printed from the employee's Workday completion history. Updates: Updates to the modules are completed through a third party (Udemy) and automatically updated into Workday. Notification of updates is issued to shared leaders as well as Intermountain IT. This service is paid for through Intermountain Health Corporation. Note: The link is available to those employed by Intermountain Health Corporation. Lead & Empower Agile Teams To Achieve Success https://intermountain.udemy.com/course/empower-agile-teams/learn/lecture/25090364#overview Description: This course was created by Peter Alkema, who provides business, technology, and self-development education. This course teaches leaders the practical steps to uplift their agile team environment to improve sentiment, drive collaboration, and acknowledge agile team principles. It gives insight into the need to empower your team for success and greater productivity. He teaches the leader to flourish despite being in traditional organizations with established hierarchy and command management practices. The course teaches servant leadership and how this leadership style helps teams succeed, the importance of trust within the LMX, the relationship between team sentiment and empowerment and why teams need to be empowered, supported, and trusted to get the work done, and how agile principles are in direct conflict with traditional management practices within organizations. This course addresses the very essence of this project. It will educate leaders on servant leadership and facilitate building the tools within them to break the traditional hierarchy so agile and empowered teams can flourish. Length: 11 hours 45 Scoring: This module can be conducted individually or as a class group, broken into 10 sessions with an hour per week allotted. There are interactive wipeboard lessons that require participation from the viewer, with recorded documentation of participation. Short quizzes are presented throughout the course, with scores recorded. The responses to the quizzes and wipeboards are recorded through Workday, and documentation of successful completion is recorded within the employee (leader) Workday required education. Physical records can be printed from the employee's Workday completion history. Updates: Updates to the modules are completed through a third party (Udemy) and automatically updated into Workday. Notification of updates is issued to shared leaders as well as Intermountain IT. This service is paid for through Intermountain Health Corporation. Leadership: How to Influence, Inspire, and Impact as a Leader https://intermountain.udemy.com/course/leadership-influenceeveryone/learn/lecture/8110868#overview Description: Lorraine Wiseman, a global executive responsible for leading change, presents this course. It addresses the concept that we make others better through leadership by empowering them to do their best. This can be accomplished through this education module that teaches leaders to become strong leaders to guide, inspire, and impact those around them to work together to achieve a common goal. It guides the individual from a manager mentality to developing an attitude of leadership. It introduces the leader to various leadership styles primarily focusing on servant leadership. It teaches the viewer how to work with different levels of performers and ways to inspire them to reach their full potential. It also provides education on inspiring others to work towards your vision in an informative and engaging way. 46 This course educated leaders on the need for support to improve mental well-being in the work environment, which is significant in this project. Length: 1:50 Scoring: This course requires successful completion of 7 exercises. The responses to the exercises are recorded through Workday, and documentation of successful completion is recorded within the employee (leader) Workday required education. Physical records can be printed from the employee's Workday completion history. Updates: Updates to the modules are completed through a third party (Udemy) and automatically updated into Workday. Notification of updates is issued to shared leaders as well as Intermountain IT. This service is paid for through Intermountain Health Corporation. Note: The link is available to those employed by Intermountain Health Corporation. References Healthy Work Environment Assessment Toolkit 2.0 (AACN, 2022) https://www.aacn.org/~/media/aacn-website/nursing-excellence/healthy-workenvironment/hweat-questions.pdf?la=en Note: The link is available to those with active AACN memberships. Intermountain Health. (2024, January). Sign on - intermountain. Workday. https://m.intermountain.net/hr/workday/Pages/Home.aspx Note: The link is available to those employed by Intermountain Health Corporation. 47 Appendix E Timeline