Transcript Nurse Leadership to Create Positive Clinical Learning

Practice & Education Partnerships
Supporting the Development of
Nurturing Clinical Learning
Environments for Students &
New Graduates
Marilyn Kelly RN MEd
Lisa-Anne Hagerman RN Ed.D
Heather Cross RN MN
Paris Jalali RN MA
Sherry Frizzell
Conestoga College
Paris Jalali
Cambridge Memorial Hospital
Maureen Leyser
St. Mary’s General Hospital
Marilyn Kelly
Conestoga College
Maria Pena
Guelph General Hospital
Lisa-Anne Hagerman
Conestoga College
Kim Pittaway
Cambridge Memorial Hospital
Judy Shearer
Grand River Hospital
Heather Cross
Conestoga College
Funded by Ontario Nursing Secretariat, MOHLTC
Agenda
• Theoretical Background
• Leadership Development Program
• Research Methods
• Results
• Conclusions
Theoretical Approaches
Leadership
“…is a process ordinary people use when they are
bringing forth the best from themselves and
others. When the leader in everyone is liberated
extraordinary things happen.”
(Kouzes & Posner, 2007)
Five Practices of Exemplary
Leadership
• Model the Way
• Inspire a Shared Vision
• Challenge the Process
• Enable other to Act
• Encourage the Heart
Kouzes & Posner, 2007
• Nurses at the bedside
contribute to inviting clinical
environments in which
students and new graduates
feel welcomed & accepted,
and challenged in ways that
help them grow
Thomka, 2007
Invitational Theory
Based on four basic assumptions about
people:
1.
Trust
2.
Respect
3.
Optimism
4.
Intentionality
(Purkey & Aspy, 2003)
Program Design
• 24 Emerging Nurse
Leaders
• 24 Mentors
• 8 health care
organizations within
the LHIN
Emerging Nurse Leaders Engaged in
• 3 six hour leadership
workshops at Conestoga
College
• A short term leadership
project
• A time limited mentorship
relationship
Mentors
• Workshops
• Supported project
• Provided mentorship
through meetings with
new leaders
Aim of Study
• investigate whether an emerging nurse leader
development program created a change in
leadership practices
• uncover the experiences of program
participation
Research Methods
Purposive sampling strategy was used to recruit
48 nurses
Measures
• Demographic information
• Learning Practices Inventory (Kouzes & Posner, 2003)
• Nursing Retention Index (Cowen, 2002)
• Focus groups
Demographics
98% female
94% RNs
6% RPNs
57% diploma
30% undergrad degree
13% graduate degree
65% full-time
35% part-time or casual
Leadership Practices Inventory
Emerging Nurse Leaders
Model the Way
p<.001
Inspire a Shared Vision
p<.001
Challenge the Process
p=.003
Enable Other to Act
Encourage the Heart
P=.001
Leadership Practices Inventory
Mentors
Model the Way
Inspire a Shared Vision
Challenge the Process
Enable Other to Act
Encourage the Heart
p=.002
Sample Group
Pre
Leadership
Workshop
Mean
Post
Leadership
Workshop
Mean
T
Score
DF
P
Total Sample (N=46)
‘Model the Way’
‘Inspire a Shared Vision’
‘Challenge the Process’
‘Enable Others to Act’
‘Encourage the Heart’
44.913
40.783
43.804
49.370
43.544
48.239
45.174
46.435
51.326
48.500
4.171
3.616
2.924
2.448
5.232
45
45
45
45
45
.000
.001
.005
.018
.000
Emerging Nurse Leaders (N=23)
‘Model the Way’
‘Inspire a Shared Vision’
‘Challenge the Process’
‘Enable Others to Act’
‘Encourage the Heart’
42.652
37.609
41.304
47.826
42.261
47.522
44.217
45.174
50.174
48.087
4.764
4.576
3.284
1.935
3.893
22
22
22
22
22
.000
.000
.003
.066
.001
Nurse Mentors (N=23)
‘Model the Way’
‘Inspire a Shared Vision’
‘Challenge the Process’
‘Enable Others to Act’
‘Encourage the Heart’
47.174
43.957
46.304
50.913
44.826
48.957
46.130
47.696
52.478
48.913
1.540
1.162
1.042
1.475
3.500
22
22
22
22
22
.138
.258
.309
.154
.002
Emerging Nurse Leader
Themes
1. Acquired Leadership Knowledge
2. Empowered to Make a Difference (Self
Awareness)
3. Learning from Their Mentor
Acquired Leadership
Knowledge
“I found I learned a lot about myself, a lot
about my own leadership. I think that was
the part that was missing”
Empowered to Make a
Difference
• “ I think ..what I got …(is that).. you have to start
the changes yourself”
• “..given me the courage to be involved in
improving the work environment”
Learning From Their Mentor
“My mentor was wonderful because she would
provide me with a lot of background...[and] what
we could do about it.”
Mentor
Development of Self as Leader
“This program has just made me realize that...I do
have a lot of ways to show my leadership
skills...and it’s helped me advance in a way”
• “I just enjoy it…..I enjoy sharing my knowledge
and experience and my leadership skills with my
colleagues.”
Successes
• Completed projects, including ones that
enhanced unit processes
• Individual empowerment and greater sense of
control over the work environment
• Enhanced leadership behaviours
• Succession planning
Completed Projects
• Medication reconciliation in the ER
• Communication tool for transfer of care between
units
• Generation gap between nurses
• Implementing responsibilities of night shift
• Orientation guide to pacemaker clinic
Limitations
• Small sample size for quantitative measures
• Participants self-selected
• Self-assessed leadership behaviours,
immediately after program participation
Recommendations & Future
Steps
• Concurrent investment in leadership &
mentorship development
• Financial investment is essential
• Does leadership development in point of care
nurses impact the clinical learning environment
for students?
Conclusion
• A leadership development
program that combines
project experience,
workshops & mentorship
may impact leadership
behaviours in mid-career
point of care nurses
• Engage nurses at their
moment of “readiness to
learn”.
References
Cowin, L. (2002). The effects of nurses’ job satisfaction on retention: an
Australian perspective. Journal of Nursing Administration, 32 (5), 283-291.
Cowin, L.S., & Hengstberger-Sims, C. (2006). New graduate self-concept and
retention: a longitudinal survey. International Journal of Nursing Studies, 43
(1), 59-70.
Kouzes, J., & Posner, B. (2003). Leadership Practices Inventory: psychometric
properties. San Francisco,CA: Pfeiffer
Kouzes, J., & Posnter, B. (2007). The leadership challenge (4th ed.). San
Francisco: John Wiley & Sons.
Purkey, W., & Aspy, D. (2003). Overcoming tough challenges: An invitational
theory of practice for human psychology. Journal of Humanistic Psychology,
43 (3) 146-155.
Thomka, L. A. (2007). Mentoring and its impact on intellectual capital: Through
the eyes of the mentee. Nurse Administration Quarterly, 31 (1) 22-26.
Nursing Retention Index
1. It is my intention to continue with my nursing career in the
near future
2. I would like to stay in nursing as long as possible
3. As soon as it is convenient for me I plan to leave the
nursing profession
4. I expect I will keep working as a nurse
5. My plan is to remain with my nursing career as long as I
am able
6. I would like to find other employment by leaving nursing
(Cowin, 2002)