Date of Award


Document Type


Degree Name

Doctor of Nursing Practice (DNP)

Committee Chair

Cindy Miller


The Bachelor of Science in Nursing (BSN) program had a deficiency in teaching graduating senior nursing students in the areas of managing and organizing care for an assigned group of patients. By the last semester of the senior year, most of the senior nursing students had no exposure to caring for more than one patient during clinical rotations. In 2017, the senior nursing students’ performance in Team Nursing and Focused Care experiences, which occur during the last semester of the graduating year, demonstrated a lack of ability to care for more than one patient at a time. In 2018, there was a total of 46 BSN nursing students in the graduating semester. The total number of students able to manage and organize care for more than one patient was 11 out of 46, or 24% of the class. Several literature reviews identified that inconsistencies existed involving feelings of anxiety, lack of confidence, and unsafe practice when new nursing students transitioned to practice without having exposure to experiences modeling care for more than one patient in the clinical settings. The literature reviews also supported evidence that large numbers of new nurse graduates often leave their first nursing job or the profession altogether within six months to a year. An analysis of the literature supports the use of simulation experiences that relate to caring for multiple patients before entering the clinical setting. A simulation experience was developed and implemented for graduating BSN students during the last semester of nursing school. A guideline tool which is titled the BOSS method was developed that guided the students on which task should occur every hour of the day during patient care. These tasks focused on basic routine care such as head-to-toe assessments immediately after change of shift report, assessing vital signs, and labs during the first hour of the day before administering medications. The guideline tool instructed the students through routine and required care during a four-hour simulation experience. During the simulation experience each student portrayed the role of a registered nurse for four or more assigned patients. Faculty facilitated keeping the students’ time on task with completing each piece of the BOSS guideline tool during the scheduled time frame. The simulation experience and guideline tool were developed using Kotter’s Eight Stages of Change and Neuman’s Systems Theory. Findings indicated a positive impact on the student’s perception of being prepared to transition to the practice of managing and organizing care for four or more patients. Data outcomes which were collected from students and faculty throughout the phases of the project demonstrated that the students ability to manage and organize care for multiple assigned patients increased from 24% in 2018 to 90% in 2019. A faculty survey was also distributed in 2018 after the Focused Care experience and overall the faculty reported that out of 46 students only 26% were able to care for four or more patients before graduating that year. This outcome was compared to 75% of 44 students in 2019 who could care for four or more patients before graduating. These outcomes denote a significant improvement in the students’ ability to care for multiple patients after the simulation experience and using the BOSS guideline tool during simulation, Team Nursing, and Focused Care experiences. The use of Kotter’s Eight Stages of Change Model and Neuman’s Systems Theory provided a structured science and theory timeline that allowed for the sustainability of this project as evidenced by the adoption of this simulation experience in the Leadership Nursing Course in the BSN program.

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Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

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