Practice

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Practice Education PartnershipsSupporting
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

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Sherry Frizzell Conestoga College
Paris Jalali Cambridge Memorial Hospital
Maureen Leyser St. Marys 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
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Agenda

• Theoretical Background
• Leadership Development Program
• Research Methods
• Results
• Conclusions

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Theoretical Approaches
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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)

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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
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• 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
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Invitational Theory

• Based on four basic assumptions about people
• Trust
• Respect
• Optimism
• Intentionality

(Purkey Aspy, 2003)
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Program Design

• 24 Emerging Nurse Leaders
• 24 Mentors
• 8 health care organizations within the LHIN

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Emerging Nurse Leaders Engaged in

• 3 six hour leadership workshops at Conestoga
  College
• A short term leadership project
• A time limited mentorship relationship

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Mentors

• Workshops
• Supported project
• Provided mentorship through meetings with new
  leaders

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Aim of Study

• investigate whether an emerging nurse leader
  development program created a change in
  leadership practices
• uncover the experiences of program participation

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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

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Demographics

• 98 female
• 94 RNs
• 6 RPNs

• 57 diploma
• 30 undergrad degree
• 13 graduate degree

65 full-time 35 part-time or casual
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Leadership Practices InventoryEmerging Nurse
Leaders
Model the Way plt.001
Inspire a Shared Vision plt.001
Challenge the Process p.003
Enable Other to Act
Encourage the Heart P.001
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Leadership Practices InventoryMentors
Model the Way
Inspire a Shared Vision
Challenge the Process
Enable Other to Act
Encourage the Heart p.002
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Sample Group Pre Leadership Workshop Mean Post Leadership Workshop Mean T Score DF P
Total Sample (N46) 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 (N23) 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 (N23) 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
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Emerging Nurse Leader Themes

1. Acquired Leadership Knowledge
2. Empowered to Make a Difference (Self Awareness)
3. Learning from Their Mentor

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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

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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

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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.

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MentorDevelopment 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 its helped me advance in a way

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• I just enjoy it..I enjoy sharing my knowledge
  and experience and my leadership skills with my
  colleagues.

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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

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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

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Limitations

• Small sample size for quantitative measures
• Participants self-selected
• Self-assessed leadership behaviours, immediately
  after program participation

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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?

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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.

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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.

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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)