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Answer discussion


Adopting EBP as the cornerstone for patient care decisions can improve patient care. Nurses have the chance to serve as role models for EBP by creating policymaking, team-based committee work environments that integrate and sustain EBP (Melnyk & Fineout-Overholt, 2018). Nurses are capable of disseminating EBP knowledge to others in the workplace. Without effective dissemination and communication, evidence-based practice in a healthcare organization is unsustainable.

Strategies to Disseminate EBP

Mentorship and staff training are the two EBP dissemination tactics that I would likely implement in my organization. For nurses to acquire and achieve expertise in routinely executing the steps of the EBP process in practice and providing evidence-based interventions to patients, EBP requires significant training, time, and resources (Nilsen et al., 2017).

All aspects of training and performance involve a high level of focus and attention, strong leadership, good communication and collaboration, and also data-based procedures and root-cause analysis of failures (Melnyk, 2012). 

Establishing a group of EBP mentors is critical to establishing an EBP attitude inside an organization and implementing evidence-based care. In a study conducted by Melnyk et al. (2012), mentors acquired information and skills necessary to successfully implement and assess EBP improvements within the hospital and were able to collaborate with their colleagues to foster an EBP culture conducive to providing high-quality evidence-based care (Melnyk et al., 2017).

 Strategies Least Inclined to Use

Email and presenting at a staff meeting are the two least likely EBP dissemination tactics I would utilize. Because some nurses only work three days a week and do not check their emails every day, they may not be able to acquire the information in a timely manner. Considering staff meetings are held once a month and not everyone attends, presenting at a staff meeting may not be the best approach to disseminating EBP knowledge. Additionally, many nurses who work a 12-hour night shift may not be as engaged and recall essential information.


Barriers to Disseminated Strategies

Obstacles exist that impede EBP from becoming a universally accepted standard of care in a healthcare organization. Obstacles include practitioners’ lack of EBP expertise and understanding, the belief that EBP is time-consuming, the culture and politics of the organization, the lack of support from nursing executives and management, and insufficient resources and involvement in EBP (Melnyk et al., 2017).

To overcome these barriers, the workplace should financially compensate nurses for attending training seminars in order to develop knowledge and competence in EBP material. Furthermore, management should provide some form of incentive to employees who demonstrate expertise and successfully execute EBP content.



Healthcare organizations with high reliability are those that provide safe care and strive to reduce errors while also accomplishing excellent results in terms of quality and safety (Melnyk, 2012). To achieve high reliability, effective dissemination of EBP strategies must be implemented. 



Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

Melnyk, B. M. (2012). Achieving a High-Reliability Organization Through Implementation of the ARCC Model for Systemwide Sustainability of Evidence-Based Practice. Nursing Administration Quarterly, 36 (2), 127-135. doi: 10.1097/NAQ.0b013e318249fb6a.

Melnyk, B. M., Fineout-Overholt, E., Giggleman, M., & Choy, K. (2017). A Test of the ARCC© Model Improves Implementation of Evidence-Based Practice, Healthcare Culture, and Patient Outcomes. Worldviews on Evidence-Based Nursing, 14(1), 5–9. https://doi.org/10.1111/wvn.12188

Nilsen, P., Neher, M., Ellström, P. E., & Gardner, B. (2017). Implementation of Evidence-Based Practice From a Learning Perspective. Worldviews on evidence-based nursing, 14(3), 192–199. https://doi.org/10.1111/wvn.12212

Answer discussion

  Response posts: include at least 2 scholarly sources of evidence, cited within the body of your discussion responses  & at the end of your posting, at least 2 references

EBP Utilization:

Adoption and implementation of evidence-based practice (EBP) in nursing and other healthcare disciplines is acknowledged as critical to maintaining optimal patient outcomes and quality of care (Kim et al., 2016). Nurses are on the front lines of health care, and Evidence-based practice provides them with a unique chance to improve patient care and outcomes. The direct patient-care nurse is an important link in implementing evidence-based improvements in clinical practice (Crabtree et al., 2016). According to Kim and colleagues (2016), although EBP is regarded as the gold standard in nursing practice, its actual implementation has been inconsistent due to challenges such as nursing workload, a lack of organizational support, a lack of EBP knowledge and abilities, and negative attitudes about EBP.

Hospitals and healthcare organizations are increasingly relying on their websites as the nation becomes more computerized. It is critical for all healthcare institutions to have a website centered on EBP because it is frequently the primary means of disseminating information to the public. The healthcare organization website that I will discuss is The National Alliance on Mental Illness (NAMI). NAMI is the leading community mental health organization in the United States, dedicated to improving the lives of the millions of Americans impacted by mental illness (National Alliance on Mental Illness, n.d.)

Grounding of EBP:

NAMI has long advocated for people with mental illnesses to receive evidence-based treatment and has fought against practices that continue to stigmatize mental diseases. This website is built on evidence-based practice, which may be found under the advocacy, education, and research sections of the NAMI website. NAMI supports and promotes nurses to continue their education, as well as nurses who perform research, through peer-led programs that provide free education, skill training, and support. One of the many examples of incorporating EBP on the website is seen in the education section of Conversion therapy. Conversion therapy is a controversial treatment that aims to change a person’s sexual orientation or gender identity. The NAMI website shares that all major medical organizations oppose it since it is not an evidence-based treatment and in fact, data shows that conversion therapy is dangerous, particularly for LGBTQ youth (National Alliance on Mental Illness, n.d.).

Perception of Healthcare Organization:

The information that I have learned about this healthcare organization has not affected my opinion of this organization’s website. I utilize the NAMI website for research projects at school and at work, and I will continue to use it in the future. As a psychiatric nurse, I currently utilize this website to print educational handouts for my patients to assist them in better comprehending and managing their mental illness and the mental health medications they are prescribed by the Psychiatrist.

It is critical for nurses and students to incorporate EBP into their daily lives in order to provide better care for their patients and conduct significant research. Nurses must only conduct research on websites that focus on the most recent EBP strategies, and it is critical for nurses who are directly caring for patients to adopt and implement EBP as it is critical to maintaining optimal patient outcomes and best practice care.


