Developing Nurse Managers Through an
Evidence-Based Education Program
Section 1: Nature of the Project
Introduction
Lack of education for nurse managers new to roles in leadership is a struggle for
health care organizations nationally (Nghe et al., 2020). In healthcare, there are no
standardized educational programs for nurse managers (Dyess et al., 2016). Learning is
often informal while on the job (Saifman & Sherman, 2019). Nurse managers make
important decisions that influence patient care, quality, organizational finances, and
personnel recruitment and retention, most often without formalized training or education
(Warshawsky, 2017). For this project, knowledge gaps in nurse managers were identified
using an evidence-based questionnaire asking participants to rate their perception of their
human resource management skills to implement a nurse manager education program. A
nurse manager education program can potentially support social change within the
organization by providing nurse managers with the opportunity to transform themselves
through the development of knowledge and the application of competencies to be more
effective leaders, promote succession planning, and decrease turnover as compared to
those who have not had formal education (Van Dyk et al., 2016). A formalized education
program provides a nursing system level approach to ensure that beginner level nurse
managers have the essential foundational tools that they require to be successful in
transitioning into a nursing leadership role by providing fundamental knowledge in
business domains of human resource management (Advisory Board, 2017).
Problem Statement
The problem that this Doctor of Nursing Practice (DNP) staff education project
addressed is the perception of knowledge related to human resource skills in beginner
level nurse managers. In addition to the aging nursing population and today’s nursing
shortage, it is estimated that 62% of nurse managers plan to leave their positions within
the next 5 years (Middaugh & Willis, 2018). Lack of nurse manager preparation leads to
lack of interest in nurse manager positions, lack of succession planning, and high turnover
rates (Sarver et al., 2019). It has been predicted that there will be an overabundance of
unfilled nurse manager positions nationally. It is critical that future nurse leaders are
prepared to fill these essential healthcare roles (Tsui & Gerard, 2019). Education is
essential to meet the decreased interest in nurse manager positions secondary to the lack
of leadership knowledge centered around the business skills and knowledge of human
resource management. The organizational expense to replace a nurse manager can cost an
organization between 75% and 125% of an annual nurse manager’s salary (Loveridge,
2017).
The development of new and future nurse leaders is crucial. This doctoral project
holds significance for the field of nursing considering the evidence has shown that
succession planning and education have been identified as lacking and formal education
to prepare nurse managers has not been standardized (Dyess et al., 2016). Bedside nurses
are often appointed or promoted into leadership positions because they are clinically
competent and possess strong clinical and critical thinking skills, but they often lack
leadership, business, and management proficiency (Warshawsky et al., 2020). As strong
as these managers are clinically, they lack knowledge and the specialized business skills
in the human resource components of management (Gunawan & Aungsuroch, 2017).
Purpose Statement
The purpose of this DNP project was to address the gap in knowledge due to lack
of nurse manager onboarding education by creating a sustainable, formal nurse manager
education program for a health care system using Benner’s stages of clinical competence:
novice to expert theory (Benner, 1982).
The DNP project addressed a perceived gap in knowledge of beginner nurse
managers and targeted those with 1 to 2 years of experience focusing on business
knowledge related to human resource management. The practice focused question of this
DNP nurse manager education project is as follows: In beginner nurse managers with 1 to
2 years of experience, does attending a course focused on human resource management
skills improve knowledge and competence of the American College of Health Care
Executives (ACHE) competencies? After completion of a nurse manager education
program, beginner nurse managers in their roles of 1 to 2 years will demonstrate an
increased perception of knowledge and competence in the business skills of human
resource management. A survey was conducted to understand the relationship between
having a formal evidence-based education program on nurse manager perceived
knowledge to not having a formal nurse manager education program.
The meaningful gap in practice that this DNP project addressed is nurse
manager’s lack of leadership knowledge in topics of human resource management. The
purpose of this quantitative DNP education project was to develop an organizational
level, standardized nurse manager education program based on modifications of Benner’s
stages of clinical competence: novice to expert theory (Benner, 1982). The novice to
expert theory was first proposed by Hubert and Stuart Dryfus in 1980 and is based on
skill acquisition and development as one moves through the five levels of competence
ranging from novice to expert (Benner, 1982). The project provided nurse managers with
the baseline knowledge of human resource management skills that they will need as
beginner level nurse managers. The nurse manager role is crucial for accomplishing
quality outcomes and success within the healthcare organization (Flatekval & Corbo,
2019). Indirectly, success equates to nurse manager retention and succession planning as
an outcome. The nurse manager role directly impacts nurse satisfaction, patient
satisfaction, and quality of care (Mudallal et al., 2017). The project holds potential
significance for social practice change due to the essential need in health care for nursing
leadership to be supportive and understanding not only for the clinical elements but also
the business components of healthcare systems.
