After earning a master’s degree, nurses hoping to pursue a doctoral degree have two options — a Doctor of Philosophy degree, which focuses on academic and research development, or a Doctor of Nursing Practice degree, which centers on advanced clinical practice and translating research into nursing practice.
Dr. Joylyn Anderson, assistant professor and program director of accelerated nursing at Concordia College, opted for the latter option, graduating with her DNP in healthcare executive leadership.
Her doctoral research project, “The Impact of Implementation of the Cultural Change Toolkit to Reduce Nursing Burnout, Turnover, and Improve Patient Satisfaction in a Long-Term Care Facility,” investigated the high turnover and burnout rates among nurses in long-term care settings.
Anderson then assessed whether patient satisfaction was affected.
“I discovered a cultural change toolkit that was well-researched and had been implemented by another nurse, Dr. Amber Adams, in the emergency department. This nurse noticed improved health outcomes of their patient population in addition to decreased burnout and nursing turnover in this fast-paced environment,” explained Anderson, who earned her bachelor’s degree from Concordia and her master’s degree from the University of Wisconsin — Eau Claire.
Anderson found that long-term care settings have some of the highest incidences of nursing burnout and turnover in the healthcare setting.
“I quickly learned that little research has been done in the long-term care setting to improve nursing burnout and turnover. I also wanted to know if strategies to reduce nursing turnover and burnout would have any effect on patient health outcomes including patient satisfaction,” explained Anderson. “This led me to implement the Cultural Change Toolkit in an area it had never been implemented in before.”
She decided to pursue her doctorate in 2020, during the COVID-19 pandemic, but that introduced some challenges into the mix, especially regarding implementing research in most settings.
Stress on the healthcare system from the pandemic, along with other longer-standing factors, began to show in the form of increasing burnout among healthcare workers, including nurses and certified nursing assistants — and then increasing turnover for those positions.
Staffing shortages became especially prevalent in long-term care settings, such as assisted living and nursing homes, Anderson said, so that’s where she decided to focus her doctoral project.
Adams’ toolkit had been implemented previously in an emergency department in a large urban hospital, where it was successful in reducing employee burnout and turnover among nursing staff.
Its major elements were meaningful recognition for employees, shared decision-making that allowed employees to be part of the governing process, and increased support from leadership that allowed direct caregiving employees to see managers on the floor.
Anderson looked at several sites, chose a local nursing home and implemented the toolkit for 10 weeks, measuring the results over time. The interventions she chose were cost-effective and relatively easy to implement.
She put up a gratitude board, where staff could recognize each other for helping out via sticky notes, which offered an opportunity to recognize people. She implemented a suggestion box for anonymous employee suggestions, which only the director of nursing could open, and employees offered up many useful ideas for improving efficiency and safety, some of which were implemented — allowing staff to feel heard and acknowledged.
Anderson also began a thank-you card program, making blank cards available for employees to pick up and fill out to give each other, either signed or anonymous. Also, units would hold prize drawings from time to time, at random, with gift certificates to local stores.
Finally, to show active support from leadership, each manager documented daily rounds on the floor, showing support for staff and asking employees what they needed and how they could help.
While 10 weeks likely wasn’t enough time to be definitive, the results of Anderson’s experiment were positive, with increased employee retention and patient satisfaction.
The facility continued to use the toolkit’s strategies after Anderson’s research was completed.
A longitudinal study would be beneficial in the long-term care environment to investigate whether the facility’s improvements had a lasting improvement on nursing turnover, burnout, and patient satisfaction, Anderson said.
Many of her innovations stayed after those 10 weeks were up, including the increased presence of leadership on the floors and the gratitude wall. In addition, one of the suggestions from the box blossomed into a mentorship program for new CNAs, allowing new employees to be paired with experienced workers for a better introduction to the profession.
“It was all cost-effective,” Anderson said. “You really could implement the Cultural Change Toolkit in any environment, not just healthcare.”
She would like to see her work continued in the future, and the Cultural Change Toolkit implemented at more sites, reducing burnout and staff turnover in more healthcare facilities.
After her project was complete, she had to defend it, as is the custom for doctoral projects, with her advisor and three board members asking questions.
She was granted approval to disseminate her research right away, earning her Doctor of Nursing Practice degree from Rasmussen University in March 2023.
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