Date of Conferral



Doctor of Nursing Practice (DNP)




Janice Long


Department structure and leadership functions can influence work climate. In one healthcare system, advanced practice providers (APPs) worked in a decentralized structure with multiple leaders. This project explored the impact of the change to centralized leadership for APPs working in an academic healthcare system in which employee turnover was high and satisfaction was low. An ad hoc committee led by the chief medical officer created a centralized department with a designated leader. Surveys and interviews were used to identify the benefits of the strategies implemented and understand whether the change in organizational structure resulted in an improved work climate for APPs in the large multicampus academic healthcare system,. Data were collected from departmental reports, 12 APP interviews, and 2 online surveys with a total of 73 responses. Results showed that centralization improved leadership support and communication with APPs within the system by 11.4%. Feedback from APPs indicated the physicians maximized APPs' expertise and licensure, thus creating a supportive work climate and environment, professional growth, and job satisfaction. With the implementation of the centralized department in 2014, the turnover rate dropped from 20.47% in 2013 to 6.1% in 2016 resulting in positive social change for APPs, providers, and patients.