Nursing higher education and leadership

Nursing Higher Education and Leadership
Clinical leadership is very important because of the problems that characterize the health care sector, including workforce shortage, high rates of change, staff chaos, quality issues, and safety concerns, among others. From history, the preparation of nurses for key roles in the health care delivery system is quite important and should not be overlooked. (Joseph & Huber, 2015). I am trained both as a clinical nursing educator and perioperative nurse. Clinical nurse educators attain that title after much experience in nursing. They mainly coach nursing students and the newly graduated ones. Perioperative nurses on the other hand are registered nurses who help in the surgical department in hospitals, day surgery units, physician’s offices and clinics. Their main work is to assist in planning, implementation and evaluation of treatment for surgical patients. (Turunen et al., 2017).
As such, the perioperative nurse starts her work immediately the patient is told of the need for surgery, and continues through the surgery and after the surgery. Spry (2016) divides the surgical process into three phases: preoperative, intraoperative and postoperative. These three make up what we call “perioperative”. The perioperative nurse is therefore tasked with providing care during all these three phases. Initially, perioperative nursing was called “operating room nursing”, which actually pointed to the care that was given to the patient during the intraoperative period. The intraoperative period is normally centred within the operating room. With time, the role of the nurse expanded into the pre- and postoperative periods, and thus the term perioperative was adopted as a more appropriate one (Spry, 2016; Turunen et al., 2017). We can therefore now rightly define the perioperative nurse as one who specializes in the care of surgical patients before, during and after the surgery.
Proposed program
The proposed program will cover two main areas: clinical rotations in the day surgery arena; and externships during school breaks. The externships serve to connect both the learner and the university to the local area hospitals. As such, there is need for a paradigm shift in regards to how nursing leaders in practice and academia work together and with the rest of the leaders in clinical practice and higher education. Such a shift is the only way to realize the full benefits of academic nursing, especially in this age where collaborations are mandatory for success. (Sebastian et al., 2018) Freshly graduated nurses are most times not skillful enough to get into leadership. After graduation, and while in the workforce, these nurses need some time for self-discovery, where they analyze themselves critically to know what their strengths are, what their weaknesses are, their fears, their threats, and so forth. This on-job training will impart important skills on the nurses, taking into account that they benefit from peers and mentors who are already in leadership. This behooves the mentors to be enthusiastic, passionate and dynamic, so that their influence on the new nurses may be sound. They ought to be people of such a character that someone else can look up to.
The transition from a nursing student to a registered nurse should be filled with clinical instruction experiences. This is especially essential in the internship year. The classroom lessons should be full of real life experience. AlThiga et al., (2017) and Fielden (2012) express the need for nurses to be endowed with theoretical and scientific know-how, particular psycho-motor and technical skills, cultural competence, communication skills, ethnic conduct and professional values. These will help the nurse to face the reality of the clinical setting. The internship should include sessions in the emergency room, operation room, and critical care, so as to equip the nurse with the required knowledge.
The student nurse intern will work under the close supervision of the registered nurse in providing care for the surgical patients. The program has a three-fold purpose as outlined below:
1. Create a realistic working environment for the student nurse intern
2. Help the student nurse intern to have a feeling of the actual health care setting.
3. Give the student nurse intern deeper insight into professional nursing. (Hemmerich et al., 2015)
It is believed that the student nurse intern will have acquired enough skills and ability to think critically by the end of the program. Below is an outline of the professional and clinical objectives of the program:
1. Successfully complete didactic programs, show demonstration of skills in a designated area of nursing
2. Impart critical thinking skills in the student nurse interns
3. Enable the student nurse intern to relate nursing to other knowledge fields such as sciences, liberal arts and humanities.
4. Train the student nurse intern to conduct physical assessments, come up with plans of care, assess patient outcomes and evaluate their responses.
5. Inculcate a spirit of team work in the student nurse intern (Holtz & Gnambs, 2017)
Evaluation of the program
Nursing students on externship should be technically evaluated to ensure the program’s objectives are met. The evaluation process is a multi-dimensional one and rigorous so to say. It should be in line with the provisions of Assisting, Developing and Evaluating Professional Nursing Interns, an initiative of the the Board of Nursing. The evaluation process is comprised of the following:
1. Assisting, Developing and Evaluationg Professional Nursing (ADEPN)
2. Assessing the Performance Standards
3. Midterm and final evaluation reports of the interns
4. Student nurse intern work samples
As earlier mentioned, ADEPN is system of helping professional nurses meet their goals. The ADEPN performance standards conform with the nationally recognized standards. And it is not only beneficial during the internship period; it serves the nurses throughout their career. Performance is something to be evaluated continuously, whether one is just a year old in the field, or has 20 years experience. Nursing candidates are also evaluated using the ADEPN system. It is for these reasons that the ADEPN performance standards should be revisited time and again for the student nurses.
The ADEPN involves giving the students formative and summative feedback throughout the course of their internship. A student nurse intern should typically be observed at least 6 times. This is best done using the Formative Observation Form. The observation should be about an hour long and the feedback should given back to the student within 3 days. The collected data is a good indication of the competencies met, and will therefore be used for the midterm and final evaluation reports.
These two reports are what will be used to assess the performance of the student nurse intern, particularly in planning, environment management, content knowledge, professionalism and instruction. The evaluation will be done by the university supervisor, but in the presence of the cooperating nurse, who will be required to append his signature on the report, as a witness that the contents of the report are truthful.
