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During this two-phase project, factors that dialysis nurses experience contributing to stress, retention, and the intentions of staying were examined. The theoretical frameworks of Kanter’s Theory of Structural Empowerment (KTSE) and The Refined Nurse Worklife Model (NWLM) were utilized in the creation of a learning module regarding structural empowerment. In phase one this was reviewed by an expert dialysis nurse focus group from seven different states with experience in dialysis from seven to forty years. During phase one, the expert panel gave high-frequency domain input including access to support, resources, and the need for strong leadership. The module was adjusted based on this input. In phase two this was launched in dialysis user groups. These nurses were asked to give quantitative and qualitative feedback. Phase two participants reported retention and stress factors including the need for information, on-call, education for pandemic procedures and policies, access to supplies, compensation, patient issues, ratios, racial and cultural differences, bullying, respect, favoritism, mental health support, and achievement of a sense of personal accomplishment. As a response to this information project management reflection tools for nurses and nurse leaders were formulated based on KTSE and NWLM. The learning module and tools were designed to facilitate changes that improve the work-life of dialysis nurses and the intention to stay in their specialty. Future studies should look at the outcomes of the implementation of the learning module and the use of the tools in improving the expertise of dialysis care for patients by better retention and empowerment of dialysis nurses.

Background: Surgical site infections (SSI’s) are a major concern for patients, providers, and healthcare organizations worldwide. SSI’s remain the costliest and most common of all hospital-acquired infections (HAI’s) (Septimus, 2019). It is estimated that SSI’s occur in 2 percent to 5 percent of all patients undergoing surgery, translating to 160,000 to 300,000 people annually at a cost of $3.5 to $10 billion (Ban et al., 2017). An SSI substantially increases morbidity and mortality as patients are twice as likely to die, are 60% more likely to be admitted to the intensive care unit (ICU), and the readmission rate is five times higher than patients who do not have a hospital-acquired SSI (Darouiche, 2019). Research Question: Did the intervention of preoperative nasal decolonization using the Profend Nasal Decolonization Kit, 10% povidone-iodine (PVP-I), reduce surgical site infections in patients undergoing an orthopedic surgery with implantation, to include total joint arthroplasty (TJA) and an orthopedic fracture repair, in a 12-month period preintervention compared to a 12-month period post-intervention? Objective: The objective of this DNP project was to evaluate the effectiveness of using a 10% PVP-I Nasal Decolonization Kits in the prevention of SSI’s in patients undergoing an orthopedic surgery for a TJA or fracture repair at the medical center. Methods: This DNP project used a retrospective data review from data points previously collected as part of standard work performed in the EMR. All patient information was blinded when the information was displayed. A standard report from the EMR was run to collect all data. Results: The preintervention group was composed of 431 patients and the postintervention group contained 365 patients. The preintervention group had eight postoperative infections for an infection rate of 1.86%. The postintervention group had an infection rate of 0.27%. This resulted in a p-value of 0.0367 using a two proportions z-score, showing a statistical improvement in SSI’s. Conclusion: The facility successfully implemented a nasal decolonization program with 10% PVP-I that decreased the number of infections, had a higher compliance rate for PVP-I nasal swab over the national average for mupirocin, and showed potential cost savings for the medical center.