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Date of Award


Degree Type

Restricted Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Nola A. Schmidt


Healthy work environments (HWEs) are associated with improved patient outcomes, higher nurse retention rates, and enhanced quality care (Rogers-Clark, Pearce, & Cameron, 2009; Rosenstein & O'Daniel, 2008; Stagg & Sheridan, 2010). The purpose of this evidence-based practice (EBP) project was to design, implement, and evaluate a multiphase intervention to build a HWE in the intensive care unit (ICU) and determine its effect over a 3 month period on (a) lateral violence (LV), (b) moral courage (MC), (c) communication, (d) collaboration, and (e) job satisfaction. The Knowledge to Action EBP model (Graham & Tetroe, 2007) and Parse's (2008) leading-following model were used to facilitate the actions towards implementing a change and understand the connections and patterns during the change process. After conducting an exhaustive literature search, a multiphase intervention was determined to be the best practice recommendation for creating a HWE. ICU nurses attending a mandatory education day in the fall of 2014 were recruited to participate. Eighty-three nurses signed informed consent forms and agreed to participate in the project. Phase I of the project was the initiation of an ICU mission and vision statement created by the shared governance council. Phase II was a didactic session for nurses. Phase III consisted of the dissemination of the hospital's harassment and intimidating behavior policy. Phase IV was the initiation of an annual web-based competency on HWEs. A modified HWE assessment survey was administered to participants pre-didactic, post-didactic, and one month following didactic. Descriptive analysis was used to describe sample characteristics. To determine the effect of the intervention, analysis of the data was conducted using a one-way repeated-measure ANOVA. Five outcomes were evaluated: (a) LV, (b) MC, (c) communication, (d) collaboration, and (e) job satisfaction. While 83 nurses participated in the project, only 78 nurses completed all three surveys (94%). The project demonstrated a significant effect for LV (p < .001), communication (p < .05) and job satisfaction (p < .05). Although no significant effect was found for MC (p > .05) or collaboration (p >.05), scores did improve and were maintained over time. In the increasingly volatile healthcare system, it is essential to illuminate the true art of nursing by creating and maintaining a HWE. The findings from this EBP project support a multiphase approach for creating a HWE.


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