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Running head: NUR-300 FINAL PROJECT
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NUR 300 FINAL PROJECT
7-1 Final Project Template Example
Lokelani Ahyo
Southern New Hampshire University: NUR 300
December 11, 2016
7-1 Final Project Template Example
The Final Project for NUR-300 compiles all of the information
that the student has presented in Milestones One through Four.
This template with attempt to give the student an example of all
of the parts that are to be graded in the rubric.
In many hospitals worldwide nurse and patient safety is placed
at risk due to unsafe staffing conditions (Pearce et al., 2018).
An unsafe staffing condition arises when nurses become
responsible for more patients than they are equipped to care for
adequately. This can occur due to short staffing related to call
outs or even a high rate of turnover on a specific unit. This
unsafe nurse to patient ratio that is occurring results in care that
is rushed which can cause both medical and medication errors.
Additionally, nurses do not have time to properly utilize the

nursing process and the outcomes of goals are not always
achieved in a timely manner.
Further review of existing research is necessary in order to
determine why these unsafe working conditions are so
prevalent. It is important to understand the many factors that
affect nurse staffing in order to adequately implement actions to
change the problem (Young, White, & Dorrington, 2018). This
paper will provide an overview of the unsafe staffing issue for
nurses. It will also look at the many aspects of healthcare that
are affected by the problem. A literature review will begin the
paper to show the correlation between the supportive references
and the nursing issue. Following this will be information that
presents the ethical, legal, and licensure implications of this
topic in nursing. Two conceptual frameworks will be reviewed
to show their connection to the nursing issue, and finally the
issue will be reviewed in a comprehensive conclusion.
Literature Review
The literature review is the first part of the Final Project. It is
important because it shows that there is evidence-based, peer-
reviewed documentation that shows the importance of the issue.
This section should include an explanation about the journals,
databases and other sources that were used to find the literature
that was used. To achieve “Exemplary” some insight should be
included as to the importance of the professional databases and
their appropriateness. This section should also include an
explanation of the process that was used to choose the
literature. This should include the process that was used
including: key words, date ranges, and narrowing of the
selection of literature findings. Keen insight into this part
makes for an “Exemplary” score.
Article One
Each of the important literature pieces should be reviewed. I
recommend that this should be limited to five for this paper.
The authors and title should be included in this part. Make sure

that you follow APA format and look it up if your need help.
The summary of the article should be included. A justification
for the appropriateness of the literature piece should also be
included. In order to achieve “Exemplary” professional insight
and commentary should be included with each article review.
Article Two
This should be repeated for each article. .
Article Three
Again, repeat the process for the next article.
Connections
The next portion of the Final Project uses the student’s skill to
show connections between the nursing issue and a
comprehensive look at the Literature, Legal implications,
Ethical implications, and Licensure implications. A brief
introduction to this portion is acceptable in this paragraph. I
recommend giving an explanatory “layout of what they will be
reading in the connections section.
Connections to the Literature
This part takes the summaries from the literature review and
draws comprehensive conclusions about how the literature
supports the issue. This means that the students should find
common themes that the articles share about the topic. This is
also where the student can note the different themes that the
articles cover. Usually there are two to three common points
noted between all of the articles. For “Exemplary” points
insightful connections need to be made here.
Connections to Legal and Licensure Implications
There are always legal ties to issues that nurse face. Utilize
high profile cases as support for your topic. Also, the

discussion of liability insurance has been used in this section.
It is important to look at the legal aspect of healthcare because
of the impact that it has on nurses and patient care.
Many of the Licensure implications connect to the outcome of
legal implications. It is recommend that students utilize
resources such as their state Board of Nursing to help compile
information that can be connected in this section. Examples of
cases are good for support. The information should show keen
insight, a comprehensive analysis, and that the student is well-
informed in order to achieve “Exemplary” status.
Connections to Ethical Implications
Students should utilize resources such as the American Nurses
Association (ANA) website to look into Ethical Principles,
Scope of Practice, Code of Ethics, and Nursing Standards to
assist them in this area. To achieve “Exemplary” keen insight
needs to be included in this section.
Relevance
The Relevance portion is important because it shows how the
nursing issue impacts overall healthcare and direct patient care.
Again, a brief introduction to this portion is acceptable in this
paragraph. It is best to give an explanatory layout of what they
will be reading in the connections section.
Overall Healthcare Relevance
This is where the student connects the issue to healthcare on a
large scale. Often the issues can be seen on an organizational
level and even on a national level. This is where the
connections can be made to quality measures and financial
reimbursement for care. Another concern is nurse retention and
the cost of replacing nurses because of the nursing topic. This

is also a great area for adding statistical data that connects to
the nursing issue. Keen insight is important for “exemplary”
points.
Helpfulness or Hindrance to Patient Care
This section shows direct patient care effects of the nursing
issue. It is good to have data to support your statements in this
section. It is also good to make connections to the specific
ways that the topic affects patient care. Examples can include:
limiting time with patients, increase in mortality numbers, lack
of education for patients, and increase in readmissions.
Scholarly information is important to support statements in this
section. In order to achieve “Exemplary” in this section
detailed examples should be used.
Theoretical Connections
The theoretical connections seem to be the most difficult part of
the Final Project for many students. This is probably because it
is not tangible, theory is vague. It is a concept. This part
introduces the two conceptual models by title and explains that
they will be discussed below.
Theory One
This section introduces the first Conceptual Framework, or
Theory, that the student will discuss. A very brief overview of
the theory should be included along with the rationale for its
choice. To achieve “Exemplary” in this section examples have
to be provided that show a connection between the theory and
the nursing issue.
Theory Two: Secondary Theory