Nature of the Doctoral Project
The sources of evidence that were collected for this DNP project were the
descriptive variables: gender, age, years with the organization, years in a leadership role,
and years in a leadership role within the organization. The ACHE 2020 Competencies
Assessment tool was used to evaluate pre/post survey results using an individualized
sample paired t test to measure pre- and post-competency. The pre- and post-survey intent
was to show improvement of knowledge in human resource management skills of
beginner nurse managers by comparing the mean scores pre- and the mean scores
posteducation. Using library databases CINAHL, MEDLINE, ProQuest Nursing, and
Allied Health Databases to search nursing databases for journals, I performed a journal
search using the following terms: nurse manager, front line nurse leader, nurse leader,
training programs, education, burnout, and orientation.
Nurses comprise most of the workforce members in healthcare organizations;
therefore, the nurse manager role has a direct impact on organizational success
(Warshawsky et al., 2016). Nurse managers directly influence financial, clinical, and
quality outcomes as well as patient satisfaction scores (Warshawsky et al., 2016). Nurse
managers in organizations that support a learning environment tend to stay in their
positions longer and assume increased responsibility (Loveridge, 2017).
Permission was obtained from the ACHE to use portions of the ACHE 2020
Competencies Assessment Tool to evaluate knowledge gaps in relation to human
resource management (see Appendix B). The questionnaire used in this project was based
on items from the Healthcare Executive Competencies Assessment Tool, published by the
Healthcare Leadership Alliance and the ACHE. Healthcare Leadership Alliance and
ACHE, however, have not endorsed or otherwise participated in this project.
A presurvey questionnaire was given to beginner level nurse managers within the
healthcare system to obtain a baseline assessment. The education was offered to beginner
nurse managers in their roles for 1 to 2 years. The same questionnaire was used for a
post-education survey. There were approximately 11 eligible subjects, which included
inpatient, ambulatory, and procedural nurse managers in the healthcare system from
multiple sites. Quantitative data were obtained anonymously from the pre- and
postassessment. The questionnaire was sent out via email with a link to the questionnaire.
The electronic questionnaire was de-linked and unable to be tracked back to the email
address and was further deidentified in the Research Electronic Data Capture (REDCap)
system. REDCap is a secure, Health Insurance Portability and Accountability Act
(HIPAA) compliant tool used for research and quality improvement studies. The
deidentified data were reported as aggregate data only. The DNP project had institutional
review board (IRB) approval from Walden University as well as from the organization
where the project was conducted. In collaboration with the organization’s learning and
development team, an evidence-based formal nurse manager education program was
implemented using both virtual and online electronic learning modalities. Modules were
in the organization’s Professional Development Resource Catalog and accessed via the
organizations learning management system: Leadership Education Advancement
Performance (LEAP).
The purpose of this DNP project was to identify the gaps in perceived knowledge
of nurse managers in their roles for 1 to 2 years in the skills of human resource
management using the human resource management section of the ACHE 2020
Competencies Assessment Tool questionnaire (see Appendix C). The participants were
asked to complete all seven online modules of the education program over 12 weeks (see
Appendix D). After completion of the nurse manager education program, nurse managers
were asked to complete the same questionnaire as a post assessment to demonstrate an
increased perception of knowledge and competence in the areas that encompass human
resource management.
Significance
Standardized nurse manager education is essential for nurse managers as they
begin their careers in leadership. The key stakeholders for this project included all nurse
managers in the system including inpatient, ambulatory, correctional, and procedural
areas encompassing all the health care system sites. Assistant nurse managers were
considered stakeholders as support to the nurse manager in promoting quality, retention,
and mentoring. Other stakeholders included C-suite leadership for nurse manager
support, guidance, mentoring, and resource commitment (see Stamps et al., 2019). The
organization's nursing staff were direct stakeholders because they are impacted by the
skill and knowledge of their nurse managers. Patients are indirect stakeholders; prepared
nurse managers lead to happy, engaged nurses, which impacts patient safety and quality
(Stamps et al., 2019). The Department of Human Resources Learning and Development
team was a stakeholder and partner in collaboration of education, virtual learning,
lectures, and modules. The organization was a stakeholder, and retention and continuity
of successful nurse managers positively impacts the organization through patient safety
and quality outcomes (Stamps et al., 2019).
To overcome knowledge gaps in nurse managers, formalized education is not
only needed but desired among nurse managers (Mosier et al., 2019). Nurse managers
have requested programs to build their confidence, knowledge, and their skill set for
success (Mosier et al., 2019). Investing in leadership development improves career
development and retention (Sarver et al., 2019). Nurse managers who are satisfied and
knowledgeable in their roles promote a positive culture, which consequently has a
positive impact on quality of care and patient satisfaction (Adriaenssens et al., 2017).
Nurse manager vacancy rates are 8.3% nationally and are expected to increase
(Stamps et al., 2019). Evidence has revealed that the nurse manager workforce is
advancing in age and approaching retirement (Advisory Board, 2017). Impending
babyboomer retirement is projected to impact an estimated 67,000 nursing leadership
positions (Titzer et al., 2014; Tsui & Gerard, 2019). In addition to the positive impact at
the nurse manager level, this DNP project may potentially contribute to nursing practice
through improved patient satisfaction, nurse satisfaction, nurse retention, and patient
quality and safety as secondary outcome measure. At the beginning of this project, the
organization’s nurse manager vacancy rate was 9.4%, and 56.6% of the filled positions
were nurse managers who had been in their roles less than 5 years. Vacancies have a
significant financial impact as well as a negative effect on nurse satisfaction, patient
satisfaction, and quality metrics (Sarver et al., 2019).