Crabtree, E., Brennan, E., Davis, A., & Coyle, A. (2016). Improving Patient Care Through Nursing Engagement in Evidence-Based Practice. Worldviews on Evidence-Based Nursing13(2), 172–175. https://doi.org/10.1111/wvn.12126

Kim, S. C., Stichler, J. F., Ecoff, L., Brown, C. E., Gallo, A., & Davidson, J. E. (2016). Predictors of Evidence-Based Practice Implementation, Job Satisfaction, and Group Cohesion Among Regional Fellowship Program Participants. Worldviews on Evidence-Based Nursing13(5), 340–348. 

NAMI: National Alliance on Mental Illness. (n.d.). Nami.Org. Retrieved February 27, 2022, from https://www.nami.org/Home

Answer discussion

  Response posts: include at least 2 scholarly sources of evidence, cited within the body of your discussion responses  & at the end of your posting, at least 2 references

Evidence-based practice guides all aspects of clinical practice, such as the design of health care facilities and the development of organizational policies and procedures (Walden University, 2018). Evidence-based practice is a key principle of healthcare and nursing. This process includes collecting data from well-designed studies and research, reviewing and analyzing this information, and integrating the best findings to improve healthcare quality as well as clinical practice and environments which ultimately will improve the outcomes of our patients (Melnyk et al.,2014). 

Scripps Health is a $2.9 billion private nonprofit health care system based in San Diego California. Scripps healthcare is ranked among the top 15 healthcare systems in the nation and serves about 700,000 patients annually. The system includes five hospitals and 19 outpatient facilities with more than 3,000 affiliated physicians and 15,000 employees (Scripps Health, n.d.). 

In the analysis of Scripps Health’s website, evidence-based practice did appear throughout the platform. The organization spoke to their commitment to quality and safety and how their institution bases their information on these topics with the research and data of a chief quality officer, as well as a manager of patient experience and quality. The organization also states how they are involved with the Hospital Quality Institute (HQI) and provides information on how HQI supports patient safety and quality improvement. Scripps Health also provides a Quality Transparency Dashboard on their website this document provides outcome measurements for maternity safety, sepsis protocols and sepsis mortality, respiratory monitoring programs, central line-associated bloodstream infection (CLABSI), colon surgical site infection (colon SSI) nulliparous, term, singleton, vertex cesarean birth rate (NTSV) and 30- day readmission – Hospital-wide all-cause 30- day unplanned readmission rate of their five hospitals. Scripps Health also provides their annual report on their website, this report includes how the organization is tackling healthcare issues such as the opioid crisis and cancer. These sections include statistical research and data that has aided Scripps health in dealing with these healthcare issues (Scripps Health, n.d.). 

As a previous employee of the organization, I have witnessed firsthand how Scripps health promotes many core values by using evidence-based practice. After the analysis of Scripps health, I still stand by the notion that evidence-based practice is utilized in all aspects of the delivery of care and empowered by providing education to healthcare staff. Scripps empowers their staff by facilitating many opportunities for their physicians and nurses to continue education. These opportunities include annual conferences, live courses, and online enduring materials. By providing their staff with high-quality evidence-based and clinically relevant education they can promote cultural change. Through education, Scripps Health can create growth and development opportunities for physicians and nurses. Preparing healthcare staff to frame clinical questions and search for answers through research and literature (Crabtree et al., 2016). Reinforcing the notion that as nurses and future advanced practice nurse practitioners, we must stay current and relevant with the ever-changing evidence and best practices in healthcare in order to deliver safe quality patient care.

Answer discussion

  Response posts: include at least 2 scholarly sources of evidence, cited within the body of your discussion responses  & at the end of your posting, at least 2 references

Current Healthcare Issue-National Shortage in Nursing Resulting in Burnout

           With the recent pandemic, the national nursing shortage has grown tremendously. I chose to analyze this topic as the healthcare issue/stressor in this discussion. Seasoned nurses are experiencing staffing shortages and decreased job satisfaction. Nursing students’ education has been interrupted or altered due to COVID 19 restrictions and mandates being implemented or enforced. Seasoned nurses dealt with political and social frustration brought about by the pandemic and new graduates dealt with difficult onboarding (Buerhaus, 2021). A 2020 survey reported nurses feeling high rates of anxiety, depression, burnout, and work overload contributing to the psychological burden associated with COVID 19 (Buerhaus, 2021). 

           Most healthcare facilities focus on patient satisfaction and reduction of cost ignoring staff job satisfaction and fulfillment. The Quadruple Aim in healthcare to optimize performance was identified by the Institute for Healthcare Improvement (IHI). The Quadruple Aim includes enhancing healthcare quality, improving patient outcomes, reducing healthcare costs, and improving staff job satisfaction (Beckett & Melnyk, 2018). Healthcare facilities should focus on building resilience amongst nurses and the future of the profession. Providing additional support to nursing staff and focusing on providing safe work environments for nurses should be a priority. Facilities should implement exercises and provide education to staff daily to assess their stress levels and promote self-care. 

           The nursing workforce is predicted to increase to 3.4 million in 2026, with an estimated need for an additional 203,700 new RNs each year to fill the newly created positions and replace retiring nurses (Rosseter, 2019).  Shortages in nursing staff result in unsafe nurse-to-patient ratios, leading to increased workload and burnout.  Thus, compromising patient care and staff retention rates.  


Impact of Nursing Shortage at My Workplace

           The pandemic has affected my work environment tremendously. The pandemic has created opportunities for nurses to leave staffing positions and travel making usual annual incomes in 3 months or less. I have seen increases in nurse-to-patient ratios. Nurses are working long hours with lots of overtime. Vacation time is being denied due to a lack of staff. Physical and mental health has declined. The stretch has become the norm and is expected in the daily routine. Staff morale is at an all-time low. The mandated vaccines at our healthcare facility also contributed to a mass exodus of employees refusing the vaccine. The shortage in nursing and wear on the remaining staff nurses has resulted in compromised quality of patient care, patient dissatisfaction, call-ins, and nurses quitting. The influx of travelers that aren’t familiar with patients in our chronic outpatient facility resulted in the neglect of monthly and weekly nursing duties such as care plans, foot checks, medication checks, and lab reviews. Bare minimal care was provided due to staffing shortages and lack of resources. As a manager, my stress level has increased leading me to seek medication to deal with anxiety and stress to cope in the workplace. We have been unable to retain new staff due to high-stress levels and chaos leading them to seek less stressful jobs after completing orientation or within a year of being hired. This is not cost-effective, as it cost the organization approximately 10,000 to train new hires who are not staying.  The plan is to continue to use travelers to lessen the burden and advertise aggressively to entice new hires with retention and sign-on bonuses. 

