The skills and knowledge that the Doctor of Nursing Practice acquired during education might substantially help patients to improve their health and ensure that they can sustain their future life after recovery. Therefore, it is essential to practice programs and establish projects that train DNP scholar’s skills and find new solutions that enhance the state of various patients. The purpose of this project paper is to discuss the proposed DNP project and the problem that exists in the medical institution to get an in-depth understanding of a program that can tackle the issue of job confidence among new nurses.
The communication with the practicum decision-makers helped identify the problem that executives want to resolve, namely the level of job confidence among new nurses that might be low because of the situation with the COVID-19. The suggested DNP project aims to handle the problem of low job confidence among new nurses on the hospital’s stroke floor that might negatively impact the medical institution and patients. The paper will include an overview of the problem, its significance, the purpose of the project and PICOT question, evidence-based intervention and science model, organizational setting and population, possible challenges, and outcomes. The paper concerns a crucial initiative that is aimed to improve healthcare and helps to prepare for real-life projects of DNP.
Problem and its Significance
The practice problem, as identified by the decision-makers, is the low job confidence among new nurses due to the COVID-19 pandemic. Many nurses entered the workforce or decided to change jobs during a hard time for all hospitals. To date, there are no specific rules in the medical organization that state how to train new nurses to enhance their job confidence and communicate changes and challenges that exist. It is suggested that mentorship programs improve job confidence and satisfaction of nurses during a coronavirus crisis (CHI Health, 2020).
From a global and national perspective, it can be stated that the support and structured mentorship systems that are implemented during the time of coronavirus crisis might be of help for nurses that need initial guidance (Kofman & Hernandez-Romieu, 2020). This traineeship might consequently increase the quality and safety of patients’ care while educating nurses to navigate through legal and ethical considerations. Furthermore, the International Council of Nurses (2020) also highlights the necessity to introduce mentorship for nurses currently due to the rise of fear of transmission and burnout. On the local level, analysts stress that nurses’ high job confidence is essential for hospitals because it consequently influences job satisfaction and intent to stay at the organization (Jones, 2016). Moreover, if appropriately introduced, mentorship programs for nurses might significantly decrease the costs of services for a facility that some hospitals have shown (Schroyer et al., 2016).
At the University of Miami hospital, there is an aim to provide excellent patient care with a focus on compassion and high-quality services (“Mission & Values,” n.d.). Mentorship programs might help new nurses to change their approach towards healthcare and encourage them to suggest projects that would save financial resources for the hospital. However, this communication and suggestions that can lead to life-changing discoveries can only be possible if nurses are confident about their jobs. During challenging times, the University of Miami hospital is determined to move the healthcare system to better outcomes for patients; thus, a mentorship program might help the facility achieve its goals, relying on others’ experience (“Mission & Values,” n.d.).
The following PICOT question will serve as the basis for the proposed DNP project: “For new nurses in the stroke unit at the University of Miami Hospital (P), how does the implementation of a structured mentoring program (I), compared to current practice (C), affect new nurse job confidence (O) over 12 weeks (T)?”
The purpose of the proposed DNP project is to increase job confidence among new nurses by implementing a structured mentorship program introduced in the hospital for the first 12 weeks after orientation. Specific objectives related to the DNP project are the following: (1) prepare and implement a structured mentorship program for new nurses in the hospital, (2) evaluate the influence of a formal mentorship program on new nurses’ job confidence in comparison to current practice, (3) achieve a quantifiable positive impact on job confidence of new nurses, (4) improve quality of healthcare services provided in the hospital due to mentorship program.
The proposed DNP project will implement the following evidence-based intervention: The Academy of Medical-Surgical Nurses (AMSN) Mentoring Program. Utilizing Benner’s Novice to Expert theoretical framework, a new nurse (mentee) will be paired with an expert nurse or professional in the hospital (mentor). The intervention is proposed by the Academy of Medical-Surgical Nurses’ (2012) research that helps to change the current practice of working with nurses and implement the required mentoring program. AMSN Mentoring Program includes mentor guide, mentee guide, and site coordinator guide that outlines the directions and principles of a mentoring relationship, self-assessment, mentoring program plan, and necessary evaluation tools (AMSN, n.d.).
AMSN Mentoring Program used by researchers helped a hospital in a study to nurture new nurses’ retention and facilitate transition into the practice (Szalmasagi, 2018). Nurses also expressed a feeling that they were essential members of the hospital team, emphasizing confidence about their jobs (Szalmasagi, 2018). It is also reported that the suggested AMSN Mentoring Program after the implementation may lead to a decrease in the turnover rate of new nurses in the hospital and make them engaged in leadership and relationship development with experiences nurses (Allen, 2017). Therefore, the evidence-based intervention can create valuable results for all stakeholders involved, including mentees, mentors, and the practicum site.