This DNP education project has the potential to be implemented in any health
care organization regardless of size without added expense of membership or licensing.
Additionally, the concepts can be used to create education to any healthcare discipline.
This project supports positive social change by providing nurse managers with the
opportunity to transform themselves as effective practitioners through knowledge
acquisition by creating strategies to promote and disseminate knowledge and
competencies. This development will allow nurse managers the ability to positively
impact social change within their organization, promote succession planning, decrease
turnover, and increase their knowledge. In addition, healthcare consumers and
organizations can see a positive impact in relation to patient satisfaction and quality
metrics.
Summary
In this section, I highlighted the importance of a standardized evidence-based
nurse manager education program for nurse managers in their roles for 1 to 2 years. The
organization’s departments of nursing, department of learning and development, and I
identified the need for such a program for the growing organization. Through the review
of scholarly literature and collaboration with the department of learning and
development team, a nurse manager education program was determined to be needed
and created for new nurse leaders. The next section highlights background and content.
Section 2: Background and Context
Introduction
Lack of nurse manager preparation leads to lack of interest in managerial
positions, lack of succession planning, and high turnover rates, which impacts an
organization’s quality and safety (Van Dyk et al., 2016). The practice-focused question of
this DNP education project is as follows: In beginner nurse managers with 1 to 2 years of
experience, does attending a course focused on human resource management skills
improve knowledge and competence of ACHE competencies? To meet the prevailing
knowledge gaps of nurse managers, there is a need for a formalized education program
within the organization. A formalized education program provides a standardized
approach to ensure all nurse managers new to leadership roles are provided the tools that
they need to be successful in transitioning into a nursing leadership role. A standardized
education program provides the fundamental knowledge for new nurse managers in the
focused area of human resource management.
This section includes a description of the concepts as well as models and theories
used to develop an evidence-based nurse manager education program. The relevance of
formal nurse manager education to nursing practice is thoroughly discussed as will my
role in the project.
Concepts, Models, and Theories
Nurse managers hold crucial roles in health promotion through nurse retention,
quality care, and safety (Kocoglu et al., 2016; Sarver et al., 2019). Benner’s stages of
clinical competence: novice to expert theory guided the development of this DNP project.
Benner’s theory has been used in career development for nursing practice by aligning
competence, skill acquisition, experience, and clinical and practical knowledge (McEwen
& Wills, 2019). Benner’s stages of clinical competence: novice to expert theory applies
the Dreyfus model of skill acquisition to nursing and delineates five levels of
achievement: novice, advanced beginner, competent, proficient, and expert (McEwen &
Wills, 2019). Nurse managers must acquire the fundamental concepts of competence,
skill, experience, and clinical and practical knowledge at each level before moving to the
next level (McEwen & Wills, 2019).
Benner’s (1982) theory defined five levels:
●Level 1 is novice, the starting point; every nurse manager begins as a novice,
having knowledge without experience.
●Level 2 is advanced beginner or beginner; nurse managers who are in their
role for 1 to 2 years functioning by task with the ability to demonstrate
marginal performance.
●Level 3 is competent; nurse managers who are in their role for 2 to 3 years,
able to recognize trends, and able to put situations together. At this level, the
nurse manager has basic skills and a clear understanding to recall and
anticipate responses that can be used in situations.
●Level 4 is proficient; nurse managers who are in their role for 3 to 5 years. A
proficient nurse manager has a deeper understanding of their roles and
responsibilities.
●Level 5 is expert; nurse managers who are in their role > 5 years. The nurse
manager has an enormous amount of experience in their field and thus can
make decisions quickly and instinctively. An expert can understand a
situation and can project future events based on intuition and experience.
Level 2, the advanced beginner; those in their roles for 1 to 2 years is the
beginner nurse manager level that was the focus of this DNP project.
Definition of Terms
The defined terms below are integral to the DNP project:
Advanced beginner: Nurse manager in their position for 1 to 2 years who can
demonstrate marginal performance and function by tasks and rules (Benner, 1982)
Competent: Nurse manager who has basic skills and can apply critical thinking to
tasks. Usually in their position for 2 to 3 years (Benner, 1982).
Doctor of Nursing Practice (DNP): Doctoral level preparation in nursing with a
clinical focus (Zaccagnini & Waud-White, 2017).
Education program: Program written by an institution that determines the learning
process of each subject in all stages of education (Wikipedia, 2021).
Expert: Amassed an enormous background of experience in their clinical field and
connects understanding to an action. Usually in position > 5 years (Benner, 1982)
Novice: Nurse manager having no experience in the position they are to perform.
Needs full observation of skills (Benner, 1982).
Nurse manager: Nursing professional responsible for the planning, organization,
delivery, and evaluation of nursing care (Gunawan & Aungsuroch, 2017).