My Organizations Response to Nursing Shortage

Our facility responded by offering competitive pay rates, sign-on bonuses, and retention bonuses. We have had several meetings with regional directors and upper management to explore the main causes of nurse shortages and burnout. Anonymous surveys were used also. The decision to use travelers reduced the nurse/patient ratios back to normal. Our facility also agreed to staff more nurses when available to reduce the load and stress level on the unit. By agreeing to staff more nurses on each shift, the staff nurses we had are willing to pick up more shifts because they were not exhausted physically and mentally at the end of a shift as before. Our facility also uses a call system where nurses can call a “code lavender” when stress levels are high on the unit. Clergy and staff respond with calming activities, lavender vials to promote relaxation, snacks, and offer prayer to those willing to accept.  



Beckett, C. D., & Melnyk, B. M. (2018). Evidence-Based Practice Competencies and the New EBP-C Credential: Keys to Achieving the Quadruple Aim in Health Care. Worldviews on evidence-based nursing15(6), 412–413. https://doi.org/10.1111/wvn.12335

Buerhaus, P. I. (2021). Current Nursing Shortages Could Have Long-Lasting Consequences: Time to Change Our Present Course. Nursing Economic$, 39(5), 247–250.

Rosseter, R. (2019). Nursing Shortage.  https://www.aacnnursing.org/News-Information/Fact-Sheets/Nursing-Shortage

Answer discussion

  Response posts: include at least 2 scholarly sources of evidence, cited within the body of your discussion responses  & at the end of your posting, at least 2 references

Work-life balance is a major stressor for health care providers. A major concern is caregiver fatigue, also known as compassion fatigue amongst healthcare workers. The quadruple aim is set to help balance the lives of health care employees, during such times as these with the COVID pandemic, stress has been paramount, and keeping bedside nurses has been challenging for many institutions. The goal was set for nurses, by the Institute of Medicine (IOM) to be bachelor certified by 2020, as stated by Gerardi, et. al (2018). This has also caused a bit of stress for many nurses to complete their education requirements. My institution offers tuition reimbursement for employees that work full-time and part-time at a decreased amount dependent on hours worked. This has helped many nurses to achieve their goals of reaching BSN, yet the work-life balance aspect of the quadruple aim still seems a bit off in the distance.

The health system that I work for offers a lot of support for self-care practices for our employees and has a health and wellness center that offers exercise classes and yoga and mindfulness classes to support the staff. There are also resilience classes offered throughout the course of the pandemic for anyone to join on a Teams meeting video conference. The education department is constantly offering classes for improvement and there is a holistic committee that is available for nurses and staff members to utilize if they need extra assistance with patients or with self-care. The team offers aromatherapy sniffers with lavender for calming, an anti-nausea blend for patients, and a variety of others to help calm moods, and the onset of anxiety. Specifically, throughout the pandemic, more people were asked to work remotely if appropriate. Our department has continued to keep remote days as it has shown better work-life balance for many of our team members. This has been in support of compassion fatigue and to improve the work-life balance of many employees across our system. Unfortunately, there has been a large loss of employees due to the ability of some companies to continue to work remotely and this we have seen as a negative change in our department. As noted by Jacobs, et al., in 2018, employee well-being is very important to assist in working with resilience and helping healthcare professionals the resources needed to help balance work-life needs. As mentioned, financial resources, mental health, benefits that are available to assist employees in managing their lives better, and all these programs are set in place in my institution, there is a financial company that is available to see employees face to face to sit down and review financial wellness and there is a company partnered with the health system for employees to use mental health services as needed. The idea is to provide staff with resources and make available face-to-face training as well as community resources and support from the employee’s benefits. As a nurse leader, it is important to know what is available to be able to assist other team members (Broome & Marshall, 2021).

Compassion fatigue can result in nursing burnout and when issues are not managed properly and the stress can build up and cause negative effects (Rivers, et al., 2011). Resilience and managing self-care are very important for nurses to maintain skills in coping to deal with major stressors related to caregiving. As a nurse leader, knowing which programs are available to the staff help to balance the well-being of the staff members; furthermore, the Professional Quality of Life Scale (ProQOL) is a survey that can be used to evaluate compassion satisfaction, burnout, and trauma compassion fatigue scales individually (Rivers, et al., 2011). I am proud to say that my institution is aware of these challenging times and offers support to the staff, it is a matter of whether the staff chooses to participate in the classes and if managers are supportive of these measures to help their staff members to become more resilient. I know my manager is always plugging the different resiliency classes and making us aware of when the financial planner is available on our calendars and informing us of new programs whenever they are available and when appropriate. It is also important for nurse leaders to participate in such programs to be able to bring back their knowledge and to share it with fellow staff members.




Auerbach, D. I., Staiger, D. O. & Buerhaus, P. I. (2018). Growing ranks of advanced practice clinicians- Implications for the physician workforce. New England Journal of Medicine, 378(25), 2358-2360.

Broome, M & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). Springer.

Gerardi, T., Farmer, P, & Hoffman, B. (2018). Moving closer to the 2020 BSN-prepared workforce goal. American Journal of Nursing, 118(2), 43-45.

