The Impact of the Nurse Manager Leadership Rounding: A Transformational Leadership Strategy on Nurse Retention Rate

Purpose: The purpose of the evidence-based practice project was to improve retention of experienced nurses within a large, urban academic hospital.

Description: A project team of two nurse managers formed to improve the retention rate of experienced nurses. Baseline turnover rate for nurses with greater than 1 year of experience at our tertiary academic medical center with two campuses was 17.5% at the downtown campus and 18.4% at the midtown campus. Using the Johns Hopkins nursing evidence-based practice model, we critically appraised 16 level III and V articles on retention strategies retrieved from Ovid MEDLINE and PubMed. Available evidence indicated that transformational leadership style from local nurse leaders is associated with low staff turnover and increased nurse satisfaction among experienced nurses. Our hospital promoted transformation leadership strategies, but resources were not standardized.

After receiving not human subjects research determination, the project team distributed standardized leadership rounding tools (e.g., preparation checklist, leadership rounding log, and spotlight report and communication resources) to managers and assistant nurse managers in the surgery division and ambulatory care divisions. Education and training on how to use the tools within current policies, processes, and structures were provided. Nurse leaders in these divisions completed rounding on their employees monthly. The project team served as a resource to leaders, with bi-weekly scheduled sessions to discuss implementation barriers, share best practices, and provide positive reinforcement and support. The project team built an electronic tracking dashboard and surveyed nurse leader perception of transformation leadership using the validated questionnaire on self-perception of nurses in exercising leadership before and after to monitor the impact of the project.

Outcome: 16 ambulatory care clinics and 7 inpatient units participated in the project, most at the downtown campus. Managers completed 158 employee rounds and 155 stoplight reports during the eight-week implementation period. After the implementation period, experienced nurse turnover rate decreased to 16.6% at downtown, but increased to 20.7% at midtown, which may reflect less unit participation. However, managers perception of how often they engaged in skills that are related to transformational leadership significantly increased (mean (SD) pre=43.9 (8.0) post=51.1 (3.5), p=0.011). Managers also voiced that the standardized transformational leadership tools and training helped to improve relationship building and trust, which are important characteristics of transformational leaders.