A pilot quality improvement project facilitating clinical leadership skills in rural new graduate nurses


  • Shelly J Luger Creighton University
  • Debra J Ford Creighton University




Purpose: The purpose of this article is to present findings from a pilot quality improvement evidence-based new nurse transition program that facilitates clinical leadership skills in novice nurses at the point of patient care at a rural critical access hospital.  Descriptive data from pre- and post-intervention scores are reported, and the percent change was evaluated. 

Sample: Due to the solitary nature of rural nursing, new graduate nurses in rural areas need support in transitioning to their new role as registered nurses.  The author designed, and pilot tested a quality improvement evidence-based new nurse transition program in a rural critical access hospital utilizing complexity science as a framework.  

Method:  A quality improvement pilot program designed for new graduate nurses was provided at a critical access hospital in a rural Midwestern State.  Data was collected using pre- and post- intervention scores on the Leadership Characteristics and Skills Assessment and TeamSTEPPS Teamwork Attitudes Questionnaire. Descriptive data was evaluated. 

Findings:  Participant post- test percent change scores increased in perceptions of ability to lead but decreased in attitudes about teamwork. Observations of participant interactions in the quality improvement project suggested that the new nurses were developing new ideas, patterns and structures regarding their roles as a team member in the healthcare setting. 

Conclusion: In a rural midwestern critical access hospital a quality improvement leadership program that used a complexity science framework was provided to novice nurses in transition. After the program participant total mean post scores increased in perception of what makes a good leader and in the participant’s perception of their ability to lead.  An overall mean score decrease in attitudes about teamwork was noted among the small group of rural novice nurses.   

Keywords: rural, frontier, new registered nurse graduate, transition program, complexity science, leadership

Author Biographies

Shelly J Luger, Creighton University

Creighton University 

College of Nursing 

Assistant Professor 

Clinical Systems Administration Track Lead 

Debra J Ford, Creighton University

Creighton University 

Interdisciplinary Leadership DoctoraL Program, 

Associate Professor