Susan Pettorini-D’Amico, DNP, RN. There is a shortage of nurses which has led to a shortage of...

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 planning

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

Chapel Street: No formal program

Year long program

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

Three months precepted clinical time

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 used in data analysis: 40

York Street: n=14

Chapel Street: n=26

Study underpowered

Characteristic Frequency Percentage

Gender Female Male

251

96.04.0

Ethnicity Caucasian Asian Other

2411

92.03.03.0

Previous leadership training Yes No

917

34.665.4

Nursing a second career Yes No

422

15.484.6

Age < 25 > 25

1610

61.538.5

Characteristic Frequency Percentage

Gender Female Male

140

100.00.0

Ethnicity Caucasian Asian Other

1310

93.07.00.0

Previous leadership training Yes No

311

28.478.5

Nursing a second career Yes No

410

28.671.4

Age < 25 > 25

95

64.235.7

Chapel Street Scores

York Street Scores

Variable

Obs Min Max Mean SD

Average 26 3.647 5.000 4.468 0.330

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 scoresP= 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 training

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 different residency programs

Compare groups of nurses without residency programs to be able to learn best practices

Questions and Answers