Date Available


Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Karen Butler

Clinical Mentor

Dr. Melissa Winter

Committee Member

Dr. Karen Stefaniak



Background: Unmitigated stress in nursing results in moral distress, burnout, turnover and poor patient outcomes. Authentic leaders can improve the nurses’ work environment and satisfaction by improving communication and implementing supportive measures.

Purpose: The purpose of this study was to determine whether a change in executive leadership at BSW Grapevine Medical Center reduced nursing job stress as evidenced by improved nurse satisfaction, nurse retention, nurse engagement, patient satisfaction and care outcomes.

Conceptual Framework: Watson’s Theory of Human Caring

Design: This study is a quantitative, descriptive retrospective measurement of two points in time, before and after a leadership change. All data collected was aggregate and anonymous. Data collected included: HAI SIR, HCAHPS, RN voluntary retention rates, People and Pulse Survey engagement and participation scores, NDNQI survey response data.

Results: Environmental and cultural changes implemented by the change in executive nurse leadership at BSW Grapevine had positive associations with nurse satisfaction, nurse engagement and patient satisfaction scores. There was no evidence supporting an association with patient care outcomes or voluntary RN retention rates.

Conclusion: Authentic leaders can implement certain measures to improve the overall culture of the work environment, directly improving nurse satisfaction and nurse engagement. A healthy work environment, combined with satisfied nurses, results in improved patient satisfaction scores.