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Clinical Leadership Skills Acquisition in Nurse Residents. Susan Pettorini-D’Amico, DNP, RN. Background. 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 - PowerPoint PPT Presentation
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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