The second conceptual framework, or theory, is reviewed in this
area. A brief description should be provided long with
examples and support from the literature to explain its
appropriateness. The added insight the student provides will
give an “Exemplary” status.
Concluding Reflections
In most professional paper personal reflection is not included.
The NUR 300 Final Project does include personal insight in a
significant section. The student will discuss the findings of the
research and how it has, or will, impact their personal practice.
The key to this section is that while it is personal the statements
must be supported with scholarly evidence. First person may be
used in this section.
Many students find that the information they compiled while
doing the research for their chosen nursing issue is eye opening.
This is where students make connections between the nursing
issue and their personal nursing practice. They should support
their statements with good references information.
Final Conclusions
Many students forget that any good professional paper must
have an overall conclusion. This is when the sections are
mentioned in a brief review. Any final notes are reviewed, and
I recommend a review of the description of the issue and its
importance. .
References
American Psychological Association. (2010). Publication
manual of the American Psychological Association (6th ed.).
Washington, DC: Author.

Daresh, J. C. (2004). Beginning the assistant principalship: A
practical guide for new school administrators. Thousand Oaks,
CA: Corwin.
Herbst-Damm, K. L., & Kulik, J. A. (2005). Volunteer support,
marital status, and the survival times of terminally ill patients.
Health Psychology, 24, 225-229. doi:10.1037/0278-
6133.24.2.225
Pearce, P.F., Morgan, S., Matthews, J.H., Martin, D.M., Ross,
S.O., Rochin, E. & Welton, J.M.
(2018). The value of nurse staffing: ANA principles
redevelopment and direction for the
future. Nursing Economic$, 36(4), 169-176.
U.S. Department of Health and Human Services, National
Institutes of Health, National Heart, Lung, and Blood Institute.
(2003). Managing asthma: A guide for schools (NIH Publication
No. 02-2650). Retrieved from http://www.nhlbi.nih.gov/
health/prof/asthma/asth_sch.pdf
Young, C., White, M., & Dorrington, M. (2018). Nurse staffing
improvements through interprofessional strategic workforce
action planning. Nursing Economic$, 36(4), 163-194.
NUR 300 Final Project Guidelines and Rubric
Overview
The world of professional nursing practice and health policy is
ever evolving to meet the new dynamics of care needs in every
setting. As a registered nurse, you

are accountable and responsible for making decisions that are
consistent with safe, competent, and ethical practices on a daily
basis. You also face a variety of
complex issues that impact the delivery of your nursing care.
A professional practice issue is any issue or situation that either
compromises client care or service by placing a client at risk or
affects a nurse’s ability to provide
care or service consistent with standards and guidelines and
agencies’ and organizations’ policies or procedures.
The final project for this course is a formal written paper that
addresses a professional nursing practice issue of your
choosing, with your instructor’s approval.
You will use evidence-based, peer-reviewed journals and
professional databases to identify current literature about the
professional practice issue you choose.
In addition, you will use literature sources to identify a relevant
nursing conceptual framework (or model) that is relevant to the
nursing issue that you have
chosen. A summation of the literature will be provided.
Following this, you will write about the relationships that exist
between the literature review of the issue
and the current state of nursing practice. Conversely, you might
also write about points of contrast between the literature and the
actual state of nursing
practice. In concluding the paper, you should reiterate the
professional nursing practice issue and identify the most salient
points of the literature review. The
nursing framework will be briefly summarized in terms of how
it was related to the practice issue. Finally, you will be asked to
briefly reflect upon the writing and
identify whether or not the literature review provided support
for the issue. Implications of the research for your own practice
will complete the paper.

Outcomes
In this assignment, you will demonstrate your mastery of the
following course outcomes:
potential professional development opportunities
researching clinical practice issues
evidence-based clinical practice solutions
, and scope
of practice on professional nurses’ ability to deliver safe,
quality care
nursing practice for improving client care
Prompt
This project is a formal paper that addresses a professional
nursing practice issue of your choice (see the American
Association of Colleges of Nursing’s website
for topic ideas). You may also consider topics such as staffing
ratios, the merits of the BSN degree, delegation to unlicensed
assistive personnel, or the role of the
professional nurse in assisted suicide, with your instructor’s
approval. To cover the appropriate range of the research, you
should consider using between three
and five scholarly or professional sources that establish context
for your issue, literature review, legal and ethical implications,
relevance to nursing practice, and

your conclusion. For this assignment, use the Cumulative Index
to Nursing and Allied Health Literature (CINAHL) database and
Cochrane database to identify
current information on the topic. Current peer-reviewed,
scholarly journals may also be used.
Specifically, the following critical elements must be addressed:
I. Introduction
a) Identify your selected nursing practice issue.
b) Provide a brief explanation of why you selected it.
II. Literature Review: In order to cover the appropriate range of
the research, you should consider using between three and five
peer-reviewed journals
and/or scholarly or professional databases as your sources of
information.
a) Identify the current journals, databases, or other sources you
have chosen to serve as the basis of your paper.
b) Justify why you feel the sources you have chosen are the
most appropriate ones for your issue.
c) Discuss how you selected the research material from those
sources that most appropriately address your issue.
d) Summarize the information you have collected from your
research with regard to your issue. In other words, read your
chosen articles and
summarize what the authors are saying. Be sure to use proper
APA format for your citations.