Patient Satisfaction: A patient’s feedback of their expectations of what they
believe should be provided during their care (Berkowitz, 2016).
Proficient: Nurse manager with a solid understanding of situations and requires
less conscious planning. Usually in the position for 3 to 5 years (Benner, 1982).
Quality metrics: Methods associated with the ability to provide high quality health
care (Centers for Medicare and Medicaid, 2019).
Retention: Ability to retain valued employees (McDougall, 2018).
Succession planning: Strategy for identifying future leaders (Kenton, 2020).
Relevance to Nursing Practice
Effective nurse managers play the most crucial role in health care organizations
in quality patient care delivery while simultaneously managing costs, resources, and
people (Van Dyk et al., 2016). The broader problem this DNP project addressed is an
impending nursing shortage, which could have negative consequences for the nursing
practice environment, leading to adverse patient outcomes and decreased quality of care.
This is further complicated by the fact that nurse managers and other formal nurse
leaders are often promoted into key leadership positions without the leadership and
business skills needed to successfully lead and manage complex change (Warshawsky et
al., 2020). It has become apparent that formal nurse manager succession planning is
needed and should be a key strategic initiative for healthcare organizations (Ramseur et
al., 2018).
Although organizations have developed and implemented methods to develop
nurse leaders, making use of internal and external sources, they struggle with
consistency and sustainability. The literature mentions several professional organizations
that have developed nurse leader educational courses to include the
American Organization of Nurse Leaders, Sigma Theta Tau International, American
Nurses Association, Association of Operative Nurses, and American Association of
Critical-Care Nurses (Ramseur et al., 2018). The educational courses developed by these
professional organizations are evidence based and have proven to be effective. Many
health care organizations, especially small organizations, may not have the ability,
staffing, or budget to participate in external courses either in person or via webinars due
to fees, schedules, or licensing requirements. An organizational level nurse manager
program that all new nurse managers consistently attend is needed and desired by the
nurse managers.
Local Background and Context
Nurse managers in health care organizations impact patient outcomes, nurse
satisfaction, and retention (Glassman & Withall, 2018). According to the literature, nurse
managers are not prepared to assume these complex roles (Glassman & Withall). Nurse
manager education and development programs have not been sufficient in preparing nurse
managers for these complex, expanding, and ever-changing roles (Flatekval & Corbo,
2019). Often nurses assume the nurse manager role without preparation, support, training,
or development, thus leading to turnover and poor outcomes (Middaugh & Willis, 2018).
With an estimated 62% of nurse managers planning to leave their jobs in the next 5 years
and an estimated 67,000 vacant nurse manager positions nationally
(Middaugh & Willis, 2017; Titzer et al., 2014; Tsui & Gerard, 2020), there is a need to
fill these vital leadership roles. Front line nurses are not interested in nurse manager roles,
as evidenced by the number of vacant nurse manager positions nationally. Millennial
nurses tend to pursue positions in organizations that offer growth opportunities, thus the
need to leverage this group through formal education (Flatekval & Corbo, 2019). As
bedside nurses receive formal, standardized training and education and move through the
stages of novice to expert, it is essential that there is formal education to entice and
onboard those nurses as future nurse managers.
This DNP education project addressed a perceived gap in knowledge of beginner
nurse managers in their roles for 1 to 2 years, focusing on knowledge and skills related
to human resource management. Bedside nurses are often appointed or promoted into
leadership positions because of their strong clinical proficiency and critical thinking
skills, but they often lack leadership and management proficiency (Warshawsky, 2017).
As proficient as these managers are clinically, there are gaps in knowledge in the
business skills of human resource management (Gunawan & Aungsuroch, 2017). A
formalized nurse manager education program provides the foundational knowledge to
feel confident and comfortable as they move through the stages of novice to expert.
The literature has indicated that there is no standard practice for nurse manager
education and onboarding. The literature does point to formal programs through national
and professional organizations that have established successful nurse manager
educational courses and assessments. These programs use in person and online learning
management systems that lack scheduling flexibility, are fee based, and may require the
purchase of a license. Research has shown that organizations who have invested in
structured development programs for nurse managers have realized increased skills and
competencies in nurse managers (Ramseur et al., 2018). There are professional resources
and tools available, but many health care organizations do not have the staffing or ability
to pay the cost to use external resources (Stamps et al., 2019).
The registered nurse (RN) turnover rate at the healthcare organization where this
DNP project was conducted is 10%, less than the national average of 17.8%, and a
vacancy rate of 7%, less than the national average (Nursing Solutions Inc., 2020). On
average, it costs an organization between $40,000 and $64,000 to replace a nurse
(Lockhart, 2020). Effective, knowledgeable nurse managers are an effective retention,
recruitment, and succession planning strategy.
