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Develop a 12-15 slide PowerPoint presentation that covers all major areas of your assignment.  Be sure to address the following: Site/organization Needs assessm


Develop a 12-15 slide PowerPoint presentation that covers all major areas of your assignment. 

Be sure to address the following:

Needs assessment results
Project topic
Project goals
Project outcome (or anticipated outcome if not implemented)

How was your project received by stakeholders? (It was thought of as a good idea, likely a good project, but would also be costly – around 500k or more to develop, take 18 to 24 months, and would replace the current workers so they don’t want to push or support this do that right now). 

If you implemented your project, how will it be sustained? If it is not sustainable, how will the one-time implementation make a difference? (It is software, and would be sustained through regular software updates and making sure it stays up with or ahead of other similar software competitors. The development is of course a one-time thing, then just normal updates). 

If you did not implement your project, how did you perform a hand-off for the next steps? (There was no hand-off, the company will not go to implement this, so the research, the presentation, and the data will stay with me until I find the right company or right investors). 

Ultimately, what did you learn from this project? (I learned that hospitals and clinics are losing money, there is a need for proper billing, AI would be superior to human coders, and AI is advancing, and those who do not embrace it will likely run the risk of being replaced by it). 

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center. Use at least 4-5 peer-reviewed articles for the assignment (Likely many of the same from the previous assignment). Make sure to include detailed speaker notes. 

This assignment uses a rubric. Please review the rubric before beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance. 


The Nursing Shortage in Texas: A Comprehensive Evidence-Based Solution

Analysis By Michael McDonald

Problem Description

The nursing shortage in Texas is an ever-increasing critical problem.

The nursing shortage impacts both healthcare quality and overall safety.

The primary drivers of the nursing shortage are as follows:

Toxic leadership

Aging population/Increase in patients

Lack of stress management tools

Lack of retention incentives vs new hire incentives

Increased registered nurse staffing reduced hospital-related mortality, failure to rescue, and duration of stay. Baccalaureate-prepared nurses are few, limiting health care quality and patient outcomes. Due to overwork and poor nurse-to-patient ratios, and toxic working environments, many nurses quit the field, causing even more shortages. This underlies the nursing problem. The newest study shows that this shortage has been decreasing healthcare quality and safety for decades and will continue to do so as the population grows and the most important generations age. New hire incentives also take experienced nurses away from their current facility (Adams et al., 2019, pp. 452-456; Kelly et al., 2021, pp. 96-102; Reinhardt et al., 2020, pp. 151-216).


Problem Description Continued

Higher stress equals higher turnover rates.

Stress management plays a critical role in nurse retention.

Monetary incentives reduce and prevent shortages:

Tuition reimbursement/continuing education grants

Yearly Retention Bonuses

Organizations offering stress reduction with retention incentives save money while reducing turnovers and shortages.

Eliminating unnecessary stress along with reducing or managing the normal stress associated with nursing has an impact on burnout and turnover rates. Organizations have found success through the use of educational benefits like tuition reimbursement and also implementing retention bonuses as part of the compensation plan (Hekel et al., 2021, pp. 30-34; Woodward & Willgerodt, 2022, pp. 664-668).


Research Support

Only Peer-Reviewed research and studies are used for data.

Multiple studies indicate that the shortage in Texas is critical.

Research shows it has a negative impact on quality and safety.

Studies show the shortage is driven primarily by toxicity, stress, and lack of retention incentives as well as an aging population.

Multiple research reveals evidence-based practices that are effective in combating the shortages.

Data from trusted peer-reviewed scientific articles must be gathered, processed, and evaluated to address problems. Evidence-based research is one of the finest approaches to uncover healthcare answers. Retention bonuses, tuition reimbursement, and minimizing working stress have reduced turnover and shortages. Several scientific publications explain Texas’s high turnover and nursing shortages. Many of these studies provide insight about the causes and successful strategies in combating the nursing shortages (Hudgins et al., 2022, pp. 88-92; Redfearn et al., 2020, pp. 370-379; Thompson et al., 2021, pp. 78-85).


Research Support Cont.

Evidence shows that eliminating Toxicity reduces turnover.

Providing nurses with tools for stress management is another effective method of reducing stress.

Several research studies have established the costs of shortages and how much is saved through retention.

Retention bonuses and education benefits are proven practices for reducing and preventing nursing shortages.

