How To Teach Nurse Leadership

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1 Susan Pettorini-D Amico, DNP, RN September 27, 2014 STTI Leadership Connection

2 Disclosure Information: No conflict of interest to disclose for this presentation No sponsorship or commercial support was received Learning Objectives: Articulate the meaning of the term Clinical Leadership Skills Describe the use of a Clinical Leadership Survey to measure Clinical Leadership Skills

Objectives: Articulate the meaning of the term Clinical Leadership Skills

There is a shortage of nurses which has led to a shortage of nurse leaders There is also a lack of nurse leadership development programs which affects leadership succession The Institute of Medicine

3 There is a shortage of nurses which has led to a shortage of nurse leaders There is also a lack of nurse leadership development programs which affects leadership succession The Institute of Medicine report (2011) has identified nurse leadership as important in realizing health care reform and calls for nurse leadership programs to be developed and used Nurse residency programs can be used to develop clinical leadership skills Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington, DC: The National Academies Press.

care reform and calls for nurse leadership programs to be developed and used Nurse residency programs can be used to develop clinical

4 To measure the ability of a residency program to impart clinical leadership skills to nurse residents Nurse residents should have clinical leadership skills taught to successfully build the next generation of nurse leaders Clinical leadership skills can be further developed into administrative leadership skills thus addressing succession planning

successfully build the next generation of nurse leaders Clinical leadership skills can

5 Patricia Benner s Model of Novice to Expert (1984) Dreyfus model of skill acquisition Five levels of skill attainment: novice, advanced beginner, competent, proficient, expert Expertise develops as nurses progress through these stages Nurse residents can been seen as students progressing through these same stages Benner, P. (1984). From novice to expert. Upper Saddle River, NJ. Prentice Hall Health.

nurses progress through these stages Nurse residents can been seen as students progressing through

6 The nurse resident is an advanced beginner Through clinical rotations and classroom content, the resident advances to a competent practitioner Measuring acquisition of the leadership topics can show that clinical leadership skills have been taught

competent practitioner Measuring acquisition of the

7 Research Model Benner, P. (1984). From novice to expert. Upper Saddle River, NJ. Prentice Hall Health.

8 Purpose of the program: To aid the nurse resident in completing the transition from an advanced beginner to competent nurse Goals include improving the resident s ability to think critically, manage patient outcomes and provide clinical leadership at the point of care Curriculum focuses on three main topics: Patient Outcomes, Professional Roles and Leadership University Health Consortium. (2010). Nurse Residency Program Guild. Retrieved from

clinical leadership at the point of care Curriculum focuses on three main topics: Patient Outcomes, Professional

9 Patient Care Delivery and Resource Management Communication Conflict Resolution Organization of data University Health Consortium. (2010). Nurse Residency Program Guild. Retrieved from

10 A non-equivalent comparison group posttest research design was used to examine the relationship between the independent and dependant variable Research Question: What is the effect of a nurse residency program on clinical leadership skills acquisition in the new nurse resident?

variable Research Question: What is the effect of a nurse residency

11 A 1500 bed tertiary medical center with two campuses (one which used the UHC/AACN residency program, one which did not) York Street campus: UHC/AACN residency program used Chapel Street campus: No formal program used

which did not) York Street campus: UHC/AACN residency

12 Power analysis: 102 subjects needed (power 0.80, effect size 0.5, alpha 0.05). Final sample: 40 (underpowered) Inclusion criteria for York Street campus was only those nurses who have completed the UHC/AACN residency program. Inclusion criteria for Chapel Street campus was any nurse who completed one year as a new nurse graduate in the hospital Excluded from the study was any nurse resident or graduate who did not complete one year of employment at either institution

13 York Street: UHC/AACN Program Year long program Chapel Street: No formal program Three months precepted clinical time Nine months precepted clinical time Three months independent clinical practice Monthly classroom content for one year: Patient Outcomes, Professional roles, Leadership Monthly meeting for about 3 months Peer to peer support Evidenced-based research project

practice Monthly classroom content for one year: Patient Outcomes, Professional roles,

14 Clinical Leadership Survey Developed by Patrick, Laschinger, Wong and Finegan (2011) Measures for clinical leadership skills at the point of care Psychometric testing: Confirmatory factor analysis on each item. Content validity index of 85%. Reliability coefficient equaled 0.86 Patrick, A., Laschinger, H. K., Wong, C. & Finegan, J. (2011). Developing and testing a new measure of staff nurse clinical leadership: The clinical leadership survey. Journal of Nursing Management, 19,

Reliability coefficient equaled 0.86 Patrick, A., Laschinger, H. K., Wong, C. & Finegan, J. (2011).

15 Sacred Heart IRB and Yale Human Investigative Committee approval Recruitment via flyers in work areas and at nursing leadership meetings Survey monkey site for survey access

16 Final number of surveys in data set: 44 Number used in data analysis: 40 York Street: n=14 Chapel Street: n=26 Study underpowered

17 Gender Female Male Ethnicity Caucasian Asian Other Characteristic Frequency Percentage Previous leadership training Yes No Nursing a second career Yes No Age < 25 >

0 3.0 3.0 Previous leadership training Yes No Nursing a

18 Characteristic Frequency Percentage Gender Female Male Ethnicity Caucasian Asian Other Previous leadership training Yes No Nursing a second career Yes No Age < 25 >

Yes No Nursing a second career Yes No Age < 25 > 25 14 0 13 1

19 Chapel Street Scores Variable Obs Min Max Mean SD Average York Street Scores Variable Obs Min Max Mean SD Average

20 . Normal Distribution of Chapel Street scores Normal Distribution of York Street scores

21 T-test for mean group scores P= (study underpowered) Pearson s Chi-square test Independent Variable P Value Age < 25 or > 25 P =0.636 Nursing a second career p =0.664 Previous leadership training p =0.646

22 First study to use the Clinical Leadership Survey to attempt to measure this concept in this population Study not powered due to small size of the sample No statistical significance found between the means of the two groups Not possible to conclude the residency program did not instill clinical leadership skills

Nursing Practice: Further research to study which residency programs are successful in building nurse leaders in the clinical arena Nursing Education: Replicate study in a broader scale to be able to

23 Nursing Practice: Further research to study which residency programs are successful in building nurse leaders in the clinical arena Nursing Education: Replicate study in a broader scale to be able to inform education about the need to build clinical Policy: Use this study as a guide to research which residency programs are successful in instilling clinical leadership skills to be able to guide both practice education and leadership skills in undergraduate programs

24 Use recruitment strategies to gain a larger sample Compare nurses at the beginning and the end of the residency program (one group, pre-test, post test) Compare different residency programs Compare groups of nurses without residency programs to be able to learn best practices

25 Questions/ Comments?

THE LIVED EXPERIENCE OF THE TRANSITION OF THE CLINICAL NURSE EXPERT TO THE NOVICE NURSE EDUCATOR

THE LIVED EXPERIENCE OF THE TRANSITION OF THE CLINICAL NURSE EXPERT TO THE NOVICE NURSE EDUCATOR Natalie Weidman MSN, RN The Reading Hospital School of Health Sciences Nursing Program Reading, Pennsylvania,