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CAPSTONE PROJECT 2
Introduction
the organization. Many of the nurses have raised concerns about their well-being and the need to
improve the environment in which they work. Owing to the numerous complaints that have been
raised by the nurses, the organization has recognized the solution to the issue which is the
facilitation of the satisfaction of the frontline nurses. The primary purpose of this capstone
project, therefore, is to help Grandview Medical Center solve the problem identified by initiating
a rounding program for the nursing directors to help improve nurse satisfaction. The nurse
directors, eight in number, will be involved in the direct implementation of the rounding
program. The program will also include maintaining close contact with the nurses by the director
nurses in a bid to recognize the source of dissatisfaction among the nursing staff.
To this end, a literature review was conducted to appraise previously completed works
and literature on the same topic. Evidence-based approaches and theories from the selected
nurse satisfaction, and frontline nurse engagement were highlighted and explored in relation to
the problem at Grandview Medical Center. The criteria used in the selection process of the pieces
of literature included searching for journals that are peer-reviewed, journals less than six years
old, use of specific search terms and within the topic. Examples of the search terms that were
used on various journal databases such as Medline, PubMed, Elsevier, and CINAHL, included
nurse satisfaction, frontline nurse engagement, leadership rounding programs in nursing, and
nurse empowerment. A total of ten journals were selected and found applicable and useful in
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determining the root cause of the relatively low nursing satisfaction in the Grandview Medical
Center. The structure for this review will begin by identifying the common themes among the
selected journals and then address the articles separately to summarize the arguments and claims
From the ten articles selected a running theme was observed, and it is that frontline
nurses were often charged with leadership responsibilities without any formal leadership training
(Scanlon & Woolforde, 2016) (Riley, Dearmon, Mestas & Buckner, 2016). Secondly, many of
the institutions within the health care industry have no training courses meant for the current
nurses and future nurses (Richey & Waite, 2019). Another theme that was identified from the
reviewing process is the existing challenges faced by nurses that often causes them frustration
and thus dissatisfaction. Some of the issues highlighted form the articles include communication
issues, lack of proper conflict management, management of staff performance and also role
clarity (McCay, Lyles & Larkey, 2018) (Fabry, 2014) (Lockhart, 2017).
required in the process of creating a culture of excellence among nurses. According to the
findings of the study, transformational leadership, effective change management and also
strategic planning were some of the key elements needed in the creation of excellence in nursing.
Additionally, the provision of a safe, positive practice environment was also identified as an
important aspect of achieving nurse satisfaction. The implication of this claim is that if
institutions fail to provide the frontline nurses with a safe environment to practice then it is likely
that the nurses will be dissatisfied and this dissatisfaction will begin to show in the patient
outcomes if not handled promptly. One of the clear suggestions by the authors to help achieve
excellence is through the use of programs such as the Pathway to Excellence program (Arthurs et
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al., 2017). Health care institutions can use programs of this nature in assessing the performance
levels of nurses and also in identifying the hindrances to excellence. While this suggestion is
helpful, it might not be applicable to all cases since some institutions such as Grandview Medical
Center might need more than a program to identify and solve issues regarding leadership,
management, and nurse satisfaction. Fabry (2014) created a survey to help learn more about the
impact of the perceptions and perspectives of frontline nurses on their responsibilities such as
hourly rounding. The hourly rounding is a practice that has been adopted by different institutions
with success and the author identified that hourly rounds by nurses not only led to better patient
outcomes and especially acute patients but also led to staff satisfaction. Nurses admitted to
feeling a sense of leadership and responsibility as well as role clarity as they did their hourly
rounds. They also reported to feeling a sense of ownership which boosted their productivity
While the hourly rounding seems applicable in helping nurses develop leadership skills
and also gain satisfaction and better patient outcomes, it is dependent on different variables.