Jacobs, B., McGovern, J., Heinmiller, J. & Drenkard, K. (2018). Engaging employees in well-being: Moving from the Triple Aim to the Quadruple Aim. Nursing Administration Quarterly, 42(3), 231-245. Doi: 10.1097/NAQ.0000000000000303

Rivers, R., Pesata, V., Beasley, M., & Dietrich, M. (2011). Transformational leadership: Creating a prosperity-planning coaching model for RN retention. Nurse Leader, 9(5), 48-51. https://doi.org/10.1016.j.mnl.2011.01.013

Answer discussion


using formal APA writing convention, using the 7th Edition APA

leadership Theories in Practice

For the quality provision of healthcare services, the nurses require to work in a healthy working environment that is motivating. Nursing leadership and administrative roles directly impact the nursing staff’s motivation to serve. The key insights I got from the articles I selected included, first, was that leaders have an essential role in creating a healthy working environment for the staff and hence determine the individual experiences of their staff (Saleh et al., 2018). Secondly, good leadership is associated with decreased burnout among the staff as the leaders empower and motivate their nurses rather than dictate them to do their roles (Tran et al., 2018). Transformational leaders, unlike transactional leaders, should motivate and inspire the employees to carry out their roles as expected.

A time last year, I witnessed a situation where the leadership skills and behaviors of the leaders created an ample working environment for their staff. Two trained nurse leaders made it difficult for a newly employed registered nurse. There were complaints that the two did not want to assist the newly employed nurse, and they would sit down all day to make stories than work. Instead of criticizing the two nurse aides, the nurse in charge of the unit called them together with the newly employed nurse to hear from them. The nurse in charge asked the two nurse aides to be kind to the new nurse and help him do his job appropriately. The nurse in charge went ahead to instruct the two nurse aides to be responsible for the activities in the ward and help guide the new nurse. The nurse was motivated to do his job and worked well with the two nurse aides a week later. In the illustrated situation, the nurse in charge applied remarkable leadership skills to solve the conflict. According to Wei et al. (2019), a leader should be a good listener and communicator. The nurse in charge listened to both parties and allowed the two nurse aides to recognize their mistakes rather than expelling them.


Saleh, U., O’Connor, T., Al-Subhi, H., Alkattan, R., Al-Harbi, S., & Patton, D. (2018). The impact of nurse managers’ leadership styles on ward staff. British journal of nursing27(4), 197-203. https://doi.org/10.12968/bjon.2018.27.4.197

Tran, K. T., Nguyen, P. V., Dang, T. T., & Ton, T. N. (2018). The impacts of the high-quality workplace relationships on job performance: A perspective on staff nurses in Vietnam. Behavioral Sciences8(12), 109. https://doi.org/10.3390/bs8120109

Wei, H., Roberts, P., Strickler, J., & Corbett, R. W. (2019). Nurse leaders’ strategies to foster nurse resilience. Journal of nursing management27(4), 681-687. https://doi.org/10.1111/jonm.12736

Answer discussion


using formal APA writing convention, using the 7th Edition APA

PICOT Question:

My clinical topic of interest is ‘Schizophrenia/psychosis and Interventions for Family Caregiver Support.’ I chose this topic since I am pursuing my PMHNP and wanted to focus on a question related to my field of study. I believe it is necessary to learn what kind of support is available to caregivers to help lessen the burden of care. Furthermore, I have witnessed the difficulties that family caregivers face when caring for someone suffering from schizophrenia or psychosis.

In order to design a search strategy, you must first formulate a review question. The PICO model is by far the most extensively utilized model for creating clinical questions, according to Eriksen and Frandsen (2018). My PICOT question is an intervention-type question. I was able to use the guide in Appendix A of our textbook; In _________ (P), how does _________ (I) compared to _________(C) affect _______(O) within _______ (T) (Melnyk & Fineout-Overholt, 2018) to formulate my question. First, I broke up the question and made it fit into the pneumonic PICOT:

P—family caregivers of schizophrenia/psychosis patients

I—educating or informing about schizophrenia/psychosis

C—not educating or informing.

O–reduced caregiver burden.

T— I decided not to include a time frame

‘In caring for individuals diagnosed with schizophrenia/psychosis, how does educating or informing caregivers of available resources compared to not educating or informing influence caregiver burden?’

Databases Utilized for Search:

I used the ‘CINAHL & MEDLINE Combined’ database search engine at the Walden library to find articles related to my topic. 

Search Results, Articles Returned, and Changes from use of Boolean Operators 

I started by typing in the complete PICOT question, which yielded 48,913 results. I found that when I limited my search to key terms, it returned 188 results. The more detailed the question, the fewer articles that will be retrieved.

Database Strategies to Increase Rigor and Effectiveness

 The following Is what I typed into the search engine that yielded fewer results:

schizophrenia OR psychosis


care* OR family*


educate* OR inform*

resources OR support OR programs OR services


burden OR stress OR fatigue OR burnout OR strain

In a search box, you can use OR to link together synonyms or related words, enabling the database to search more thoroughly. The AND operator does two things: it connects distinct notions and it narrows down your search. The * character at the end of a word allows you to search for different versions of the same term; for example, type educate* to search for education, educated, or care* to search for carer, caregiver, caring, and so on (Walden University Library, n.d.).

I had no clue this was the best approach to search for EBP and peer-reviewed publications on a database until I read about these methods for finding them. In addition, I discovered that creating a PICOT question is a desired method  for asking questions to search for existing research and to find the most relevant and best evidence-based literature (Melnyk & Fineout-Overholt, 2018).




Eriksen, M. B., & Frandsen, T. F. (2018). The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: a systematic review. Journal of the Medical Library Association : JMLA, 106(4), 420–431. https://doi.org/10.5195/jmla.2018.345

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer.  

Walden University Library. (n.d.-e). Evidence-based practice research: MEDLINE search help. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/medlinesearchhelp


Answer discussion


using formal APA writing convention, using the 7th Edition APA

Transformational Leadership Style

A good leadership style plays an important role in nursing and the retention of nurses because it helps in shaping the healthcare practice environment to produce quality outcomes for staff nurses and patients. The type of leadership that one chooses to use in a leadership role or position determines the outcome and accomplishment of the mission set before an organization. The leadership style that I prefer and that is productive is transformational leadership. Adopting the qualities of a transformational leader will allow nurse managers to feel more comfortable and confident when engaging in the development of healthcare policies, the ever-changing components of healthcare technology, and the mentorship of new graduate nurses” (Smith, 2011). 