These studies and reports used similar studies that had previously been conducted under comparable restrictions and intended objectives to extract the data needed to prove that Texas has a nursing shortage that is exacerbated by high turnover rates due to several factors (Hudgins et al., 2022, pp. 88-92; Reinhardt et al., 2020, pp. 151-216). These statistical analyses will also show that retention bonuses, tuition reimbursement, continuous education perks, and stress reduction will reduce the nurse shortage.


Proposed Solution

Organizations without shortages often offer stress management tools or retention and education benefits.

Eliminating workplace toxicity reduces turnover, a key metric in nursing shortages.

Organizations that offer retention bonuses and education benefits along with stress reduction often eliminate nursing shortages.

Workplace stress reduction, annual retention bonuses, and college debt repayment or continuing education tuition and grant programs perform best. These methods have reduced turnover and shortages and helped organizations refocus on excellent care for Texas and other areas (Reinhardt et al., 2020, pp. 151-216).


Proposed Solution Cont.

Given the Data collected from multiple peer-reviewed research studies, a combined comprehensive solution is needed.

The solution needs to include the following measures:

Eliminate workplace toxicity.

Provide stress management tools and resources.

Offer tuition and education benefits.

Implement yearly retention bonuses.

Reasonable and fair expectations will prevent burnout and attrition by lowering workplace stress and toxic leadership. Multiple studies show that this will happen in Texas (Hudgins et al., 2022, pages. 88-92; Reinhardt, 2020, pp. 151-216). It will then minimize the shortfall through retention bonuses and tuition benefits, which have helped most businesses eliminate their nurse shortages in two years (Reinhardt et al., 2020, pp. 151-216).


Change Model: Roger’s Theory

EBP must be assessed for relevance before being applied.

There are several theories that help assess EBP data.

Roger’s Theory on the spread of innovations is effective in assessing relevance and suitability of EBP data.

Roger’s Theory has five main levels in its process: Knowledge, Persuasion, Decision, Adoption and Confirmation.

Relevant data must be reviewed before use. EBP programs should use data to make judgments from the individual to the system. Any theoretical framework can assess an EBP’s suitability and acceptability. Rogers’s theory on innovation spread, one of the first to be effective, may be used to discover elements that favor evidence-based practice (EBP), how it spreads, and how to model it. Roger’s innovation diffusion hypothesis has four steps: knowledge, persuasion, choice, acceptance (or rejection), and confirmation (Mohammadi et al., 2017, pp. 25-32).


Change Model: Roger’s Theory

Knowledge: Formed when individual is presented with innovation and realizes it’s potential.

Persuasion: Opinion is developed on the perceived advantages.

Decision: Activity leads to choosing to either adopt or reject proposal.

Adoption: Decision is made that solution is viable and would be beneficial, solution is implemented.

Confirmation of successful solution leads to continued use.

Rogers describes diffusion as the gradual spread of an invention across social systems. Innovation, communication channels, time, and social system are the four main factors in innovation dissemination. Five-step decision-making diffuses. Over time, individuals of a comparable social system communicate through various routes. Ryan and Gross defined adoption in 1943. This approach underpins Rogers’ five steps—awareness, curiosity, assessment, trial, and adoption. During or after adoption, a person might reject an invention. Abrahamson asked: How do technically inefficient ideas spread, and what stops technically efficient inventions from spreading? Abrahamson suggests how organizational scientists might better assess innovation dissemination (Mohammadi et al., 2017, pp. 25-32).


Implementation Plan

The first step in implementation is gathering and allocating resources.

This proposal needs several different resources:

Human Resources

Technical Tools/ Equipment (Computer’s, Internet)


Fiscal Resources


Every endeavor or strategy needs resources. Lack of resources is a major reason initiatives fail. This project requires a precise mix of human, tool, information, and financial resources to succeed (Meador & Manson, 2022, p. 18).


Implementation Plan Cont.

Plan is feasible.

Much of the Technical Equipment already available.

Workplaces already available.

Main Barrier is misconception about added cost.

Total Implementation time 6-9 months, yielding results 12-14 months later.

This EBP is ultimately feasible. Most of the equipment is readily available. The implementations are scientifically proven; workspace is available at most facilities. The primary barrier is the idea of the solution being overly costly. Studies show that every bedside nurse that is retained saves the organization tens of thousands of dollars, with turnover costing hospitals between 3 and 6 million per year (Woodward & Willgerodt, 2022, pp. 664-668).


EBP Evaluation

EBP must be evaluated periodically to ensure estimated progress and projected success is being met.