III. Drawing Connections
a) Discuss the extent to which the literature supports the
professional issue. In other words, think about whether or not
the literature reflects the
current issue or problem. Does the literature agree or disagree?
In what way? Discuss what the authors are saying with regard to
the issue.
b) Analyze your issue in terms of its legal and ethical
implications. Be sure to provide specific examples to
substantiate your claims.
c) Assess your issue for its implications on professional
licensure.
IV. Relevance to Healthcare Delivery
a) Explain the relationship between your issue and overall
healthcare delivery.
b) Assess the extent to which your issue might improve or
hinder patient care. Be sure to provide current scholarly
evidence to support your
position.
V. Theoretical Foundations
a) Select a current conceptual framework that most
appropriately applies to your issue. What are the main points of
the conceptual model? How
do these points relate to your selected issue? Be sure to explain
your rationale behind your selection.
b) Suggest an alternative conceptual framework that might
appropriately apply to your issue, being sure to substantiate

your claims with specific
examples and research.
VI. Concluding Reflection
a) What impact do you feel the issue you selected might have on
your own practice as a professional nurse? Be sure to provide
current scholarly
evidence to support your position.
b) Discuss the ramifications of the issue you selected on your
own nursing licensure and practice. In other words, how would
this issue affect your
nursing license and your overall nursing practice if you
encountered it in your work?
c) How is healthcare delivery overall affected by your issue? In
other words, how does the issue that you chose affect healthcare
in general and
the delivery of quality healthcare?
Milestones
Milestone One: Identify a Topic
This milestone is due in Module Two. Identify a topic for the
final issue paper and propose one conceptual model that will
provide the framework for the issue
paper. This is a non-graded but required activity.
Milestone Two: Literature Review for the Issue Paper

This milestone is due in Module Three. For this milestone
assignment, you will submit a presentation that includes the
highlights of your literature review. This
milestone is graded with the Milestone Two Rubric.
Milestone Three: Drawing Connections and Relevance
This milestone is due in Module Four. This milestone
assignment focuses on the Drawing Connections and the
Relevance portions of the issue paper. This
milestone is graded with the Milestone Three Rubric.
Milestone Four: Theoretical Foundations and Conclusion
This milestone is due in Module Five. This milestone is graded
with the Milestone Four Rubric.
Final Project: Submit
The final project is due in Module Seven. This final project is
graded with the Final Project Rubric.
Final Project Rubric
Guidelines for Submission: Your paper should be between 5 and
7 pages in length, not including your cover page and references
page, and should be formatted
using Times New Roman, 12-point font, and one-inch margins.
All citations should be made using proper APA publication
format.
Instructor Feedback: This activity uses an integrated rubric in
Blackboard. Students can view instructor feedback in the Grade
Center. For more information,
review these instructions.
Critical Elements Exemplary (100%) Proficient (85%) Needs
Improvement (55%) Not Evident (0%) Value

Introduction: Issue Meets “Proficient” criteria and
uses industry-specific language to
establish expertise
Identifies, with precision, the
selected nursing practice issue
Identifies, generally, a selected
nursing practice issue
Does not identify selected
nursing practice issue
6
http://snhu-
media.snhu.edu/files/production_documentation/formatting/rubr
ic_feedback_instructions_student.pdf
Introduction:
Explanation
Meets “Proficient” criteria and
uses industry-specific language to
establish expertise
Clearly articulates rationale for
issue selection
Articulates rationale for issue
selection but with gaps in clarity
Does not provide an explanation

for issue selection
6
Literature Review:
Sources
offers insightful review of
sources from professional
databases and how they are
appropriate to the chosen issue
Identifies current journals,
databases, or other sources
appropriate to selected issue
Identifies journals, databases, or
other sources, but they are not
current or are not appropriate to
selected issue
Does not identify journals,
databases, or other sources
4.5
Literature Review:
Appropriate
offers insightful explanation of
the appropriateness of selected
sources
Accurately justifies

appropriateness of selected
professional sources
Justifies appropriateness of
selected professional sources but
with gaps in accuracy
Does not justify appropriateness
of selected sources
4.5
Literature Review:
Selected
offers keen insight into rationale
for the selection criteria
Discusses selection criteria for
research material appropriate to
selected issue
Discusses selection criteria for
research material, but with gaps
in detail or relevancy
Does not discuss selection
criteria for research material
4.5
Literature Review:
Summarize