Examples of the variables include the educational level of the registered nurse; shift worked, the
job category and unit worked. Results were slightly inconsistent with at least 25% of the
participant nurses feeling a sense of ownership and thus satisfaction (Fabry, 2014). On the other
hand, Lockhart (2017) claimed that purposeful rounding was impactful improving frontline nurse
satisfaction. However, unlike (Fabry, 2014) the emphasis was on the leadership rounds being
consistent and with a nurse leader. According to Lockhart (2017), consistency in rounds and with
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a nurse leader would help frontline nurses develop a habit of rounding on their patients more
frequently and also potentially teach them critical leadership skills. The rounds are meant to
improve patient outcomes and be engrained as part of the leader nurses routine. Another
important argument made by the article is that for the routine rounds to help with improving
leadership skills and lead to nurse satisfaction, they have to be organic and natural as opposed to
(Luk, 2018) conducted a one-year long program in a hospital in Hong Kong with the
primary aim of investigating the influence that senior nursing managers have on their nursing
team members. The relationships between the senior nursing management and the nursing team
members were found to be impactful of the quality of care given by the nurses to their patients.
The author’s quest was embedded in transforming the senior nursing managers to become caring
leaders and in turn helping their team members to provide holistic care (Luk, 2018). Based on the
structure of the program it is evident that while the senior nursing management acquired skills on
how to become better-caring leaders, their team members gained useful leadership skills
applicable in their provision of care to patients. Following the results of the study, the author
concludes that servant leadership in hospital management can be used in improving a caring
environment and a more qualified workforce. This study can be used to improve the leadership
skills of the frontline nurses and also significantly impact their job satisfaction levels.
In a systematic review, McCay, Lyles & Larkey (2018) argues that nurse leadership,
nurse satisfaction, and patient outcomes are interconnected. The purpose of the systematic
review was to investigate how nurse leadership styles affect nurse satisfaction and patient
satisfaction. The authors wanted to identify specific leadership styles that would be instrumental
in increasing nurse job satisfaction and positive patient outcomes. The results showed that some
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styles negatively affected nurse satisfaction such as task-oriented styles while some other styles
positively impacted the level of satisfaction such as relational leadership. Relational leadership
suggests that the leader should help in creating positive relationships at the workplace to help
model that focusses mostly on the tasks to be performed in a bid to reach set goals and objectives
of the organization. According to (McCay, Lyles & Larkey, 2018) the relational leadership
model increases the level of job satisfaction among nurses and should be applied. It is important
to note that even though there exists an interconnection between nurse leadership, nurse
satisfaction, and patient satisfaction, the biggest connection is between nurse leadership and
nurse satisfaction. The connection between patient satisfaction and nurse leadership is minimal.
The study shows critical revelations such as the influence of nurse leadership on nurse
satisfaction. Based on the study, Grandview Medical Center can implement the approach
suggested by (McCay, Lyles & Larkey, 2018) for increased nurse satisfaction and possibly
patient satisfaction.
Richey & Waite (2019) based the study at Ann & Robert H. Lurie Children's Hospital
situated in Chicago to assess the level of engagement and leadership development in seven areas.
The authors helped the management at the institution develop rounding programs and
engagement areas that would be useful in improving the staff and the leadership. The director of
leadership and the Associate Chief Nursing Officer (ACNO) were involved in the development
of a leadership program for frontline nurses which would help encourage engagement and
innovation. Innovation could mean allowing the nurses to also help find solutions to problems
that cause them to feel frustrated and dissatisfied with work. Having frontline nurses learn to
engage with the senior management could be advantageous for an institution because issues
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would be communicated first hand and as they happen. Rounding programs such as hourly
rounds, group rounds, and nurse management rounds, teaching rounds and matron rounds and
ensuring that they are limited by a few elements such as ensuring that hourly rounds are done
and a filling of a form to show consistency. Alternatively, teaching rounds can be limited in
terms of times, such that they take 20-30 minutes. It is critical to note that having rounds
In a different study, authors, Riley, Dearmon, Mestas & Buckner (2016) use a
efforts to empower the frontline nurses benefits the nurses, the organization and the patients.