Role of the DNP Student
I served as the project leader for this evidence-based nurse manager education
DNP project. In collaboration with the organization’s department of human resource
learning and development education team, modules were chosen out of the human
resources Professional Development Resource Catalog. The project was completed in an
essential needs Level 1 Trauma center located in the Midwest. There was a current,
signed Walden affiliation agreement with this organization on file. Although I oversee
inpatient nursing at the organization, the nurse managers report through a director of
nursing, so there was no concern for issues related to direct reporting or conflict of
interest.
The motivation for this DNP education project was to prepare beginner nurse
managers with the ability to positively affect succession planning and retain nurse
managers. Prepared nurse managers positively impact nurse satisfaction scores related to
nurse manager ability, leadership, and support as a secondary outcome. The nurse
manager turnover rate at the beginning of this project was 9.4%, with 56.6% of nurse
managers in their roles < 5 years and 20% in their role for 1 to 2 years. The nurse
manager turnover rate was in line with the organizational RN turnover rate.
To eliminate bias, all courses were taught virtually by the human resources
learning and development team using Microsoft Teams, webinars, and electronic learning
modules. Subject privacy was protected by using an electronic survey for both pre- and
post-education. Participation was voluntary, with no bearing on employment, and
supervisors were unaware of feedback. Additionally, all responses were deidentified in
REDCap, and all results were reported as aggregate data only.
Role of the Project Team
The project team consisted of the human resource learning and development team
and me. The project team collaboratively chose and used electronic modules as well as
virtual classroom formats. Both electronic modules and virtual courses were chosen out
of the organization’s human resources Professional Development Resource Catalog. An
email link was sent to the nurse managers to register and access the learning modules and
virtual courses. Nurse managers had 12 weeks to complete the modules and courses.
The project team used a virtual classroom platform in Microsoft Teams. The
Microsoft Teams virtual platform allowed for interactive learning of team members to
share information and to ask questions of each other and the live instructor. Team
members reviewed questions and comments of beginner nurse managers and were able to
provide essential feedback. The learning and development team was able to gather
information through the sessions to develop and refine future learning and development
opportunities.
Summary
In section 2, I highlighted and aligned the use of Benner’s stages of clinical
competence: novice to expert theory and the relevance of a beginner nurse manager
education program to nurse manager retention and quality. The gaps in the literature
included many vacant positions and lack of interest to apply for nurse manager positions
due to a lack of formal education. Section 3 will focus on further collection and analysis
of evidence.
Section 3: Collection and Analysis of Evidence
Introduction
Lack of preparation of nurse managers has led to lack of interest in nurse manager
positions, lack of succession planning, and high turnover rates, which impact quality and
safety of a healthcare organization. To meet the prevailing knowledge gaps of nurse
managers, a formalized education program within the organization was developed. Using
Benner’s stages of clinical competence - novice to expert theory - a successful nurse
manager education program was created to provide beginner nurse managers human
resource management skills.
In this section, I clarify the purpose and alignment of the nurse manager education
project as well as sources of evidence. Additionally, databases, outcomes, and key terms
used to perform a literature search are described.
Practice-Focused Question
The local practice problem that this DNP education project addressed is the
knowledge gap of beginner nurse managers in human resource management. The
practice-focused question that this DNP education project addressed was as follows: In
beginner nurse managers with 1 to 2 years of experience, does attending a course
focused on human resource management skills improve knowledge and competence of
ACHE competencies?
The organization has not provided ongoing formal education for beginner nurse
managers, and nurse managers have expressed a desire for this level of education. The
purpose of this DNP project was to address the lack of perceived knowledge of nurse
managers in their role for 1 to 2 years. The goal of the project was to evaluate the
relationship between perceived knowledge of having a formal evidence-based
managerial education program to no formal nurse manager education program.
Sources of Evidence
The sources of evidence for the nurse manager education project included a
synthesis of current literature, 5 years or less, and a review of education programs for
nurse managers. The theory used in this education project was Benner’s (1980) stages of
clinical competence, novice to expert theory. I used library databases CINAHL,
MEDLINE, ProQuest Nursing, and Allied Health Databases to search nursing databases
for journals applying the following terms: nurse manager, front line nurse leader, nurse
leader, orientation, education, training programs, and burnout. Evidence was collected
from several professional journals to include The American Journal of Nursing, Nursing
Management, Nurse Leader, and Journal of Nursing Administration.
The research literature indicated that nurse manager development promotes
quality of care that leads to patient satisfaction, nurse satisfaction, decreased nurse
manager and nurse turnover, and succession planning for leadership roles (Cox, 2019).
Authors have also suggested a need and desire for formalized nurse manager education
and onboarding. In addition to the literature, professional organizations such as American
Organization of Nurse Leaders, American Nurses Association, and AACN have
established a need for formalized education to prepare beginner nurse managers. The
education programs offered by these professional organizations also incorporate human
resource management into their content.
To identify nurse managers in their role of 1 to 2 years, the human resources
department provided a list by job title, which is manager, nursing: inpatient and
ambulatory. Seniority within the role was drilled down to the number of years within their
nurse manager role. Nurse managers in their role of 1 to 2 years were selected. There are
currently 57 nurse managers in the organization and 11 who are considered beginner, in
their roles for 1 to 2 years.