offers professional commentary
about the information collected
from research
Accurately summarizes
information collected from
research with regard to selected
issue
Summarizes information
collected from research with
regard to selected issue, but with
limited summations and gaps in
detail
Does not summarize information
collected from research
4.5
Connections:
Supports
draws insightful connections
between literature and the issue
Comprehensively discusses the
extent to which the literature
supports the issue
Discusses the extent to which the
literature supports the issue, but
with gaps in detail
Does not discuss the extent to

which the literature supports the
issue
6
Connections: Legal
and Ethical
Meets “Proficient” criteria, and
analysis is exceptionally clear and
well-informed
Comprehensively analyzes the
issue in terms of legal and ethical
implications
Analyzes the issue in terms of
legal and ethical implications, but
with gaps in detail
Does not analyze the issue in
terms of legal and ethical
implications
6
Connections:
Licensure
offers professional insights about
the implications for licensure
Comprehensively assesses the
issue for its implications on
licensure

Assesses the issue for its
implications on licensure, but
with gaps in detail
Does not assess the issue for its
implications on licensure
6
Relevance:
Relationship
between the issue and
healthcare delivery
Explains the relationship
between the issue and overall
healthcare delivery
Explains the relationship
healthcare delivery, but with
gaps in detail or accuracy
Does not explain the relationship
healthcare delivery
6
Relevance: Patient
Care

provides detailed examples of
how the issue will improve or
hinder patient care
Assesses the extent to which the
issue might improve or hinder
patient care and provides current
scholarly evidence to support
position
Assesses the extent to which the
issue might improve or hinder
patient care, but does not
provide current scholarly
evidence to support position
Does not assess the extent to
which the issue might improve or
hinder patient care
6
Theoretical: Current
Framework
how the framework applies to
the issue
Selects a current conceptual
framework appropriate to the

issue and explains rationale
behind selection
Selects a conceptual framework,
but it is not current , is not
appropriate to the issue, or does
not explain rationale behind
selection
Does not select a conceptual
framework that applies to the
issue
6
Theoretical:
Alternative
Framework
how the framework applies to
the issue
Suggests an alternative
conceptual framework
appropriate to the issue and
substantiates claims with specific
examples and research
Suggests an alternative
conceptual framework that is not
appropriate to the issue, or does
not substantiate claims with
specific examples and research

Does not suggest an alternative
conceptual framework
6
Concluding
Reflection: Own
Practice
offers keen insights from the
literature and professional
practice concerning the impact of
the issue
Discusses impact of issue on own
practice as professional nurse
and provides current scholarly
evidence to support position
Discusses impact of issue on own
practice as professional nurse,
but provides evidence that is not
current, is not scholarly, or does
not provide evidence
Does not discuss impact of issue
on own practice as professional
nurse
6
Concluding
Reflection: Licensure

offers keen insights from the
literature and professional
practice concerning the impact of
the issue
Accurately articulates the
ramifications of the issue on
one’s own nursing licensure and
practice
Articulates the ramifications of
the issue on one’s own nursing
licensure and practice, but with
gaps in accuracy and description
Does not articulate the
ramifications of the issue on
one’s own nursing licensure and
practice
6
Concluding
Reflection:
Healthcare Delivery
healthcare delivery
Accurately discusses how
healthcare delivery overall is
affected by the issue

Discusses how healthcare
delivery overall is affected by the
issue but with gaps in accuracy
Does not discuss how healthcare
delivery overall is affected by the
issue
6
Articulation of
Response
Submission is free of errors
related to citations, grammar,
spelling, syntax, and organization
and is presented in a professional
and easy-to-read format
Submission has no major errors
spelling, syntax, or organization
Submission has major errors
that negatively impact readability
and articulation of main ideas
Submission has critical errors
that prevent understanding of
ideas

10
Earned Total 100%
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NUR 300 FINAL PROJECT
Milestone 4: Theoretical Foundations and Conclusion
Professions such as nursing are based on distinctive theories.
Kearney-Nunnery (2016) defined theory as “a set of interrelated
constructs (concepts), definitions, and propositions that present
a systematic view of phenomena by specifying relations among
variables, with the purpose of explaining and predicting the
phenomena” (p. 20). Nursing theories affect everyday nursing
practice. Ideally, nursing theories serve to provide a foundation
to nursing care in every patient encounter. They help nurses
improve their thought process and comprehension and use
critical thinking and decision-making skills that are
concentrated on the patient. Furthermore, nursing theories
improve patient care, patient outcomes, nurse-patient
communication and communication between all healthcare
providers.
Through the use of nursing theories in practice, new knowledge
and data are obtained influencing the future of nursing practice.

