Nurse Management Education in Today\'s

Nurse Management Education

In today's world, knowledge is a product. Successful individuals and companies obtain additional expertise that others require, so it pays to continually learn. As noted by Malcolm Knowles, learning must be an ongoing process that continues throughout one's life. This is especially true in the healthcare fields, such as nursing, where there is continually changing technology and growing needs of patient care. The American International Health Alliance stresses that the ideas, achievements, and strengths of individual nurse leaders and physicians greatly impact the healthcare reform process. Providing nurses with management skills is a means for strengthening the role they play in healthcare improvement (McClaran et. al. 1999, p. 181).

Over the centuries, the emphasis in American learning has been placed on pedagogy, or the education of children and young adults. In the pedagogic model, teachers assume responsibility for making decisions about what, how and when something will be learned. It has only been in recent decades that increasing numbers of companies have also recognized the importance of continual training and development for adults. Also, most recently, there has been an increase in andragogy, or having adults participate in the learning experience.

In the1950s, Malcolm Knowles developed a specific learning module for adult learning. He reintroduced the term andragogy, or "the art and science of helping adults learn." Learning can be defined as the act, process, or experience of gaining knowledge or skills to help people move from novice to expert. Over the years, the concept of andragogy has taken on a wider meaning as learner-focused education for individuals of all ages. The andragogic model consists on the evolution of learning in adulthood: 1) self-concept-as a person matures, self-concept moves from one of being a dependent personality toward one of being a self-directed human being, 2) experience -- as people grow older, they accumulate an expanded reservoir of experience that becomes an increasing resource for learning; 3)readiness to learn -- as individuals mature, their readiness to learn becomes oriented increasingly to the developmental tasks of social roles; 4) orientation to learning -- as a person ages, time perspective changes from postponed application of knowledge to immediacy of application and from subject-centeredness to problem centeredness; and 5) motivation to learn -- as a person matures, the motivation to learn is internal (Knowles 1984, p.12).

In other words is it important to 1) let learners know why something is important to learn; 2) show learners how to apply self-direction through information; 3) relate the topic to the learners' experiences; 4) recognize the importance of motivation in the learning process and 5) help learners overcome prior inhibitions, behaviors, and beliefs about learning (Knowles 1984, p.13).

Adult learning is influenced by the needs and preferences of the learner, educator, organization, and content. Too often, the needs of the learner are overshadowed by the other three factors. The educator may be content to repeatedly do things the same way. The organization may think that solving the present problem matters more than making improvements for the future. The content may prove too difficult to offer in a more useful form. Learners need respect, relevancy, immediacy, safety, engagement, and active participation. Until educators and organizations develop content correctly, learning suffers.

Knowles offered three reasons for the importance of self-directed learning for adults. First, people who take initiative in educational activities seem to learn more and better than passive individuals. Second, an important part of the maturation process is the ability to take increasing responsibility for life. Third, the many evolving educational innovations, such as Open University, weekend colleges, etc. require that learners assume significant responsibility in their learning. Most important, the world is changing so that rapid change will be the only stable characteristic (Knowles, 1975, p. 15). It is this ability to carry out individual learning long after an activity, such as when a course is already completed, that people believe results from personalizing the instructional process (Hiemstra & Sisco, 1990).

Knowles' suggestions for the ideas of self-direction evolved into a five-step model of adult learning: 1) diagnosing learning needs; 2) formulating learning needs;

3) identifying human material resources for learning; 4) choosing and implementing appropriate learning strategies; and 5) evaluating learning outcomes (Knowles, Holton and Swanson, 1998).

Advanced education for nurses in the area of management needs to be based on these concepts of self-direction and motivation. As Narsavage notes in "Education in Nursing Management," (1996) nurses have continually been an integral part of the healthcare provider team, but due to the different levels of education provided for "nursing," there has been no consistency in the nursing role. As in business, a team of healthcare providers needs managing, but team members may not intuitively be able to manage. That is why the world of business now see the importance of management training for individuals who have leadership potential. "Nurses have not traditionally been considered in that world."

Nursing research has shown that education that includes the learners' input (Knowles would define as self-direction) on decision-making and management skills can succeed in nursing. Methods such as the "assessment center" in major organizations can be adapted to effectively evaluate and develop nurse managers. Able nursing at many levels can be provided through opportunities to develop knowledge and skills required to advance as managers.

Preparation of nurse managers has mainly consisted of in-service education, post-basic certificate education, management education provided within a four-year baccalaureate program of study such as nursing or health administration, and a graduate level program of study. In addition, it is necessary for nurses to be empowered

Empowerment is... An enabling process...arising form a mutual sharing of resources and opportunities which enhances decision making to achieve change." Nurses who have been educated in management and become empowered have increased self-esteem, are able to set realistic goals, control the change process, and can communicate a sense of future hope to physicians, staff nurses, and patients (Narsavage, 1996).

Nursing staff development is based on the fact that adult learners are self-directed and desire to practice in an environment of rapid change that requires them to update their knowledge or skills or a learn a different area of expertise. Nursing development programs need to motivate adults to consider the learner process as a natural part of living. Staff development can be defined as "a management program to aid staff in developing skills and knowledge which adds to their professional goals and at the same time increases their value as employees (Swansburg, 1996).

Educating nurses in management is effective for everyone involved in a healthcare situation. Gotoh (1992) reported a "marked positive change" in her unit following a nursing management education program; staff nurses desired to stay on the unit, which lowered turnover rates and disciplinary actions. Studies also show nurse manager effectiveness within healthcare organizations empowers the nurses they supervise to initiate change to improve patient care. The nurse management impact on patient care includes: 1) Patients learn self-care strategies; 2) Continuity of care is supported through acceptance of team roles; 3) Use of expensive medications and therapies can be controlled; 4) Infections can be decreased; 5) Patients can be discharged earlier; and 6) Patient satisfaction with hospital care is improved.