Transformational leadership style has been identified as the most effective approach to building up a business organization. Leaders that use the transformational style of leadership showcase integrity, high emotional intelligence, and they motivate people with a shared vision of the future and communicate well to their team or organization. As a nurse, I prefer this leadership style because it embraces self-awareness, authenticity, and humility which is among the list of styles that is missing in today’s management. A nurse leader who uses a transformational leadership style will promote a healthy atmosphere for her nurses to work in and promote job satisfaction for everyone. A good nurse leader brings out the best in their nurses by promoting a good leader for their nurse to climb on career-wise and promote a thriving environment for everyone in the team. Transformational leaders create a safe and soft influence and provide a high job satisfaction by supporting followers’act of making individual choices (Long et; al 2014)

 In nursing today, we find more autocratic leadership that doesn’t care about anyone else but themselves and what they stand to achieve. Such leaders don’t last very long in an organization, and this is the leadership style that I have seen, and it doesn’t work.  According to Smith, Transformational leadership qualities promote a healthy environment for employees and staff, which will produce improved staff satisfaction, retention, and patient satisfaction (Smith, 2011). I have been opportune to work with good nurse leaders and a few of them I have admired and am still in close contact with them.  I worked with a good manager as a delegating nurse, and she showed me what a good leader is supposed to be. She was someone that I admired so much because she was a team leader, she has positive energy, easy to talk to, and is very humble. Her attributes made me see a leadership position as an asset instead of deplorable. She made the atmosphere very conducive and welcoming for everyone who worked on her team even as a new hire.




Choi Sang Long, Wan Mardhia M. Yusof, Tan Owee Kowang and Low Hock Heng 1 The Impact of Transformational Leadership Style on Job Satisfaction retrieved from https://www.researchgate.net/profile/Choi-Sang   Long/publication/289580477_The_impact_of_transformational_leadership_style_on_job_satisfaction/links/59e6ad544585151e545ce679/The-impact-of-transformational-leadership-style-on-job-satisfaction.pdf

Smith, Mary Atkinson FNP-BC Are you a transformational leader?, Nursing Management (Springhouse): September 2011 – Volume 42 – Issue 9 – p 44-50 doi: 10.1097/01.NUMA.0000403279.04379.6a

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using formal APA writing convention, using the 7th Edition APA

Top Five Signature Themes of Talent

            After completing the Clifton Strengths Finder Assessment, I learned that my top five strengths are developer, learner, achiever, harmony, and belief. As a developer, I see the potential in everyone and want to help others to become successful while also challenging them so that they can learn and grow. As a learner, I constantly want to learn new things, especially about subjects that draw my attention. The more I learn, the more my confidence in myself grows. As an achiever, I am productive and must accomplish my daily goals or I feel dissatisfied with myself. Being an achiever helps me face any challenges that come my way and gives me the drive to keep going. As a harmonist, I prefer to avoid conflict and keep my personal views and beliefs to myself and feel that others should too. When there is a disagreement, I try to find common ground so that everyone can get along and have productive conversations. As a believer, I am very family-oriented, dependable, and trustful, and I value responsibility and ethics, in my personal and work life.

Two Core Values

            To be an effective leader, it is important that you are aware of your core values and strive to be an authentic leader. Authentic leadership has four main principles: “balanced processing, relational transparency, internalized moral perspective, and self-awareness” (James et al., 2021, p. 2). Authentic leadership can promote a positive work environment and improve patient care. The two core values that are the most important to me are being a developer and an achiever. As a developer, I always see the potential in my coworkers and those in my personal life. If I see someone struggling at work, I try my best to help so that they can learn and be successful. I find satisfaction in watching others grow and improve and I like that my coworkers feel comfortable coming to me when they need encouragement or guidance. As an achiever, I always want to perform to the best of my ability. Each day at work, I set goals for myself, and if I do not reach every goal, I feel a sense of dissatisfaction with myself. Being an achiever helps me to be more productive and keeps me going even when I am tired or feeling burnt out.  

Two Strengths

            My top two strengths are developer and a believer. I am currently in a unit manager position, and I believe it is important to give others the tools and guidance that they need to be successful because I believe everyone has potential. I try to be a support person and mentor to staff, especially those that work on my unit, so they know that they can come to me for help and for words of encouragement when needed (Brunt & Bogdan, 2021). I feel my other value, belief, explains me so accurately. I am very family-oriented, strive for success, feel a sense of meaning and satisfaction in my life, and value responsibility and ethics in myself and others. Because of this core value, I feel that my team members feel that they can trust me and that I am dependable.

Two Weaknesses

            I believe two areas that I could improve upon would be the core values of activator and command. I struggle as an activator in my personal life because I oftentimes lack the energy or motivation that is needed to get things done. I have not always been this way, but recently feel that I sometimes push things off until the last minute possible. I think establishing a good routine and sticking to it and setting personal goals for myself will help me to become a better activator. I struggle with command in my work life because I do not like to come off as bossy, confrontational, or insensitive, however, there are many situations where I must take control and make difficult decisions (Lead Through Strengths, 2021). I believe because my core values include belief and harmony, that it makes the value of command difficult for me.



Brunt, B. A., & Bogdan, B. A. (2021, September 8). Nursing professional development leadership. StatPearls [Internet]. Retrieved March 29, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK519064/

Gallup. (2022, March 28). Gallup.com. Your Signature Themes. Retrieved March 29, 2022, from https://gx.gallup.com/services/pdf?v=pdfGeneration.prince.7.0.binPath

James, A. H., Bennett, C. L., Blanchard, D., & Stanley, D. (2021). Nursing and values‐based leadership: A literature review. Journal of Nursing Management29(5), 1–15. https://doi.org/10.1111/jonm.13273

Lead Through Strengths. (2021, April 26). Cliftonstrengths command – strengthsfinder 2.0 talent themes. Lead Through Strengths – StrengthsFinder. Retrieved March 29, 2022, from https://leadthroughstrengths.com/command/

Answer discussion


Organizational Policies and Practices to Support Healthcare Issues

            Long-term care is an extremely vulnerable healthcare setting because they often lack adequate staff, resources, and updated technology that is required to provide quality patient care. This is because not enough money is being invested into nursing home facilities, their staff, or the care that the residents receive. Ensuring that residents at long-term care facilities receive high standard care should be a priority, however, many quality improvement challenges still exist, especially those involving fall prevention measures, dementia care, antibiotic management, and prevention of unnecessary hospitalizations. (Toles et al., 2021, p. 2) Many of these quality improvement challenges revert to the staffing shortages in nursing homes, as the staff is unable to provide quality care because they are being pushed to their limits and are unable to spend adequate time with each resident to provide the care they need.