Two theorists whose framework preserves the heritage of these
principals are Myra Levine and Imogene King. However, as
most health care systems around the world are changing, nurses
are challenged with abiding by these principals, as we expose
ourselves to the risk of desensitizing patient care as the
responsibilities and workloads for nurses have intensified.
Nurses must now deal with patients’ increased awareness and
complications in regard to their health care situation.
Theory One
Imogene King developed the theory of Goal Attainment in 1981.
King’s Conceptual System focuses on the continuing ability of
the individuals to meet their basic needs so that they may
function in their socially defined roles (Keanery-Nunnery, 2016,
p. 36). Here, King theorizes that individuals are goal seeking
within the framework of a three open, dynamic, interacting
system – the personal system, the interpersonal system, and the
social system. Within this system, King developed a ten step
Interaction-Transaction Process that was essential in her theory
of Goal Attainment. This included perception, judgment, action,
reaction, disturbance, mutual goal setting, exploration of means
to achieve goals, agreement on means to achieve goals,
transaction and attainment of goals. As Keanery-Nunnery
(2016) states under King’s theory of practice, “nursing practice
is directed toward helping individuals maintain their health so
that they can function in their roles” (p. 36). A nurse cannot
properly uphold this framework with the continuous arising
issues of decreased nurse retention. Decreased Nurse retention
may inhibit a nurse's ability to meet basic needs, such as
sleeping, eating and having a break to reduce stress level. It can
also have adverse outcomes for nurses; many of these are
fatigue-related - for example, nurses working short staffed are
found to be at increased risk of occupational hazards,
potentially harming patients causing staff injuries amongst
themselves.

Theory Two
Myra Levine’s Conservational Model of nursing practice is
directed toward promoting wholeness for all people, well or
sick and focuses on conservation of the person’s wholeness.
According to Kearney-Nunnery (2016) her theory outlines that,
“Adaptation is the process by which people maintain their
wholeness or integrity as they respond to environmental
challenges and become congruent with the environment” (p.37).
In order to maintain wholeness and adapt to environmental
changes, an individual must respond to the challenges using
Levine’s four essential integrated principals that constitute an
organismic response: fight-or-flight mechanism, inflammatory-
immune response, stress response and perceptual awareness,
which includes the basic orienting, haptic, auditory, visual, and
taste-smell systems. Levine’s goal is for “nurse’s to end the
dependence as quickly as possible, as patients are partners or
participants in nursing care and are temporarily dependent on
nurses” (p. 38). As Levine’s Model guides the nurse to focus on
the influences and responses at the organismic level and
accomplish the goal of model through the conservation of
energy, structure and personal and social integrity, the issue of
decreased nurse retention may obstruct that. If a nurse fails to
adapt to continuous low nurse retentions, this hinders their
ability to meet the patients’ needs. As the nurse isn’t effective
due to matters like burn out, errors like incorrect judgments or
assessments can occur and patient outcomes suffer.
Concluding Reflections
Working in long-term care, a nurse can be responsible for an
average of twenty-two patients to forty-five patients depending
on the unit one’s working on. This is very taxing and
overwhelming for a nurse to manage. Between medication
administrations, prescribed treatments, admitting and
discharging patients, and simply providing basic care, the
workload intensifies and it can be easy for errors to occur at any

moment. This also in turn creates job dissatisfaction, which is
another factor that is behind increased nurse turnover. With
decreased patient load, good leadership, proper collaboration
and communication, the stress level of a nurse would be at a
minimum, hence improving nurse retention, allowing for nurses
to practice to the best of their ability and improving patient
outcomes.
Final Conclusions
Nursing theories can be helpful at all stages of the nursing
process and may guide a nurse to perform specific actions or
make certain decisions during patient care. As matters such as
decreased nurse retention continues to arise, in researching
King’s and Levine’s conceptual and conservational theories, I
am able to see the practicality and application of the theory.
Despite such hardships, nurses must find ways to preserve their
caring practice and Myra Levine and Imogene King’s
conceptual and conservational theories can be seen as
indispensable to this goal.
References
Mcqueen, L., Cockroft, M., & Mullins, N. (2017). Imogene
Kings Theory of Goal Attainment
and the Millennial Nurse: An Important Mentoring Tool for
Nurse Educators. Teaching and Learning in Nursing, 12(3), 223-
225. doi:10.1016/j.teln.2017.03.003
Kearney-Nunnery, R. (2016). Advancing your career: Concepts
of professional nursing.
Philadelphia: F.A. Davis Company.
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Running head: NUR-300 FINAL PROJECT 7

Drawing Connections and Relevance
Connections
There are common themes that support the reasons and the
costs behind the overwhelming statistics regarding increased
nurse turnover and unsteady nurse retention. Outside of
individual factors—such as age and level of education—that
cause nurses to leave their organization or the profession
altogether, the common factor that is behind increased nurse
turnover is a lack of job satisfaction. Nurses are dissatisfied
with the social work environment of the organizations they
work with. This environment is defined by a lack of good
leadership, a lack of proper collaboration and communication,
and burnout stress due to the physical demands necessary
because of scheduling issues and inadequate staffing.
Connections to the Literature
To promote positive change in nurse retention, organizations
should consider employing a mentorship program to combat the
feeling of being without support that nurses often feel within
the profession. Mentoring is beneficial for both new nurses and
experienced nurses. Experienced nurses are granted the
opportunity to hone their leadership skills, build professional
relationships and develop stronger problem-solving skills. New
nurses, when paired with a mentor, are allowed the room to
build confidence, competence and develop the skills that will
assist them in transitioning into their new position, thus,
increasing job satisfaction and nurse retention. (Ennis,
Broadbent, Happell and Reid-Searl, 2013; Schroyer, Zeller &