Procedures
The ACHE 2020 Competencies Assessment tool was used to evaluate nurse
managers’ perception of knowledge pre- and post-education of human resource
management skills (see Appendix C). The literature supports a formal nurse manager
education program in addressing the knowledge gap in human resource management.
Lack of preparation of nurse managers leads to lack of interest in nurse manager
positions, lack of succession planning, and high turnover rates, which impact quality and
safety outcomes of an organization. A formalized nurse manager program provides a
standardized approach to provide beginner nurse managers with the tools needed to
successfully transition into a nurse manager role.
Using the Human Resource Management section under the Business Skills and
Knowledge domain of the ACHE 2020 Competencies and Assessment Tool, beginner
nurse managers were asked to participate in a questionnaire to rate their perception of
their skills in human resource management, using a 1 to 5 scale, novice to expert. The
same tool was used post-education. Quantitative data were obtained anonymously from
the pre- and post-assessment.
After obtaining a list of nurse managers in their role for 1 to 2 years from the
organization’s human resource department, the pr survey link was sent out via email. The
presurvey addressed 27 human resource management skills and took 5 to 10 minutes to
complete. The presurvey was sent to participants who fit the inclusion criteria via the
healthcare system email with a link to the questionnaire in the REDCap system. The
email notified participants that participation was completely voluntary and that they were
able to withdraw at any time. Additionally, the email contained an informed consent and
notified participants that there was no direct link to their email and that data from the
questionnaire would be further deidentified in REDCap. REDCap is a secure, HIPAA
compliant tool used for research and quality improvement studies.
After the presurvey was completed, a link to the education was sent via email to
the 11 beginner nurse managers. In collaboration with the organizations’ learning and
development team, an evidence-based formal nurse manager education program was
implemented using two formats. One course was an electronic, online module, and six
courses were in a virtual classroom setting that allowed for interaction between the
instructor and the participants. Courses were accessed through LEAP, the organization’s
learning management system. Beginner nurse managers received a link and instructions
to access and register for the seven learning modules via the LEAP system. The nurse
managers had 12 weeks to complete all seven modules, equaling 12 hours in total (see
Appendix D).
Ethical Protections
To ensure ethical protection of the participants, this DNP project was reviewed
and approved by both the organization’s IRB and Walden University’s IRB. Participants
were informed that their participation was voluntary and that they were able to withdraw
at any time. All participant responses were de-identified and entered into the secure and
HIPAA compliant REDCap system.
Analysis and Synthesis
After the beginner nurse manager completed the learning modules, they were sent
a link to complete the postsurvey. The same 27 human resources skills were assessed
using the same ACHE 2020 Competencies and Assessment Tool. The postsurvey was
also delinked from the participant’s email, and the data were deidentified in REDCap.
Data were entered into REDCap and were analyzed using Statistical Package for the
Social Studies (SPSS) Version 26. In total, the pre- and postsurvey and modules took less
than 12 hours over the course of 12 weeks. For those who desired further education after
taking the postsurvey, additional learning opportunities were made available through the
Professional Development Resource Catalog and accessed via the LEAP system.
Answers to the questions in the pre- and post-survey were de-identified and
assigned a continuous variable number to correlate pre- and post-data in line with
Benner’s novice to expert theory: 1 = fundamental awareness, 2 = novice, 3 =
intermediate, 4 = advanced, 5 = expert. Categorial variables were coded and de-identified
and assigned a number, 1 for yes, 2 for no. To answer the practice-focused question, in
beginner nurse managers with 1 to 2 years of experience, an independent samples t test
was conducted to determine if attending a course focused on human resource
management skills improves knowledge and competence of ACHE competencies.
Analyses were conducted to determine the correlation between the pre-education and post
education mean survey scores in nurse managers who completed the education. Data were
provided from REDCap in an Excel spreadsheet and were analyzed using SPSS Version
26. All data were and continues to be securely stored in an organizational, password
protected computer accessible only to me.
Summary
The nurse manager role in health care organizations is crucial for quality
outcomes (Van Dyk et al., 2016). The purpose of this quantitative DNP education project
was to develop a standardized nurse manager education program based on Benner’s
stages of clinical competence: novice to expert theory (Benner, 1982). This project
provided nurse managers with the baseline foundation of human resource management
knowledge and resources they need as nurse managers new in their role. A pre- and
postassessment was conducted using the human resource management domain of the
ACHE
2020 Competencies Assessment Tool.
Section 4: Findings and Recommendations
Introduction
Lack of preparation of nurse managers leads to lack of interest in nurse manager
positions, lack of succession planning, and high turnover rates, which impact quality and
safety of an organization. To meet the prevailing knowledge gaps of nurse managers,
there was a need for a formalized education program within the organization. The
practice-focused question that the DNP nurse manager education project addressed is as
follows: In beginner nurse managers with 1 to 2 years of experience, does attending a
course focused on human resource management skills improve knowledge and
competence of ACHE competencies? The primary purpose of this DNP evidence-based
project was to develop a formalized nurse manager education program.