            Staffing shortages are the main healthcare issue that is currently affecting the long-term care facility I work at the most. Our shortages are mostly due to inadequate pay, poor leadership, and our high staff turnover rates, however, poor policy for adequate staffing ratios in nursing homes also plays a huge role. Virginia is one of sixteen states that does not require a minimum number of staff hours per resident in nursing home facilities and a big reason for this is because more money will be needed for what is required to provide facilities with safe staffing ratios. These staffing issues are especially prevalent in low-income areas. (Masters, 2021) This policy will soon be discussed in an upcoming General Assembly session, and if this policy is passed, it will have a huge positive impact on nursing home residents and staff. Residents are not able to receive the care they need and deserve due to short staffing, which leads to adverse events such as an increased number of falls, weight loss, dehydration, depression, acquired pressure ulcers, infections, and preventable hospitalizations. Competing needs, such as those of the workforce, resources, and patients, should impact the development of policy because healthcare policies are put into place for the benefit of patients, staff, and healthcare facilities to help prevent errors and to help with decision making and communication.

            All healthcare facilities are focused on providing efficient and cost-effective care; however, they must keep in mind that providing high-quality, patient-centered care is of equal importance. Right now, at the healthcare facility I work at, I do not feel that our residents are receiving high-quality, patient-centered care because of our poor staffing ratios. This negatively impacts our residents in so many ways and leads to higher mortality rates, but also has a negative impact on our staff and can lead to nurse burnout, frustration, and job dissatisfaction. Some barriers that affect patient care include organizational policies, resources, and staffing ratios. (Kelly & Porr, 2018) While I do believe that it is important to provide efficient, cost-effective care, I also think that the healthcare industry needs to put patient-centered care as a number one priority. I truly believe improving staffing ratios, which may be more costly upfront but will save money in the long run due to fewer adverse events in patients, is one of the best ways to improve patient care.



Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN Practice. OJIN: The Online Journal of Issues in Nursing23(1). https://doi.org/10.3912/ojin.vol23no01man06

Masters, K. (2021, December 9). Virginia lawmakers endorse staffing requirements for nursing homes. Virginia Mercury. Retrieved March 14, 2022, from https://www.virginiamercury.com/2021/12/08/virginia-lawmakers-endorse-staffing-requirements-for-nursing-homes/

Toles, M., Colón-Emeric, C., Moreton, E., Frey, L., & Leeman, J. (2021). Quality Improvement Studies in nursing homes: A scoping review. BMC Health Services Research21(1), 1–15. https://doi.org/10.1186/s12913-021-06803-8

Answer discussion


using formal APA writing convention, using the 7th Edition APA

 This week’s assignment included taking a strength finder assessment and analyzing our individual results. According to the signature theme report, My five main strengths include relator, achiever, discipline, consistency, and learner. A relator is an attitude toward relationships. My theme included being pulled toward people I already know. I am not afraid of meeting new people, however, prefer people I  already know. As an achiever, in order to feel accomplished, I must complete tasks no matter how small. This theme describes a fire burning within me. As far as discipline, I like a plan and routines. I feel the need to be in control. When it comes to consistency, balance and fairness are important. 

Two Core Values

       Core values can be defined as, “Personal values are the things we hold important to us, the behaviors and attributes that guide our decisions and motivate us to action” (Small Business Coach, 2021, para. 3). The two core values of utmost importance to me are discipline and consistency.  Discipline keeps me grounded and focused on the right choices. Discipline steers me in the right direction in life. Consistency is important to continue to stay focused and grounded. Consistency creates balance in my life which I value. “Our research shows employees display greater performance and well-being when the level of challenging tasks they work on is consistent or stable” (University of Nebraska-Lincoln, 2020, para. 2). I would also choose both of these themes as my strengths for the same reasons listed. 

Two Characteristics to Strengthen

     The first characteristic to strengthen would be relator. Although I form deep relationships with people I know, as a leader I want to be vulnerable and approachable. Although the relator theme states it’s a positive due to building strong teams, I feel it would be hard if one does not come across as approachable, to begin with. The second characteristic I would like to strengthen would be an achievement. While this is usually a positive, there are times the need for achievement can almost become like a competition. This is where I would like to strengthen this theme. Achievers tend to never shut off and tend to be judgmental (literacymn, 2010). I would definitely want to strengthen this area of this theme for effective leadership. 


literacymn. (2010). Theme descriptors and barrier labels [PDF]. Strengths: Light and Dark (in balance or over-calibrated).


Small Business Coach. (2021, March 31). How to define your core values and beliefs. https://www.smallbusinesscoach.org/how-to-


University of Nebraska-Lincoln. (2020, June 16). Research shows connection between consistency, productivity.


Answer discussion


using formal APA writing convention, using the 7th Edition APA

PICOT Question

The clinical issue of interest that I chose to formulate my PICOT question was, telehealth and remote monitoring. According to Melynk and Fineout-Overholt (2019) a PICOT question will formulate the best evidence as well as the most relevant and up to date search related to already existing literature. My PICOT question is: In telehealth and remote monitoring in clinical settings, how does the impact of face-to-face visits compared with telehealth visits affect clinical outcomes?

Search Terms

The search terms that I used to find articles for my PICOT question were “face-to-face visits and telehealth visits.” This initially brought up 372 results in the Thoreau at Walden University Library database. I used the same terms to search in APA PsycInfo which initially gave me 40 articles. 