Pre-project / Premortem provide needed baseline measures and help identify risk and potential issues.

Process Evaluations will be conducted to ensure activities are completed on time and as intended.

Outcome-based evaluation can be compared to baseline measures and show the extent of positive change.

All EBP must be thoroughly evaluated prior to the start of the project and periodically throughout the progress of the implementation, including periodic assessments after implementation is complete. A premortem analysis is critical to identifying possible issues as well as gathering needed baseline measurements. These baseline measurements can be used to compare with results of the outcome-based evaluations to measure how much change occurred. Of course, there should be process evaluations conducted throughout implementation to ensure the proper activities are undertaken and progress is on schedule or if adjustments are needed (Palinkas et al., 2019, pp. 423-444).



The Nursing Shortage in Texas negatively impacts healthcare.

Primary causes are many, including aging populations, stress, turnover, and lack of retention and education incentives.

Studies show organizations implementing stress reduction/management solutions with monetary retention incentives and educational benefits reduce and prevent dire shortages.

Texas hospitals and facilities need to implement this EBP to reduce shortages.



? ? ? ? ? QUESTIONS ? ? ? ?


Adams, A., Hollingsworth, A., & Osman, A. (2019). The implementation of a cultural change toolkit to reduce nursing burnout and mitigate nurse turnover in the emergency department. Journal of Emergency Nursing, 45(4), 452-456. https://doi.org/10.1016/j.jen.2019.03.004

Crabtree‐Nelson, S., DeYoung, P. M., Vincent, N. J., Myers, T. P., & Czerwinskyj, J. (2022). Compassion fatigue, compassion satisfaction, and burnout: A study of nurses in a large Texas health‐care system. Journal of Nursing Scholarship, 54(6), 720-727. https://doi.org/10.1111/jnu.12780

Hekel, B., Branson, S., Michel, A., Fontenot, H., & Eunjung, L. (2021). Factors associated with Texas Nurses’ Consideration to Leave the Nursing Workforce: Impact of the COVID-19 Pandemic. Texas Public Health Journal, 73(4), 30-34. https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=152960107&site=eds-live&scope=site&custid=s8333196&groupid=main&profile=eds1

Hudgins, T., Brown, K. D., Layne, D., & Maggard Stephens, T. (2022). The effect of academic nurse leaders’ toxic behaviors. Journal of Nursing Education, 61(2), 88-92. https://doi.org/10.3928/01484834-20211213-02

Kelly, L. A., Gee, P. M., & Butler, R. J. (2021). Impact of nurse burnout on organizational and position turnover. Nursing Outlook, 69(1), 96-102. https://doi.org/10.1016/j.outlook.2020.06.008

Mohammadi, M. M., Poursaberi, R., & Salahshoor, M. R. (2017). Evaluating the adoption of evidence-based practice using Rogers’s diffusion of innovation theory: A model testing study. Health Promotion Perspectives, 8(1), 25-32. https://doi.org/10.15171/hpp.2018.03

References Cont.

Palinkas, L. A., Mendon, S. J., & Hamilton, A. B. (2019). Innovations in mixed methods evaluations. Annual Review of Public Health, 40(1), 423-442. https://doi.org/10.1146/annurev-publhealth-040218-044215

Redfearn, R. A., Van Ittersum, K. W., & Stenmark, C. K. (2020). The impact of sensory processing sensitivity on stress and burnout in nurses. International Journal of Stress Management, 27(4), 370-379. https://doi.org/10.1037/str0000158

Reinhardt, A. C., León, T. G., & Amatya, A. (2020). Why nurses stay: Analysis of the registered nurse workforce and the relationship to work environments. Applied Nursing Research, 55(1), 151-216. https://doi.org/10.1016/j.apnr.2020.151316

Scheidt, L., Heyen, A., & Greever-Rice, T. (2021). Show me the nursing shortage: Location matters in Missouri nursing shortage. Journal of Nursing Regulation, 12(1), 52-59. https://doi.org/10.1016/s2155-8256(21)00023-5

Thompson, S. C., Holmgren, A. J., & Ford, E. W. (2021). Information system use antecedents of nursing employee turnover in a hospital setting. Health Care Management Review, 47(1), 78-85. https://doi.org/10.1097/hmr.0000000000000308

Woodward, K. F., & Willgerodt, M. (2022). A systematic review of registered nurse turnover and retention in the United States. Nursing Outlook, 70(4), 664-678. https://doi.org/10.1016/j.outlook.2022.04.005






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