Transcript Clinical Leadership Skills - American Association of Critical

Susan Pettorini-D’Amico, DNP, RN
 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
 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
 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
 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
Theoretical Diagram
 What
is the effect of a nurse residency
program on clinical leadership skills
acquisition in the new nurse resident?
 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
 Patient
Care Delivery and Resource
Management
 Communication
 Conflict
Resolution
 Organization
of data
A non-equivalent comparison group
posttest research design was used to
examine the relationship between the
independent and dependant variable
 Independent Variable: The UHC/AACN
Nurse Residency Program
 Dependant Variable: Clinical leadership
skills acquisition in nurse residents

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
 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
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
Evidenced-based research project
Monthly meeting for about 3 months
Peer to peer support
 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
 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
 Final
number of surveys in data set: 44
 Number
 York
used in data analysis: 40
Street: n=14
 Chapel
 Study
Street: n=26
underpowered
Characteristic
Frequency
Percentage
Gender
Female
Male
25
1
96.0
4.0
Ethnicity
Caucasian
Asian
Other
24
1
1
92.0
3.0
3.0
9
17
34.6
65.4
Nursing a second career
Yes
No
4
22
15.4
84.6
Age
< 25
> 25
16
10
61.5
38.5
Previous leadership
training
Yes
No
Characteristic
Frequency
Percentage
Gender
Female
Male
14
0
100.0
0.0
Ethnicity
Caucasian
Asian
Other
13
1
0
93.0
7.0
0.0
3
11
28.4
78.5
Nursing a second career
Yes
No
4
10
28.6
71.4
Age
< 25
> 25
9
5
64.2
35.7
Previous leadership
training
Yes
No
 Chapel
Street Scores
Variable
Obs
Min
Max
Mean
SD
Average
26
3.647
5.000
4.468
0.330
 York
Street Scores
Variable
Obs
Min
Max
Mean
SD
Average
14
3.765
5.000
4.311
0.423
.
Normal Distribution
of Chapel Street scores
Normal Distribution
of York Street scores
T-test for mean group scores
P= 0.200 (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
p =0.646
 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
 Recruitment
procedure a challenge
 Homogenous nature of the sample
 History, maturation and conflicting
organizational initiatives
 Was leadership content of residency
program overshadowed by other
components?
 Natural leadership tendency of nurses
who work at Level 1 trauma centers?
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
leadership skills in undergraduate
programs
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
and education
 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
 Compare
different residency programs
groups of nurses without
residency programs to be able to learn best
practices
Questions and Answers