Abraham, 2016).
Connections to Legal and Licensure Implications
For all health care professionals, licensed by the state, laws and
regulations are set in place defining their scope of practice. In
keeping with the terms of the nursing professional license, the
American Nurses Association (ANA) has clearly defined the
scope and standards of nursing practice as a guideline for
delivering quality patient care (2010). The scope of practice of
nurses can also be defined by hospital policies and procedures.
If a nurse does not meet the accepted standards of practice, he
or she may be accused of violating a standard of care or found
negligent if his or her negligence caused a patient harm, also
referred to as malpractice in the medical profession.
Some might argue that nurses continue to perpetuate this
potential of "losing our license" to justify being overly cautious
and engrain this culture of anxiety and fear regarding licensure
for generations to come. But the fact remains that patients value
nurses and can recognize a workforce that is demoralized as
result of inadequate staffing or other professional issues. In
healthcare, where our consumers are often sick, exhausted, and
in pain, they do not deserve to hear that someone is too busy for
them, nor do they need to sense that they are being shirked of
high-quality care. The Shirley Keck v. Wesley Medical Center
case is one in which a 63-year-old woman was admitted to a
hospital for pneumonia, found brain damaged prior to her
discharge, requires 24-hour care, and settled with the hospital
for $2.7 million. It was reported that the failure to appropriately
monitor the level of oxygen, per the nurse (plaintiff) was due to
the hospital being high understaffed.
In 1999, California passed legislation mandating patient-to-
nurse ratios for its hospitals, which went into effect in July
2003. The California legislation was motivated by an increasing
hospital nursing shortage and the observation that lower nurse
retention in hospital practice was related to burdensome
workloads and high levels of job-related burnout and job
dissatisfaction. One year after the establishment of the nursing

law, Aiken, Clarke, and Sloane (2002) noted that California
reported their nurse-license rate grew by more than 60%
compared to other states.
Connections to Ethical Implications
Ethics is an integral part of the foundation of nursing. The Code
of Ethics for Nurses was developed by the ANA which
established the ethical standard for the profession and provided
a guide for nurses, including primary goals, values and
obligations to use in ethical analysis and decision-making
(ANA, 2010b), Maintaining safe care is the first ethical and
legal duty of any hospital, and of all health professionals.
However, due to insufficiency of staffing, many nurses find it
difficult to carry out their obligations, creating an ethical
dilemma, whereby one must choose between caring for their
own welfare or the needs of their patients. One ethical
obligation nurses are to fulfill during their daily duties involves
ensuring they protect patients from any harm (ANA, 2010b).
Nonetheless, factors such as moral distress, burnout and
decrease in job satisfaction compromise that ethical
responsibility, creating poor quality of care.
Relevance
Healthcare organizations require a stable, well-trained, and
fully-engaged nursing staff to provide effective levels of patient
care but the challenges of nurse turnover pose a threat to this
foundation. The costs and consequences of burnout and turnover
are significant and raise several implications for health-care
delivery. While research fails to indicate significant
correlations, it is worth mentioning that nursing turnover has
tremendous impact on the quality of care and patient outcomes
in addition to creating a financial burden for the institution. A
healthcare implication worth examining in depth are the reasons
why nurses are leaving health care organizations or the
profession altogether.
Overall Healthcare Relevance

Brewer et al. (2011) estimated the costs of newly licensed RN
turnover to be $856 million for organizations and to range
between $1.4 and $2.1 billion for society. In as the financial
implications are worth mentioning, as aforementioned, it is
crucial to understand the reasons behind nursing turnover. One
study associated health-related factors such as disability or
illness from work-related injuries, and high physical demands to
reasons for leaving the job or profession (Mazurenko, Gupte, &
Shan, 2015). This very study also corroborated previous
research that dissatisfaction, high stress levels, leadership
compensation, and opportunity for advancement influences
nurses’ decision to leave an organization.
Helpfulness or Hindrance to Patient Care
Despite the dearth of information on the correlation between
nurse turnover and patient care, one study has found that
“Instead of RN staffing, job satisfaction might be a potential
mediator for the relationship between RN turnover and patient
outcomes because high turnover on a unit can lead to low job
satisfaction of the remaining staff, resulting in poorer patient
outcomes” (Park et al., 2014, p. 1219). The study specifically
used the incidences of unit acquired pressure ulcers (UAPU) to
determine that while RN staffing might not exactly be the
mediator between nurse turnovers and UAPUs, better outcomes
of UAPUs on units can be achieved through organizational
efforts to maintain stability within a workforce (Park, 2014).
References
American Nurses Association. (2010a). Nursing: Scope and
standards of practice (2nd ed.). Silver Spring, MD: Author.