Translational Science Model
The intervention that will be deployed to address the issue of job confidence among nurses in the stroke unit based on the needs of the hospital is the structured mentorship program. The program will be based on the translational science model with a specific focus on the Knowledge-to-Action (KTA) Framework (“About the Model,” n.d.). The framework premises state that it is essential to summarize information on the project and program before its implementation (WHO, n.d.). It is crucial to stay vigilant to issues at each stage of the knowledge generation, summarize and exchange date, and document any problems along with the work (WHO, n.d.).
Scientific activities will include the identification of problems, adaptation of knowledge, assessment of barriers to knowledge use, selection of intervention, monitoring the implementation, evaluating outcomes, and sustaining knowledge use for future utilization (WHO, n.d.). During the DNP project, job confidence as a problem will be addressed. Barriers of knowledge will be discussed; the intervention in the form of the AMSN Mentoring Program will be deployed. Further, the outcomes, such as recommendations on improving job confidence among new nurses, will be presented, and suggestions that can be applied to different units will be discussed.
The organizational setting is the following: the stroke unit at the University of Miami Hospital. The typical client is a patient with neurological problems, aged 55 and above, residing in the area near the hospital. Typical diagnoses include neurological issues, such as ischemic strokes, vascular issues, and other problems, such as high blood pressure, obesity, type 2 diabetes. The number of patients seen annually is 1500 with strokes and 35,000 in the whole Department of Neurology (“Neurology,” n.d.).
The anticipated sample population is 10-15 new nurses who were hired during the COVID-19 pandemic in the hospital that will be given informed consent and recruited with the help of the practicum executives. Inclusion criteria include the following characteristics: newly hired licensed registered nurses in the stroke unit, less than one month out of orientation to the unit, willing to be mentored, and able to commit time. Exclusion criteria include traveling or agency nurses, non-nurses, nurses who have been out of orientation for greater than one month, nurses in orientation, and those who are unwilling/unable to be mentored.
Considerations and Challenges for Implementation
The project requires substantial time from employees that is currently limited due to a challenging situation with COVID-19. The nursing staff resistance to change may also arise; thus, the hospital executives should emphasize the value of mentorship. The University of Miami Hospital employees are open to evidence-based practice; therefore, there will not be any significant objections. Among the barriers might be a lack of senior nurses’ availability to provide mentorship, time limits, and the lack of motivation from nurses. To avoid these issues, the hospital management team and leaders should help nurses get used to new guidelines.
Permission to conduct the research must be given by the Institutional Review Board (IRB) of the University of Miami. Approval should also be obtained from the hospital administrators to implement the study and provide voluntary consent (Szalmasagi, 2018). The measurable outcome for this proposed project is an increase in new nurses’ confidence after participation in a structured mentorship program in comparison to the current practice. The New Nurse Confidence Scale will be administered pre- and post-intervention. Besides, the mentor will complete the Assessment of the Relationship with the Mentee and Mentoring Program Satisfaction Survey. The mentees will complete the New Nurse Confidence Scale, the Assessment of the Relationship with the Mentor Survey, and the Mentoring Program Satisfaction Survey (AMSN, 2012). Both tools and surveys will be used as data collection methods, and they are free to use. These measurement tools are available through the AMSN mentorship program toolkit (Szalmasagi, 2018).
A paired t-test will be conducted to analyze the confidence level of the new nurse before and after the mentorship program. The reliability analysis will be assessed by Cronbach’s Alpha indicator (Price et al., 2019). The validity statistics will be evaluated by exploratory factor analysis (AMSN, 2012). The Assessment of the Relationship with the Mentee, the Mentoring Program Satisfaction Survey (mentor), the Assessment of the Relationship with the Mentor Survey, and the Mentoring Program Satisfaction Survey (mentee) will be analyzed based on satisfaction with the program (AMSN, 2012). Demographic data, such as age, sex, and education, will help answer PICOT question. The survey will be administered both electronically and manually, before and after the implementation of the program. It will take around 15-20 minutes from mentors and mentees for 30-40 questions. There will be both open and closed questions; closed questions will be asked with a 1-5 numeric Likert scale that assesses interviewees’ confidence (AMSN, 2012). The data will be gathered manually without the usage of the Electronic Health Records. Overall, it is expected that the mentorship system will contribute to the successful rise of job confidence among new nurses.
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