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An Innovative Nurse Leader Redesign to Improve Span of Support

  • Author(s): Tolentino, Michelle Carolyn
  • Advisor(s): Hodge, Felicia S
  • et al.
Abstract

Background: Hospital budget constraints and re-allocation of resources have led to a decrease in nurse manager positions, increasing spans of control (SOC). Large SOC can have direct impacts on nurse engagement and clinical outcomes. Nurse managers in the organization with large SOC were overwhelmed by administrative functions that took them away from daily interactions with patients, families, and staff. Management roles and responsibilities were not clearly defined, resulting in role confusion and role blending. Wide ranging SOC were worsened by the varying levels of experience and competency among managers. Additionally, there was an increase in labor activity in the organization and a notable reduction in nurse participation in hospital surveys, with Press Ganey Nurse Engagement survey scores lower than national benchmarks.

Methods: This quality improvement project examined the feasibility of a nursing leadership structure and practice-based change. The project involved conducting a needs assessment and re-designing unit leadership structure to improve SOC. A thorough needs assessment, review of past performance in standardized benchmarking surveys, and review of the literature were

utilized in the leadership redesign. Baseline measurements were established for the organization to assess the effectiveness of the change. The measurements included: 1) Leadership Access and Responsiveness domain from Press Ganey Nurse Engagement survey; 2) nurse perception of unit management and work environment using a focus group approach and Qualtrics survey with pilot unit staff; 3) patient satisfaction scores; and (4) nurse sensitive indicators.

Results: Comprehensive needs assessment, SWOT analysis, nurse manager ratios, nurse sensitive indicator performance, and patient satisfaction scores suggested the need for quality improvement project to address the gaps in unit leadership.

Conclusion: A new leadership structure was designed and new manager position was created to improve SOC. Outcome measures that include nurse engagement, patient satisfaction, and nurse sensitive indicators were established. The best evidence suggests that smaller SOC is related to higher levels of nurse engagement and ultimately to improved patient safety and staff satisfaction. Redesigning the SOC model is essential to achieving improved nurse engagement and clinical outcomes.

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