Date of Award

Spring 5-5-2023

Document Type

DNP Project

Project Team Faculty Member

Dr. Amy Hamilton

Project Team Faculty Member

Sheri Compton-McBride


speaking up behavior, safety communication, healthy work environment, speaking up climate



This project describes results of a multifaceted approach to promoting Speaking Up Behavior (SUB) among nurses in a community hospital. Patient safety outcomes, perception of healthy work environment, and nurse retention are connected to caregiver communication.


Interventions included development of a structured SUB communication and debriefing tool, SUB administrative policy, leadership rounding and verbal support for SUB, formal recognition of SUB, and SUB education including role-playing activities. Cross-sectional surveys evaluating nurse comfort and confidence with SUB using validated tools were implemented before and after the multifaceted interventions.


The bedside nurse voluntary turnover rate reduced from 14.5% to 13.0% and the rate of patient safety events with communication as a factor reduced from as high as 2.25 to 0.76 per 1,000 patient days. Nurses had higher levels of comfort speaking up for patient safety and professionalism, as well as higher levels of engagement and trust in speaking up that were statistically significant following the interventions.

Implications for Practice

Interventions that promote SUB involving organizational culture, policy, leadership, recognition, and education may result in improved outcomes in patient safety, nurse turnover, and likelihood of SUB.

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Literature Review_Carls.pdf (368 kB)
Literature Review

Conceptual Framework_Carls.pdf (281 kB)
Conceptual Framework

Project Methods_Carls.pdf (362 kB)
Project Methods

Evaluation Process_Carls.pdf (392 kB)
Evaluation Process/Instruments

References_Carls.pdf (335 kB)
Final Reference List



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