Databases Utilized for Search

The databases that I used for my search were Thoreau at Walden University Library and APA PsycInfo. I chose APA PsycInfo as I am enrolled for the PMHNP program and thought that the articles related to psych health and telemedicine would be interesting as one day they will affect my practice.  

Search Results, Articles Returned, and Changes from use of Boolean Operators 

According to Walden University, LLC (2018) by using the clinical issue of interest topic and transforming it into a question, such as the PICOT question, it is like designing our own treasure map that will lead to discovery of treasures of literature that can be used to apply to practice. The APA PsycInfo initially gave me 40 articles. From there I put in the dates from 2018-2022 which gave me 28 results. From there I didn’t add any more search terms into my boolean operators but instead I looked through the articles and chose articles that had the terms qualitative, quantitative or mixed-methods study in them.  I did a similar type of thing with the Thoreau at Walden University Library database. When searching just for telehealth and face to face visits 381 articles pulled up. I then limited my search to peer reviewed articles and used the dates 2018-2022 it brought it down to 372 articles. I then continued my search by choosing articles that had the words quantitative, qualitative or mixed-methods study. 

Database Strategies to Increase Rigor and Effectiveness

To increase rigor and effectiveness of searching the databases I believe that I could’ve continued to add or reduce words to make it much more specific. I could have added words under “and” such as benefits or clinical outcomes. By doing this my search would only gather articles containing all of the terms (Library of Congress, n.d.). This is something that I didn’t know about until I was reading the course materials and found this to be beneficial for my future database searches. 


Library of Congress. (n.d.). Search/browse help-Boolean operators and nesting. Retrieved March 22, 2022 from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html

Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer. 

Walden University, LLC. (Producer). (2018). The Value of Clinical Inquiry [Video file]. Baltimore, MD: Author.

Answer discussion


Upper management in acute hospitals has long been concerned about staffing shortages, which has been at the forefront of healthcare challenges in the past. A large number of research have found a link between nurse staffing levels and patient outcomes. Low nurse staffing levels not only result in poor patient outcomes, but they also have a negative impact on the nurse’s job satisfaction and contribute to nurse burnout. In addition, nurses are more likely than the general population to become mentally and physically exhausted, as well as to face workplace violence. The nursing profession is the one that is most vulnerable to workplace violence, and the majority of these actions are perpetrated by patients and their relatives, as well as by coworkers and managers (Bernardes et al., 2021). When a nurse has more patients than she or he can adequately care for, she or he feels the additional weight of not having aid and having to shoulder increased workload and duties. It was reported by Crystal Martin in 2015 that “job discontent among nurses is four times greater than the overall rate of dissatisfaction among U.S. workers, and one in every five nurses reports that they aim to quit their job within a year.” That is a scary statistic to take in at this point.Healthcare professionals are simply overburdened. It is common for them to work in circumstances that are chaotic, high-pressure, and non-stop. As a result of low job satisfaction among nurses, the number of nurses who quit and those who become burned out increases. A high nurse-to-patient ratio is one of the most significant factors contributing to an increase in medical errors. Another factor contributing to nurses’ feelings of overwork is the assumption that they will work 12-hour shifts without the opportunity to take the food and restroom breaks to which they are legally entitled. The majority of the time, nurses are simply too busy to take time off during a shift to restock their supplies, rest, and use the restroom. Every hour a nurse spends on the job each day, including each shift and overtime, and every week has a direct impact on patient safety (Martin, 2015). Patient’s may begin to feel abandoned and frustrated with the lack of attention they are receiving as a result of nurses being overworked and overburdened with their patient load. Patient dissatisfaction might then manifest itself in the form of aggression against employees, whether it be physical, verbal, emotional, or sexual assault. 

For years, the California Board of Nursing has continually been at the forefront of the nation’s efforts to transform healthcare practice, and it just enacted a new regulation requiring each nurse to take periodic breaks. Every five hours, a nurse is entitled to one 30-minute break and one 10-minute break, both of which must be taken in separate locations. Breaks would be divided between two 30-minute breaks and two 10-minute breaks during a 12-hour shift (Bernal, 2018). Given that this rule has not yet been established in the rest of the country, each state’s Board of Nursing and nurse advocates would need to collaborate with their respective state lawmakers in order to enact this into law. What would be even better is to make it a national legislation that would be enforced by all healthcare systems to ensure that nurses had healthier and safer working conditions by requiring them to take breaks during lengthy hours of work. 

It is sad that nurses cannot put their faith in our healthcare systems to protect them and their patients’ best interests. It takes numerous debates, a long period of time, and even the passage of legislation to ensure that we as healthcare workers are protected. Given the above example, the California Board of Nursing (BON) was required to go above and beyond the healthcare system by involving the government in the creation and mandate of a legislation that would be enforced and followed, improve nurses’ working conditions, and assist with staffing shortages. If employers do not comply with the provisions of the law requiring nurses to take rest breaks, the nurses will risk severe fines for failing to comply with the provisions. During the coronavirus pandemic, nurses in California held protests and nursing staff in numerous hospitals went on strike to express their genuine dissatisfaction with labor law violations, such as inadequate staffing, which caused them to work through meal and rest intervals (Spicer, 2020). If hospitals in the rest of the country want to find solutions to their high nursing turnover and burnout rates, they must start by adopting California’s standards of practice as a starting point. California is definetely moving in the right direction in providing their nurses ample breaks to hydrate and eat.  Needs that are amongst the basic needs of human existence. We can only hope that legislation amongst the states moves toward better treatment.


Bernal, C. (2018, October 23). Healthcare compliance with California meal break law. https://blog.accu-time.com/timecom/healthcare-compliance-with-california-meal-break-law

Bernardes, M. L. G., Karino, M. E., Martins, J. T., Okubo, C. V. C., Galdino, M. J. Q., & Moreira, A. A. O. (2021, February 11). Workplace violence among nursing professionals. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7879475/

Martin, C. J. (2015). The Effects of Nurse Staffing on Quality of Care. MEDSURG Nursing, 4–6.