Then there is the Nurse Work Sample (NWS) which the nursing students should complete. The NWS shows how proficient the students are in short and long term planning. The cooperating nurse should assist the student in drafting the NWS, as well as the Nursing Education and Leadership instructor and the University supervisor, who will finally grade the NWS by help of the accompanying rubric.
How to infuse leadership into perioperative practice
For any clinical setting to provide quality care, the clinical leadership must be effective enough. These leadership skills can best be imparted on the students by the nurse educators. According to Parks (2013), leadership can actually be taught. This teaching should begin as early as possible in the nursing education program. The students should be encouraged to critically think through any situation they are presented with. They ought to create new solutions to problems, they can disagree with some issues and debate knowledgeably, they should not fear making mistakes, etc. (Curtis et al., 2011). They can also engage in projects that benefit the campus and the surrounding communities.
The transformational leadership theory best fits the student nurse intern. James MacGregor Burns was the one who initially outlined this theory. He sees transformation leadership as that which the leader and the follower psyche up each other to greater heights, which results in value system congruence between the follower and the leader (Krishnan, 2002). Transformation leadership is all about bringing change. Thus change agents are those who use whatever is in their hands to encourage the followers to meet their set goals.
The health care sector needs transformational leadership so as to realize the much needed change. The Institute of Medicine (2001) stressed the importance of transformational leadership in achieving quality care for patients. It is worth to note that clinical leadership has been somehow weak, and this has raised a lot of concerns, given that the person who ends up suffering most is the patient.
The transformational leadership theory requires the nurse educator to set aside some time for some direct talk with the student, to cultivate that much needed trust between the leader and the follower. The talk should not be critical in nature; it should be more of a bonding talk, more of a sociable talk, more of a friendly talk. The nurse educator should allow the student to share his thoughts and concerns, so as to understand his pressing needs. It is now upon the nurse to gauge the urgency of the problems raised and act accordingly. The director of this intern program should likewise outline what he expects from the student and the unit in general. This will help the nurse educator work better with the student towards career development and future promotion. (Xu, 2017) Transformational leadership is also a sure way of positively influencing the behavior of the student. Through it the student will improve his commitment to the organization, which is a prerequisite for achievement of any organization’s objectives.
Lee & Fitzgerald, (2008) and Read & Betancourt (2016 ) propose the following strategies to be employed by a nursing educator in promoting leadership skills in the student nurses:
1. Underrepresented students should be included in programs that:
· Cultivate self-efficacy
· Include vast experiences in the nursing field
· Provide role models who treasure the role of nurses in bringing positive change.
2. Take part in sociocultural conversations
· Make clear their own perspectives
· Understand the perspectives of others in the team
· Understand how individual values fit into the bigger social structure
· Know how to bring about positive change in the community
3. Establish effective student-mentor relationships
· Academic coaching
· Clinical preceptors
· Undergraduate research partners
4. Engage in community service
5. Take part in activities of organizations outside the campus jurisdiction
6. As a nursing educator, I will look for sponsorship of students from under resourced and underrepresented backgrounds, so as to offer them an equal opportunity for development
References
AlThiga, H., Mohidin, S., Park, Y. S., & Tekian, A. (2017). Preparing for practice: Nursing intern and faculty perceptions on clinical experiences. Medical teacher, 39(sup1), S55-S62.
Curtis, E. A., Sheerin, F. K., & de Vries, J. (2011). Developing leadership in nursing: the impact of education and training. British Journal of Nursing, 20(6), 344-352.
Fielden, J. M. (2012). Managing the transition of Saudi new graduate nurses into clinical practice in the Kingdom of Saudi Arabia. Journal of nursing management, 20(1), 28-37.
Hemmerich, A. L., Hoepner, J. K., & Samelson, V. M. (2015). Instructional internships: Improving the teaching and learning experience for students, interns, and faculty. Journal of the Scholarship of Teaching and Learning, 104-132.
Holtz, P., & Gnambs, T. (2017). The improvement of student teachers’ instructional quality during a 15-week field experience: a latent multimethod change analysis. Higher Education, 74(4), 669-685.
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Lee, G. A., & Fitzgerald, L. (2008). A clinical internship model for the nurse practitioner programme. Nurse Education in Practice, 8(6), 397-404.
Parks, S. D. (2005). Leadership can be taught: A bold approach for a complex world. Harvard Business Review Press.
Read, C. & Betancourt, D.P. (2016). Preparing nursing students as leaders for social change. Willian F. Connell School of nursing, Boston College.
Sebastian, J. G., Breslin, E. T., Trautman, D. E., Cary, A. H., Rosseter, R. J., & Vlahov, D. (2018). Leadership by collaboration: Nursing's bold new vision for academic-practice partnerships. Journal of Professional Nursing, 34(2), 110-116.
Spry, C. (2016). Essentials of perioperative nursing. Jones & Bartlett Publishers.
Turunen, E., Miettinen, M., Setälä, L., & Vehviläinen?Julkunen, K. (2017). An integrative review of a preoperative nursing care structure. Journal of clinical nursing, 26(7-8), 915-930.
Xu, J. H. (2017). Leadership theory in clinical practice. Chinese Nursing Research, 4(4), 155-157.