The sources of evidence collected for this DNP project were the descriptive
variables: (a) gender, (b) age, (c) years in organization, (d) years in a leadership role, and
(e) years as a leader in the organization. The ACHE 2020 Competencies Assessment tool
was used to evaluate pre- and post-survey results using an individual sample t test to
measure pre- and post-competency. Library databases CINAHL, MEDLINE, ProQuest
Nursing, and Allied Health Databases were used to search nursing databases for journals,
using the following terms: nurse manager, front line nurse leader, nurse leader, training
programs, education, burnout, and orientation.
Findings and Implications
There are 57 nurse managers within the health care organization in multiple sites
that encompass ambulatory, inpatient, procedural, and corrections areas. Of the 57, 11 or
19.2% had been in their role for 1 to 2 years at the start of the project. The 11 eligible
nurse managers received an invitation to participate in the educational offerings; eight
took the presurvey, and four took the postsurvey. For analysis of pre- and post-data from
the ACHE Competency Assessment, I used data from eight completed presurveys and
four completed postsurveys. Group statistics revealed lower postsurvey mean scores, pre
M = 69.5 and post M = 47.25, see Table 1. However, this could be attributed to the fact
that only 50% of the post surveys were completed.
Table 1
Pre and Post Data Group Statistics
Pre-Post N Mean Std. deviation Std. Error Mean
Presurvey 8 69.5 22.46903 7.944
Postsurvey 4 47.25 25.83763 12.91882
The results indicated that beginner nurse managers did not vary significantly in
perceived human resource management knowledge following the nurse manager
education, t = (10) = 1.544, p = 0.154, see Table 2.
Table 2
Levene’s Test for Equality
95%
95% sig
(2 Mean Std. Error Confide
Variances F Sig t df tailed) Difference Difference nce Confidence
upper
Lower
Equal
0.00
variances 0.928 1.544 10 0.154 22.25 14.40931 -9.85594 Upper
9
assumed Equal
variances
1.467 5.369 0.198 22.25 15.16585 15.9433 54.35594 not
8 assumed
Pearson correlations were also examined for all years as leader (N=11, p =.118)
and years as a leader in the organization (N = 10, p = .473), see Table 3.
Table 3
Pearson Correlation
Total score
Pearson Correlation
Total score Years org leader
1 0.257
Sig. (2-tailed) 0.473
N 12 10
Years Org Leader Pearson Correlation 0.257 1
Sig. (2-tailed) 0.473
N 10 10
Total Score
Pearson Correlation
Years Leader All
1 0.499
Sig. (2-tailed) 0.118
N 12 11
Years Leader All Pearson Correlation 0.499 1
Sig. (2-tailed) 0.118
N 11 11
Mean scores of combined pre- and post-survey results were calculated for
descriptors, total years as a leader (M = 5.409, SD = 5.2001) to years as a leader within
the organization (M = 1.075, SD = 0.442), see Table 4.
Table 3
Combined Scores
Total score
Mean Std. Deviation
62.0833 24.9671
Years org. leader 1.075 0.44175
Years leader all 5.409 5.2001
Due to a small sample size (pre-N = 8, post N = 4) and nonpaired pre- and
posttests, study findings were not significant for improving nurse manager development.
Although no significance was found in the study, nurse managers indicated a desire for
ongoing professional development, which is also supported by the literature. This
education project supports positive social change through flexibility. This DNP education
project can be implemented in any health care organization regardless of size without
added expense of membership or licensing. Additionally, the concepts can be used to
create education for any healthcare discipline. This project supports positive social
change by providing nurse managers with the opportunity to transform themselves as
effective practitioners through knowledge acquisition. It supports them creating strategies
to promote and disseminate knowledge and competencies. Through professional
development, nurse managers can positively impact social change within their
organization by promoting succession planning, decreasing turnover, and increasing their
knowledge. Patient satisfaction and quality metrics are vital components of health care
organizations (McNicholas, 2017). Through preparedness and education, nurse managers
can promote working conditions that fulfil essential needs, thereby cultivating a positive
impact on patient satisfaction and quality metrics (Perry et al., 2018).
Recommendations
Areas for future projects and education could include in-person learning for
increased participation and discussion and opening education up to all nurse managers.
Future nurse manager education planning includes expanding educational offerings to
incorporate broader manager topics to include the current courses of this project plus
leading people, leading change, emotional intelligence, authentic conversations, and
career development. Educational offerings will be built into nurse manager orientation,
and participation will be mandatory during the first 2 years as a nurse manager.
Additionally, it is recommended that the new nurse manager has a preceptor for day-
today learning and an experienced mentor for ongoing support and guidance.
Contribution of the Doctoral Project Team
The project team consisted of the human resource learning and development team
and me. The project team worked in collaboration to provide the context for the learning
courses. Due to the pandemic, the human resource and learning and development team
transitioned all organizational in-person learning to the virtual format. Beginner nurse
managers contributed by taking the educational offerings and completing the pre- and
post-surveys.
