Date of Award

Spring 4-5-2020

Document Type

Scholarly Project

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Amy Hite, DNP, FNP-BC, ONC

Second Advisor

Marci Newcome, DNP, APRN, CNP

Third Advisor

Barbara McClaskey, PhD, APRN, RNC

Fourth Advisor

Pawan Kahol, Ph. D


Cardiovascular Surgery Practice Remodel: Increasing Job Satisfaction and Reducing Turnover Rates of Advanced Practice Providers

Background: The CVS practice in a Midwestern state had a shift in morale and job satisfaction in their advanced practice providers (APPs). This shift lead to the high turnover rate of 35% in 2018. In an effort to bring a halt to the high turnover rate, and to continue the excellent patient care for which the hospital is known, hospital administration became involved and set up a committee to guide the development of a new CVS APP practice model. The goal was to develop a practice model that allowed the continuation of excellent patient care, with APP job satisfaction and role clarity, and lower the turnover in the department of CVS.

Purpose: APP’s turnover rates are at a record high not only for the CVS department, but they are also high across the nation. The goal of this research study is to assess the job satisfaction and turnover rate of CVS APPs before and after the implementation of the new practice model. The goal of the new practice model would be improved job satisfaction and low to no turnover after its implementation.

Methods: The APP job satisfaction and retention rates were compared before and after the implementation of the new practice model. All CVS APP staff members were included in the study by default as all staff members were sent the Sirota survey and all staff was included in the retention and turnover rates. Turnover rates and job satisfaction were analyzed using a paired sample comparison.

Discussion: Suggestions would be to send more specific surveys to the APPs to determine more specifically if the satisfaction was due to the practice model change or the difference in year to year satisfaction. The data collection will continue every 3-6 months after this scholarly project completion to continue workflow adjustments as necessary.

Limitations: The study and data collection are lacking as it was limited to only nine months after the implementation of the new practice model. The inpatient APPs also worked understaffed throughout the study and still had seven APP openings at the end of 2019. There were two unexpected interdepartmental transfers when new positions in the hospital opened that held special interest to some of the APP staff. The inpatient APPs did not have an opportunity within this study timeframe to work in fully staffed conditions and this may have contributed to APP burnout and frustration.

Results: The turnover rates decreased from 35% to 8% in one year and the job satisfaction rates increased from 83% to 94% for the inpatient providers and from 83% to 100% for in outpatient providers. The work culture also increased for both groups with the inpatient providers work culture increasing from 68% to 84% and increasing in the outpatient providers from 50% to 89%. These increases are significant and demonstrate the positive impact of the practice remodel revision.