The University of San Diego Counseling Center (USDCC) has been established to provide enrolled students with access to quality counseling and healthcare services. Employing a diverse selection of the university's most accomplished psychiatrists, psychologists, medical doctors, registered nurses, and other healthcare professionals, the USDCC operates a high-volume Critical Intensive Care Unit with the assistance of a 50-member nursing staff. Although the USDCC has built a reputation for delivering competent and qualified critical care services across a number of years, the organization's management structure has become concerned that educational priorities have not been updated to reflect modern advancements in the field. To that end, the USDCC recently elected to conduct a comprehensive Learning Needs Assessment and Analysis to identify the paramount educational needs in place, and the institutional forces working to facilitate or impede the implementation of these needs. Empirical research on the efficacy of various instructional design models has consistently demonstrated that because "individual and organization needs are ever changing, problem identification often has a limited life span and requires continual updating to identify critical performance problems" (Morrison et al., 2011). Simply put, the needs assessment process applied by USDCC will observe the structural components of the organization's emphasis on educational goals, and identify any observable gaps in performance and productivity before devising strategic interventions to address these shortcomings.
In any sphere of human existence which requires the coordinated cooperation of people working in teams, including corporate offices, political parties and emergency rooms, strong and definitive leadership is essential to assure that goals and objectives are pursued and met. Without effective leadership, whether from an office manager, a campaign strategist or a registered nurse, teams of people holding varying positions within any organizational structure will invariably succumb to inefficiency and inefficacy. With approximately 50 nurses working under the auspices of the USDCC's internships and training programs, the ability of the organization to provide educational opportunities is contingent on the leadership abilities of the experienced medical professionals tasked with improving their student's skills. Renowned research psychologist Kurt Lewin pioneered the analysis of leadership styles through his groundbreaking 1939 study, identifying autocratic (authoritarian), democratic (participative) and laissez-faire (delegative) leadership as the three predominant methods of stewarding large organizations. Lewin and his colleagues concluded that the genuine motivation of subordinates is best achieved by utilizing a variety of tactics, including positive encouragement, punishment for failure and the provision of incentives, depending on the distinct leadership style exhibited by a particular manager. Despite the lessons offered by Lewin's groundbreaking research, however, a series of interviews and questionnaires administered to a sample of working student nurses, in conjunction with the overall educational needs assessment, revealed that the USDCC's management structure has continually failed in its obligation to foster a workplace environment that is conducive to educational achievement.
Within the confines of a medical facility setting, which is universally defined by both indispensability and complexity, the traits of true leadership are essential in balancing the intense pressure of providing quality healthcare. Because the extremely time-sensitive decisions made by doctors, nurses and other members of the USDCC staff inevitably produce either positive or negative health outcomes for patients, they must be made decisively and with authority. This need for resolute leadership within the organizational structure of a hospital means the leadership style exhibited by the vast majority of charge nurses and chiefs of medicine is a combination of autocratic and democratic, simply because the casual nature of laissez-faire leadership is inappropriate and reckless during the treatment of ill patients. Nonetheless, as the results of the educational needs assessment demonstrate, the management structure at the USDCC has engaged in the most counterproductive practices associated with the laissez-faire leadership style, including favoritism in assignment choices, dismissal of employee-voiced grievances, and inattentive supervision during internship and training programs. These management failures represent a clear set of identifiable needs that must be addressed through legitimate reforms, because when healthcare professionals are subjected to subpar leadership, the collective morale of staff members inevitably plummets, conflict between management and subordinates intensifies, and educational priorities are compromised. A recent study on the connection between leadership and healthcare delivery confirms this trend, finding that "clinical nurses employed at 'magnet' hospitals experience greater levels of empowerment and job satisfaction than do nurses employed at 'non-magnet' hospitals" because of "differences in leadership effectiveness between magnet and non-magnet nurse leaders that & #8230; included greater visibility and responsiveness by magnet leaders, better support of nurse autonomous decision making by magnet leaders and greater support of a professional nursing climate among magnet leaders" (Nyberg, Bernin & Theorell, 2005).