These group of empowered nurses can be perceived as an army that will bring change to the
institution. From the article, some of the major points made include the importance of choosing
levels and also empowering the nurses through professional development. This study revealed
the importance of implementing an appropriate leadership style based on the objectives and goals
being aimed for by the organization. The transformational leadership model is impactful in
addressing any empowerment and engagement issues ensuring that nurses are on board with the
goals and objectives. Reduced resistance to programs and development of new ideas is achieved
by applying the transformational leadership model. In the case of Grandview Medical Center, a
comprehensive investigation can be carried out to help determine the kind of leadership that was
being applied and also establish the reason it worked in some areas and failed in others. The
main takeout from this journal article is that institutions can invest in understanding their staff
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and their needs as a company and then determine which leadership model to use since as it has
been shown, the leadership model impacts the empowerment and engagement of frontline nurses.
Scanlon & Woolforde’s (2016) study also supports the idea of engaging the frontline
nurses by making it the responsibility of both the frontline nurses and that of the senior nurse
management to attempt engaging and forming productive relationships with each other. The
journal article detailed the characteristics of the participating frontline staff nurses with the aim
In addition, the article advocates for increased engagement and empowerment of frontline nurses
(Scanlon & Woolforde, 2016). Senior nurse management and frontline nurses should have close
engagement so that the frontline nurses can be better placed to take charge and the senior
management nurse are helped retain their caring skills. Constant engagement of these two groups
could potentially lead to the creation of a leadership rounding program that would also increase
nurse satisfaction. The engagement would also lead to acquiring of new approaches to daily tasks
Conclusion
Overall, the journals reviewed show a strong correlation between nurse leadership styles,
engagement, empowerment of the frontline nurses and increased performance and nurse
satisfaction. The leadership style chose influential in different ways with one of the primary
impacts being either an increase or decrease of productivity and nurse satisfaction. The articles
also showed that use of programs such as the pathway to excellence could be used in driving
change in organizations among the frontline nurses. Additionally, the use of rounding schedules
is significant in enabling the frontline nurses to improve their leadership skills and also develop
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clarity of their role. In general, institutions attempting to identify the reason behind the
dissatisfaction among their nurses can engage different approaches as suggested by the various
authors. Examples of the steps to take in the development of leadership rounding programs to
improve nurse satisfaction include evaluating the current leadership model and determining if it
is apt for the set goals and objectives. Another step would be understanding the perceptions and
perspectives of frontline nurses and then use the information obtained to improve and further the
level of nurse satisfaction. Also, assessing the culture by the frontline nurses can help in building
culture is one way of working towards nurse satisfaction at health care institutions.
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References
Arthurs, K., Bell-Gordon, C., Chalupa, B., Rose, A., Martinez, D., Watson, J., & Bernard, D.
Fabry, D. (2014). Hourly rounding: perspectives and perceptions of the frontline nursing staff.
Lockhart, L. (2017). Purposeful leadership rounding. Nursing Made Incredibly Easy!, 15(6), 55.
doi: 10.1097/01.nme.0000525559.82774.58
Acute General Hospital in Hong Kong. The Open Nursing Journal, 12(1), 133-141. doi:
10.2174/1874434601812010133
McCay, R., Lyles, A., & Larkey, L. (2018). Nurse Leadership Style, Nurse Satisfaction, and
10.1097/ncq.0000000000000317
Richey, K., & Waite, S. (2019). Leadership Development for Frontline Nurse Managers
10.1016/j.mnl.2018.11.005
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Riley, B., Dearmon, V., Mestas, L., & Buckner, E. (2016). Frontline Nurse Engagement and
10.1097/naq.0000000000000186
Scanlon, K., & Woolforde, L. (2016). Igniting Change through an Empowered Frontline: A