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Running head: CAPSTONE PROJECT 1

Development of a Leadership Rounding Program for Nursing Directors in Improving

Frontline Nurse Satisfaction

Name

Institutional Affiliation
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Chapter 2: Literature Review

Introduction

Grandview Medical Center is encountering a challenge concerning nurse satisfaction at

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.

Literature Search Strategy

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

scholarly literature on leadership, leadership rounding programs in nursing, nurse empowerment,

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

made by the authors.

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).

In ‘A Culture of Nursing Excellence’ Arthurs et al., (2017), identify the components

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,

excellence and nurse satisfaction.

Understanding the perspectives and perception of frontline nurses is beneficial because

perception and perspective are significantly influential in nurse performance, change

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

levels (Fabry, 2014).

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

being a hardwired process with a rigid set of questions.

(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

improve productivity and job satisfaction. Conversely, task-oriented leadership is a leadership

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

scheduled or programmed is beneficial in that they empower the frontline nurses.

In a different study, authors, Riley, Dearmon, Mestas & Buckner (2016) use a

transformational model to achieve higher engagement and empowerment through the

professional development of the frontline nurses. As mentioned in the study collaboration of

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

an appropriate leadership model, increasing engagement by evaluating the existing engagement

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

of using these characteristics to advance leadership by demonstrating a comprehensive

understanding of relationships among quality improvement, practice environment, and outcomes.

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

and be a significant learning opportunity for both groups.

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

a better rounding program to improve nurse satisfaction. Emphasis on creation of an excellence

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.

(2017). A culture of nursing excellence: A community hospital’s journey from Pathway

to Excellence to Magnet recognition. Journal of Nursing Education and Practice, 8(5),

26. doi: 10.5430/jnep.v8n5p26

Fabry, D. (2014). Hourly rounding: perspectives and perceptions of the frontline nursing staff.

Journal of Nursing Management, 23(2), 200-210. doi: 10.1111/jonm.12114

Lockhart, L. (2017). Purposeful leadership rounding. Nursing Made Incredibly Easy!, 15(6), 55.

doi: 10.1097/01.nme.0000525559.82774.58

Luk, L. (2018). Assessment of a Leadership Enhancement Program for Nursing Managers of an

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

Patient Satisfaction. Journal of Nursing Care Quality, 33(4), 361-367. doi:

10.1097/ncq.0000000000000317

Richey, K., & Waite, S. (2019). Leadership Development for Frontline Nurse Managers

Promotes Innovation and Engagement. Nurse Leader, 17(1), 37-42. doi:

10.1016/j.mnl.2018.11.005
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Riley, B., Dearmon, V., Mestas, L., & Buckner, E. (2016). Frontline Nurse Engagement and

Empowerment. Nursing Administration Quarterly, 40(4), 325-333. doi:

10.1097/naq.0000000000000186

Scanlon, K., & Woolforde, L. (2016). Igniting Change through an Empowered Frontline: A

Unique Improvement Approach Centered on Staff Engagement, Empowerment, and Professional

Development. Nurse Leader, 14(1), 38-46. doi: 10.1016/j.mnl.2015.11.007


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