In today's world of modern medicine, typified by the rancorous national debate over health care reform and the crippling costs of rising insurance premiums, the only constant appears to be change. For patients in need of qualified and competent medical care, whether they are suffering from life threatening illness or simply inconvenient allergies, the distinction between family nurse practitioners (NP) and primary care physicians has become irrevocably blurred. The budgetary constraints affecting most major hospitals have led to a shortage of primary care medical doctors (MD), giving rise to a trend in which "an increasing number of patients who are entrusting much of their routine health care to nurse practitioners, who are registered nurses with advanced training and expertise" (Rough, 2009). As this phenomenon becomes ever more apparent with each passing year, the nation's crucial reliance on nursing trainee programs such as that offered by the USDCC has grown in kind. With millions of ailing or aging Americans turning to their NP for regular checkups, preventative testing, and other routine medical issues, a growing debate has developed over the education, qualification, and credentialing of NPs vs. MDs, with many students who hold aspirations of working as healthcare professionals electing to become registered nurses, nurse practitioners, or nursing administrators. As the educational needs assessment conducted within the USDCC has shown, unless the management structures in place throughout instructional nursing programs work collaboratively with their own students, severe deficiencies in educational objectives can quickly become rampant.
As student demographics change, and technology progresses, instructional methods have necessarily evolved to keep pace. As an instructor, it is crucial to make sure that the process of evaluating student needs and instructional goals remains adaptable as well, recognizing that the models and methods that may have worked for previous generations may not be applicable today. According to the American Academy of Family Physicians (AAFP), the majority of NPs "receive their education typically through a one-and-a-half to three-year degree program that confers a Master of Science in Nursing (MSN), depending on the prior education of the student," while nearly 80% of NPs have attained their MSN degree (AAFP, 2011). The internships and training programs offered by the USDCC fulfill many of the prior education requirements mentioned above, serving to augment the instruction provided through the classroom setting. Two major accrediting organizations, the Commission on Collegiate Nursing Education (CCNE) and the National League for Nursing Accreditation Commission (NLNAC), are responsible for upholding standards within more than 340 educational institutions which grant MSNs (AAFP, 2011). A rigorous combination of didactic and laboratory hours must be met by a prospective NP student, as well as the completion of over a thousand hours of clinical study. In order to earn an MSN through an accredited institution of nursing education, a student must first pass the National Council Licensure Exam for Registered Nurses (NCLEX-RN) and complete the Graduate Record Examination (GRE). While these rigorous accreditation standards are mandatory for aspiring professional nurses, the interviews and questionnaires provided to over 50 nurses working for the USDCC shows that the organization's management structure has simply not provided sufficient access to the instructional materials needed to prepare nursing students for the proverbial gauntlet of certification. While the presence of certain institutional forces, including budgetary and staffing constraints caused by the prolonged economic recession, has obviously reduced the ability of USDCC management to implement a full array of educational resources, the needs assessment process has revealed a clear lack of commitment of their part to adequately address the problem.
Having completed a thorough educational needs assessment, the management structure of the USDCC must devise a workable framework from which customizable instruction and instructional material can be developed to meet the particular needs of each nursing student under its supervision. The importance of engaging in an active process of continual needs assessment and needs analysis has been confirmed by the results of this process, because after failing to update its own needs assessment provisions to a sufficient degree, the USDCC began to suffer systemic breakdowns in efficiency and productivity. When a well-planned educational program fails to achieve preset instructional goals, it can become quite tempting to blame external factors like budgetary limitations and managerial apathy, but as the recent educational needs assessment reveals, these failures are most often due to the absence of sound instructional design. Rather than rely on the outmoded methodologies currently in place to achieve educational objectives, the characteristics…