Spicer, C. (2020, December 11). How do California nurse labor laws protect nurses? Top Class Actions. https://topclassactions.com/lawsuit-settlements/employment-labor/how-do-california-nurse-labor-laws-protect-nurses/

Answer discussion


Incivility is simply Rude or disruptive behaviors that often result in psychological or physiological distress for the people involved and, if left unaddressed, may progress into a threatening situation. In addition, incivility is a growing issue across all public and private sectors and is gaining attention due to the harm it causes individuals and workgroups without being legally punishable (Collins & Rogers, 2017).

The result of my Work Environment Assessment calls for concern, and it goes a long way to change the perception of a typical healthcare facility environment. Society views the healthcare environment as a place beyond comparison to a healthy workplace. Even in countries at war, the hospital and other health institutions are deemed peaceful and a place of refuge.

However, after carefully completing the assessment and getting a score of 60, I began to see why the organization continuously engages employees in active shooter and other self-defense drills. The result indicates that my workplace leans towards incivility than a healthy environment.

While there is no reason for an individual to be hostile and bully others, some workplaces have weak policies and lenient corrective actions that favor incivility. Sometimes an individual’s leadership style brings about incivility. Of note is a situation where the leader gives preferential treatment to followers. For instance, in my organization, a particular nursing assistant is always at the manager’s office, backbiting and gossiping against other staff members. The manager and the nursing assistant became big-time friends, even outside work.

Hence, the manager shows favoritism to the nursing assistant at all times. Because she is the managers’ friend, the nursing assistant will not take directives from the RNs anymore. She bullies the RNs, and CNAs and tells patients to complain to the manager about people she does not like. This behavior of the manager and the nursing assistant was made known to the union leaders. The union leaders intervened by having a dialogue with the manager and resolved it. In this case scenario, the incivility of the nursing assistant was impacting patients’ safety and care. There was no effective and quality care delivery because the nursing assistant tends to be disruptive and give the RNs directives.

Notwithstanding, some strategies could reduce the incidence of incivility. Employee wellness programs have historically been implemented as separate initiatives from employee assistance programs, with wellness programs classified as preventive. Secondary interventions such as mindfulness-based stress reduction programs and others have been suggested in the nursing and medical literature to improve personal resilience (Clark C. M., 2015; Clark, Olender, Cardoni, & Kenski, 2011; Collins & Rogers, 2017).











Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10(11), 18-23.

Clark, C. M., Olender, L., Cardoni, C., & Kenski, D. (2011). Fostering Civility in Nursing Education and Practice: Nurse Leader Perspectives. THE JOURNAL OF NURSING ADMINISTRATION, 41(7/8), 324-330.

Collins, N. R., & Rogers, B. ( 2017, November ). Growing Concerns With Workplace Incivility. Workplace Health & Safety.


Answer discussion


Workplace Environment Assessment

The results from the Clark Healthy Workplace inventory revealed that the organization that I work for is a moderately healthy workplace with a score of 86. This inventory evaluation was impressive and based on these results the organization is recognized as a moderately healthy environment.

I have had a positive experience working in the population health department over the past four years, prior to that, working in the operating room in the same institution was completely the opposite. The two departments are completely different viewpoints of the organization. While in the OR there were many cases of incivility and workplace bullying. In my current position, there is constant communication and teamwork. There have been a lot of changes made to the organization within the past ten years including moving to become a highly reliable organization, that has developed many shared governing bodies, professional growth, and effective communication with transparency of the organization. There is a strong emphasis on self-care and wellness and there are many holistic certified nurses. Even during transition periods with upgrades to electronic health records, the management staff continues to work with employees and offers a teamwork strategy and patient safety is at the core.

What surprised me from the results? I did not think that the organization was as healthy as it is. I had not realized how far it has come over the few past years. In my previous role as an OR nurse, I was often caught off guard by the way people communicated to each other and how rude and obnoxious doctors could be in an operating room while the patient was fast asleep, this affected morale and new management was working to improve overall workplace environment safety. As cited by Griffin and Clark (2014), the TeamSTEPPS approach provides a framework to improve patient safety, this program was very successful in our organization, and CUS- Concerned, Uncomfortable, and Safety is the acronym our organization uses when there is something related to patient safety that needs to be addressed. Prior to conducting this assessment, I believed that the organization was heading towards healthier practices and that the work environment had become safer.

The results suggest that the health of the organization is moderately healthy with room for growth, yet with a score of 86 on the Clark Healthy Workplace Inventory, this does explain civility, which I do believe can be siloed. Every department has different personalities and cultures, within the past five years a new Chief Safety Officer took his role to the utmost seriousness of making the hospital a safe and secure location, with his leadership, many changes have been made to improve the overall health of the organization. Collaboration and communication amongst all departments have improved with daily safety huddles. Respect and trust must be established by leadership to create healthy environments (Broome & Marshall, 2021).

Theory from Article

                Cognitive rehearsal theory as discussed by Griffin & Clark (2014) empowers nurses to address behaviors that are uncivil. This tool can be applied to all disciplines in the healthcare environment. Nurses that are educated about such behaviors and ways of dealing with them properly have a positive sense of self. Any work environment that is uncivil draws negative attention and poor morale, which can affect patient care. With the use of cognitive rehearsal, nurses are prepared to deal with these unfortunate circumstances. Nurse leaders have a responsibility to create civil environments (Broome & Marshall, 2021).

Our organization would benefit from a program for new nurses during our onboarding orientation to help impact the workplace environment with the proper education about lateral violence. TeamSTEPPS program was beneficial and could be of use within the organization again. Continuing education should be a part of annual mandatory education for all nurses about workplace violence and there is a crisis intervention team that could be utilized if necessary and leaders can promote open-mindedness and acceptance to provide ways to deal with incivility.




Broome, M., & Marshall, E.S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). Springer.

Griffin, M., & Clark, C. M. (2014). Revisiting cognitive rehearsal as an intervention against incivility and lateral violence in nursing; 10 years later. Journal of Continuing Education in Nursing, 45(12), 535-542.