American Nurses Association. (2010b). Code of ethics for
nurses with interpretive statements. Silver Spring, MD: ANA,
American Nurses Association.
Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH.
(2002). Hospital Nurse Staffing and Patient Mortality, Nurse
Burnout, and Job Dissatisfaction. (16):
doi:10.1001/jama.288.16.1987
Brewer C.S., Kovner C.T., Greene W., Tukov-Shuser M. &
Djukic M. (2011) Predictors of actual nurse turnover in a
national sample of newly licensed registered nurses employed in
hospitals. Journal of Advanced Nursing 68 (3), 521–538.
Mazurenko, O., Gupte, G., & Shan, G. (2015). Analyzing US
nurse turnover: Are nurses leaving their jobs or the profession
itself. Journal of Hospital Administration, 4(4), 48-56.
https://doi.org/10.5430/jha.v4n4p48
Park, S. H., Boyle, D. K., Bergquist-Beringer, S., Staggs, V. S.,
& Dunton, N. E. (2014). Concurrent and lagged effects of
registered nurse turnover and staffing on unit-acquired pressure
ulcers. Health services research, 49(4), 1205–1225.
doi:10.1111/1475-6773.12158
Shirley Keck v. Wesley Medical Center, (Sedwick County (KS)
District Court, Case No. 99C2307, 2000)
Running head: LITERATURE REVIEW
1
LITERATURE REVIEW 2

Literature Review
Literature Review
There’s an ongoing instability in the nursing workforce of nurse
retention that is a problem experienced worldwide. Left
unresolved could have a serious impact on the foundation of
quality health care. The purpose of this paper is to explore the
reasons for low nurse retention, to acknowledge its effects on
patient care quality, and to present strategies to combat this
professional issue. A systematic and comprehensive literature
review of data was undertaken retrieving articles from the
Shapiro Library using several electronic databases including
CINAHL, Ovid, PubMed, Google and Google Scholar. The key
words used for the terms searched were “nurse retention,”
“turnover,” “nurse mentors,” and “communication.” The
limiting factors were that the work was peer reviewed and the
search resulted in articles published from 2011 to 2017.
Article One
The article, “Analyzing U.S. nurse turnover: Are nurses
leaving their jobs or the profession itself?” was published by
Mazurenko, Gupte and Shan (2015). Their objective was to
assess and compare amongst registered nurses (RN), factors
associated with making the decision to vacate a job
(organizational turnover) versus leaving the profession
(professional turnover). This article suggests that a number of
individual, organizational and environmental factors were
associated with an RN’s decision to leave an organization and
the profession. RN’s who left an organization or profession,
“Were dissatisfied with their jobs due to factors such as

(burnout, stress, physical demands, disability, illness, lack of
good leadership, lack of collaboration, scheduling issues,
inadequate staffing, lack of advancement opportunities, better
pay benefits, age, marital status, level of education,
race/ethnicity, geographical location, and previous place of
work). Job satisfaction can be defined as the extent to which an
employee likes his or her job and has been consistently
associated with the intent to leave and actual organizational
turnover (Mazurenko, Gupte and Shan, 2015).
Job dissatisfaction is essentially very important as it results in a
decrease of nurse retention. The authors collected a data
analysis survey on RN’s who either left the organization to
work in a different health care setting or left the profession in
total. Their findings revealed a total 62.4 percent of nurses who
left the organization and the profession altogether. According to
(Mazurenko, Gupte and Shan, 2015), “Approximately 14 percent
(4,682) of RNs left the profession and 14 percent left their
organization (4,114) from a total sample size of 36,646” related
to the factors mentioned above. This article is important
because it gives understanding as to why RNs are leaving health
care organizations or the profession altogether.
Article Two
Lin (2013) published a review of literature in the article,
“The impact of nurse staffing on quality of patient care in acute
care settings: An integrative review paper.” The objective of
this study was to examine the relationship between nurse
staffing and quality of care in acute care settings. Twelve
measurable studies were included in this review focusing on
acute care in the adult setting. Although two studies found no
significant association between nurse staffing and quality of
patient care, the remaining ten studies proposed that higher
staffing level and higher level of RN skill is associated with
improved patient outcomes. According to Lin, (2013), the
studies, “concluded that hospitals with lower levels of nursing
staff encountered a 7% increase in 30-day mortality and a 7%

increase in failure-to-rescue.” This finding was supported by
another study performed by Zhu et al. in 2012, which
established that when nurse-to-patient ratio decreased, patient
outcomes were significantly deteriorated. Turnover within
hospitals can compromise organizational functioning, continuity
of care, and provision of evidence-based treatment (Lin, 2013),
thus leading to poor quality of service and client outcomes. The
significance of this article is that it supports the issue of low
nurse retention affecting patient quality of care.
Article Three
published a review of literature in their article,
“The Importance of Communication for Clinical Leaders
in Mental Health Nursing: The Perspective of Nurses
Working in Mental Health.” Their objective of the study
explored the attributes and characteristics required for
effective clinical leadership in mental health nursing,
specifically the views of nurses working in mental health and
the importance of effective communication in day to
day clinical leadership.
"Leaders should have the insight and knowledge to identify
aspects in the workforce that threaten the overall function and
strength of the organization. Values that strengthen cohesion in
a work force include effective communication, teamwork and
collaboration. Communication in nursing is essential but for
nursing leadership in mental health settings it is pivotal for
working relationships, retention of staff, improved patient
outcomes, and the development of our profession (Ennis,
Happell, Broadbent and Reid-Searl, 2013).
Effective teamwork and collaboration is essential in a
healthcare setting, especially in stressful settings, such as the
ER, Psych unit or ICU. Nurses and other healthcare providers
rely on each other within the team to provide care and in pursuit
of optimal patient outcome. According to Ennis, Happell,
Broadbent and Reid-Searl, “teamwork can be fostered in an
environment that acknowledges the values, talents, and work
ethics of each generational cohort. However, when team