Strengths and Limitations of the Project
Senior leadership support of nurse manager professional development is a strength
of the project. The ACHE 2020 Competencies Assessment Tool is an established
measurement tool designed to identify strengths and opportunities for improvement in
relation to the ACHE’s competencies. Using it was a strength of this project. The human
resource leadership and development team’s ongoing support and willingness to flex
learning methods and add courses to the Professional Development Resource Catalog
based on nurse manager feedback was also a strength of this project.
In addition to the small sample size, limitations of the project included the timing
of the project, as the project was launched in the middle of the COVID-19 pandemic,
resulting in course offerings being changed from in-person to online modules and virtual
formats, cancellation of the Inclusion and Diversity and Labor Relations courses, and
rescheduling courses without notice, lengthening the project timeline. From initial project
planning to project launch, several nurse managers moved from the beginner category of
1 to 2 years into the competent 2- to 3-year category, decreasing the study size from an
expected 20 to 11. During the study, four of the project participants separated from the
organization due to health and personal reasons. Additionally, the pandemic brought
about compassion fatigue and burnout in nurse managers, resulting in them not being able
to complete additional tasks. The surveys and education were anonymous, which
prevented pairing of survey data to education resulting in an individual t test instead of an
individual paired t test. It is unknown how many managers completed the courses and
how many courses each completed. The data were limited, making it difficult to evaluate.
The project sample was nurse managers in their roles for 1 to 2 years at this
organization, not considering nurse managers who may have had prior leadership
experience. Thus, the beginner nurse manager sample of this project had nurse managers
with 1 to 14 years’ experience but who had been in their current leadership role for 1 to 2
years. Nurse manager education typically leads to succession planning and retention;
however, four of the eight participating nurse managers separated from the organization
for health and personal reasons, contributing to the small postsurvey sample.
While there were several limitations, the project did provide foundational
knowledge, and beginner nurse managers indicated that they desired more learning
opportunities. They also recommended that learning opportunities need to be scheduled
and planned for consistency. This program can help nurse educators identify the factors
that may address the gaps in knowledge for new nurse managers and guide the
development of managerial programs, which can effect positive social change.
Additionally, the human resources learning and development team was
overwhelmed with virtual course conversions, which prevented open dialogue between
me and the team. The nurse managers had to juggle their schedules as courses were
canceled and rescheduled, often on short notice. Even in the virtual format, the human
resource learning and development team received feedback from the attendees on current
and future courses. This adds value for future course offerings and methods of teaching.
Communication is vital; this project was set up anonymously, not allowing for
collaboration, communication, or feedback between participants and me. Anonymity did
not allow for me to monitor registration or participation in courses. To remind
participants, I sent out blanket reminders to all 11 of the original eligible participants
before each upcoming scheduled course.
Section 5: Dissemination Plan
The objective is to disseminate the data and feedback of this project to nursing
leadership and to the human resource learning and development team. Presentations of
the project data will be disseminated to all nurse managers in the monthly nurse manager
council, to senior nursing leadership at Chief Nursing Officer Council, and to current and
future DNPs through DNP council.
Analysis of Self
Role as a Practitioner and Leader
Completing the rigors of a DNP project during a pandemic added another layer of
pressure to an already challenging journey. The DNP journey has challenged me to be
more resilient and to balance the requirements of a family, a full-time career, and
everyday life. Nurse leader development is a passion of mine. Through this project, I
wanted to highlight the need for evidence-based education through professional
development of nurse managers. Due to a small sample size and the pandemic, the project
did not have the results I had anticipated, but there is still considerable value in the
project.
As a transformational leader and practitioner, I saw improvement in my listening
skills. Verbal, written, and listening skills are essential components of communication
and fundamental skills in leadership and project management. This project prepared me to
experience a higher level of intellectual thinking and become more abreast of evidence-
based practices. The DNP process has provided me the opportunity to look at nursing and
nurse managers in a different light, focusing on the strengths of each individually to help
them grow and advance their practice through evidence-based methods. This is beneficial
to me as I continue to advocate, support, and expand the knowledge and decisions of
nurse managers.
Role as a Scholar
As a scholar, this project has opened my eyes and provided me the opportunity to
become more familiar with surveys tools, competencies, and spreadsheets. Prior to the
project, I had limited experience using REDCap and SPSS, both powerful tools for
information management and analysis. These experiences were appreciated for project
completion and will be invaluable as a DNP prepared nurse leader. Coordinating and
evaluating this project from inception to completion has elevated my project management
skills through strategic and effective communication. Completing a project during a
pandemic prompted me to be more strategic through added layers of communication,
collaboration, and follow through.
Summary
The goal of this DNP project was to identify the knowledge gaps associated with
lack of formal nurse manager education in a healthcare system. The practice-focused
question of this DNP nurse manager education project is as follows: In beginner nurse
managers with 1 to 2 years of experience, does attending a course focused on human
resource management skills improve knowledge and competence of ACHE
competencies? Due to several limitations, the postsurvey revealed a reduction in
perceived knowledge. Although the project outcomes were different than expected, there
is value in nurse manager education, and future education will be required over the course
of a longer orientation period utilizing preceptors and mentors.