members do not respect and value one another’s generational
differences, conflict, distress, and incivility are unavoidable.”
(2013). The significance of this article is to demonstrate that
effective communication, an attribute of
effective clinical leadership is considered important and
essential for successful working relationships, improved
learning experiences and overall helped combat the issue of
nurse retention and motivate employees to stay with an
organization or within the nursing profession, especially in the
mental health setting.
Article Four
Schroyer, Zeller and Abraham (2016) produced an important
review titled, “Increasing Registered Nurse Retention Using
Mentors in Critical Care Services.” The objective of their study
focused on retention rates after the implementation of a
mentorship program for RNs entering a specialty unit within
critical care service. Their study covered five years and
eighteen hospitals, targeting nurses who were new graduates,
re-entry nurses, and nurses new to the critical care specialty.
According to Schroyer, Zeller and Abraham (2016), “The
retention rate of nurses with a mentor was 91%, a significant
increase from 66% for the not-mentored group” hence proving
that nurses are retained when a mentor program is used. This
study indicated an increase in retention when a mentor was used
with a new graduate or a nurse new to the critical care service
specialty. Increasing RN retention creates an environment of
stability, fosters teamwork, builds confidence, and increases
patient satisfaction (Schroyer, Zeller and Abraham 2016). This
article is important because it supports the fact that introducing
mentorship programs within the nursing field decreases nurses’
intent to leave their workplace and the subsequent
organizational turnover.
References
Aarons, G. A., Sommerfeld, D. H., & Willging, C. E. (2011).
The Soft Underbelly of System

Change: The Role of Leadership and Organizational Climate in
Turnover during
Statewide Behavioral Health Reform. Psychological
Services, 8(4), 269-281.
nurse turnover: Are nurses leaving
their jobs or the profession itself. Journal of Hospital
Administration, 4(4), 48-56.
Schroyer, C. C., Zellers, R., & Abraham, S. (2016). Increasing
registered nurse retention using
mentors in critical care services. The health care
manager, 35(3), 251-265
Yoder-Wise, P. S. (2015). Leading and managing in
nursing (6th ed.). St. Louis, MO: Mosby,
Inc., an affiliate of Elsevier Inc.
Ennis, G., Happell, B., Broadbent, M., & Reid-Searl, K. (2013).
The importance of
communication for clinical leaders in mental health nursing: the
perspective of nurses working in mental health. Issues in mental
health nursing, 34(11), 814-
819.doi.org/10.3109/01612840.2013.829539
Chin How Lin. (2013). The impact of nurse staffing on quality
of patient care in acute care
settings: An integrative review paper. Singapore Nursing
Journal, 40(4), 10–23.
Running head: NURSE RETENTION
1
NURSE RETENTION 3

Nurse Retention
Nurse Retention
Employee retention is a critical professional issue faced by
nursing leadership today and reasons for low retention vary
across the continuum. Some nurses graduate and begin their
career only to determine the profession is not what they thought
it would be. Others may experience burnout and subsequently
leave the profession. In the first year, an estimated 35 % to 60%
of new graduate nurses will leave the profession (Schroyer,
Zellers & Abraham, 2016). Other sources state that “the current
United States (U.S.) nurse turnover rate is 16.5% and is
projected to increase over the next decade” (Mazurenko, Gupte,
& Shan, 2015, p.48). The figures may seem insignificant at face
value however low nurse retention is fiscally and professionally
expensive and has potentially adverse effect on patient-care
quality.
The purpose of this paper is threefold- to explore the reasons
for low nurse retention, to acknowledge its effects on patient
care quality, and to present strategies to combat this
professional issue. Aarons, Sommerfeld, and Willging (2011)
suggested that recognizing organizational factors as well as
adjustable aspects of a workforce that predict employee
turnover is a strategy to improve leadership and retention.
Whether it is a matter of expectations not being met or dreams
turning into disappointment, nursing leadership is tasked with
uncovering the reasons for low retention for the sake of the
development of the nursing profession. One leader attribute as
noted by Yoder-Wise (2015) is the ability to “see possibilities
in the midst of challenging, often complex, uncharted, or even
dire circumstances” (p.4). Leaders should have the insight and
knowledge to identify aspects in the workforce that represent as

threats to the overall function and strength of the organization.
References
Aarons, G. A., Sommerfeld, D. H., & Willging, C. E. (2011).
The Soft Underbelly of System
Change: The Role of Leadership and Organizational Climate in
Turnover during Statewide Behavioral Health
Reform. Psychological Services, 8(4), 269-281.
nurse turnover: Are nurses leaving
their jobs or the profession itself. Journal of Hospital
Administration, 4(4), 48-56.
Schroyer, C. C., Zellers, R., & Abraham, S. (2016). Increasing
registered nurse retention using mentors in critical care
services. The health care manager, 35(3), 251-265
Yoder-Wise, P. S. (2015). Leading and managing in
nursing (6th ed.). St. Louis, MO: Mosby,
Inc., an affiliate of Elsevier Inc.

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