The hidden treasure in nursing leadership: informal leaders

downey m., parslow s. & smart m. (2011) Journal of Nursing Management 19 , 517–521
The hidden treasure in nursing leadership: informal leaders Aim The goal of the present article was to generate awareness of characteristics of informal leaders in healthcare with the emphasis on nurses in acute care settings. There is limited research or literature regarding informal leaders in nursing and how they positively impact nursing management, the organization and, ultimately, patient care. Identification of nurses with leadership characteristics is important so that leadership development and mentoring can occur within the nursing profession. Background More than ever, nursing needs energetic, committed and dedicated leaders to meet the challenges of the healthcare climate and the nursing shortage. This requires nurse leaders to consider all avenues to ensure the ongoing profitability and viability of their healthcare facility. Key issues This paper discusses clinical nurses as informal leaders; characteristics of the informal nurse leader, the role they play, how they impact their unit and how they shape the organization. Implication for nursing management Informal nurse leaders are an underutilized asset in health care. If identified early, these nurses can be developed and empowered to impact unit performance, efficiency and environmental culture in a positive manner.     

Clinical leaders in paediatric nursing: a pilot study

This pilot study explored the appropriateness and suitability of a questionnaire for discovering who the clinical nurse leaders are in a paediatric unit of a large NHS trust and what the qualities and characteristics of clinical leaders might be. Thirteen respondents made 24 separate nominations for clinical leaders, 20 of whom were 'F' grade junior sisters who were seen as having the clinical leadership qualities of: coping well with change; integrity; being supportive; considering relationships valuable; being flexible; and clinical competence. These results highlight aspects of clinical leadership in paediatrics and the value of conducting a pilot study.     

Developing a culture of nursing research through clinical-academic partnership

Evidence based practice is essential to advanced practice nursing, enabling the delivery of quality care and improved patient outcomes. As the name suggests, it requires healthcare decisions to be based on the best available and current evidence. Advanced practice nurses need astute critical analysis skills to appraise the evolving literature, and require research skills to lead on scientific inquiry and develop the profession. Yet, advanced practice nurses may not recognize themselves as research leaders. Participation in a journal club can promote evidence-based practice, improve clinician's critical thinking skills, and expose members to different research methodologies, however, nurses continue to face barriers to participation in these clubs. Establishing a clinical-academic partnership appears to be both mutually beneficial for clinicians and academics and is a significant enabler in the sustainability and functioning of the club through sharing expertise and experience. A supportive workplace culture is favourable to research utilization and knowledge translation. This paper outlines the role, practicalities, challenges, and benefits of setting up a hybrid urology journal and research club for advanced practice nurses in a clinical-academic partnership.     

Implementing a journal club in a palliative care setting: A link in the chain of evidence-based practice

This paper describes the implementation and evaluation of a journal club in a privately funded palliative care unit. Journal club meetings were initiated as part of a quality improvement process to foster the uptake of evidence-based practice. Nurses were presented with research articles each month and discussions were conducted focussing on methodological considerations of the research and implications of the research for patient care. The maximum number of attendees at any one meeting was nine and the minimum number was four. Overall, evaluations were positive about all aspects of the meetings. Attendees found that the selected articles were relevant, providing new information, stimulated discussion and reflection on clinical practice and encouraged further reading. One of the positive aspects of the meetings identified by participants was the facilitation style that enabled discussion in a safe and supportive environment. An important outcome of the meetings is the potential to explore evidence-based practices relevant to palliative care and to implement new practices or revise existing ones. As part of this process practice changes and clinical guidelines have been implemented. A dedicated facilitator with university links and a supportive organisational culture promoted club meetings as a practical way to provide clinical nurses with the opportunity to explore evidence-based research in the area of palliative care.     

Facilitating safe care: a qualitative study of Iranian nurse leaders

Aim The purpose of this study was to explore and describe how nurse leaders facilitate safe care from the perspectives of both nurses and nurse leaders. Background The health-care system’s success in improving patient safety pivots on nursing leadership. However, there is a lack of knowledge in the international literature about how nurse leaders facilitate provision of safe care and reaching the goal of a safe health-care system. Method A qualitative design using a content analysis approach was applied for data gathering and analysis. In this study, 20 nurses (16 nurses and four head nurses) working in a referral teaching hospital in Tehran, Iran, were recruited through purposive sampling. Semi-structured interviews and 10 hours of structured observations were conducted to collect data. Results The data analysis resulted in three main themes: ‘providing environmental prerequisites for safe nursing practice’, ‘uniting and integrating health-care providers’, and ‘creating an atmosphere of safe care’. Conclusion The results indicate that to facilitate providing safe care, nurse leaders should improve nurses’ working conditions, develop the nurses’ practical competencies, assign duties to nurses according to their skills and capabilities, administer appropriate supervision, improve health-care providers’ professional relationships and encourage their collaboration, empower nurses and reward their safe practice. Implications for nursing management Approaching the challenge of patient safety requires the health-care system to combine its efforts and strategies with nursing leadership in its vital role of facilitating safe care and improving patient safety.     

Incorporating a service improvement project into an undergraduate nursing programme: A pilot study

Although service improvement projects have been incorporated into some postregistration nurse education modules in the UK, they have not been generally available to pre‐registration students. This paper reports on the implementation and evaluation of a pilot project in pre‐registration nurse education at one university in eastern England. It concludes that the nursing students found the project to be a useful addition to their course. Supportive reactions were obtained from nurse managers, mentors and academics. A need to improve communication with clinical areas through the use of web‐based materials was highlighted.     

Clinical nurse leaders' and academics' perspectives in clinical assessment of final‐year nursing students: A qualitative study

The nature of nursing practice is diverse; therefore, clinical assessment is a complex process. This study explores the perceptions of clinical nurse leaders and academics on clinical assessment for undergraduate nursing education during transition to practice. An explorative qualitative approach was applied. Eight nurse managers, six clinical nurse educators, and eight academics from two tertiary hospitals and a university in Singapore participated in four focus group discussions. Thematic analysis was conducted. Four overriding themes were revealed: the need for a valid and reliable clinical assessment tool, preceptors' competency in clinical assessment, challenges encountered by the students in clinical assessment, and the need for close academic and clinical collaboration to support preceptors and students. Closer academic‐clinical partnership is recommended to review the clinical education curriculum. Clinical and educational institutions need to work closely to design a learning program to enhance preceptors' competence in clinical pedagogy and assessment. Furthermore, a stress management program could build students' resiliency in coping with unfamiliar clinical environments. Ongoing support needs to be provided for both preceptors and students to enrich the preceptorship and learning experiences.     

Self-directed learning in nurse education: a review of the literature

RATIONALE: Self-directed learning is essential in assisting nurses to meet the challenges presented in today's health care environment. Nurse educators have an important role to play in assisting nurses to acquire the skills for self-directed learning, and to do this they need to understand the concept of self-directed learning. AIM: The aim of this review is to explore the concept of self-directed learning and its use in nurse education. METHODS: A review of the literature was conducted using CINAHL, Medline and other databases and the keywords 'self-directed learning', 'student nurses', 'classroom', 'nursing education' and 'adult education'. FINDINGS: The concept of self-directed learning is based on the principles of adult education and can take many different formats. Self-directed learning has many benefits. However, acquiring the necessary skills is dependent on a students' preference and readiness for self-directed learning and nurse educators' implementation of the concept. In implementing self-directed learning, nurse educators become facilitators of learning and require ongoing staff development. Not all students are self-directed and a variety of teaching methods should be used in curricula. CONCLUSIONS: A consensus definition of the concept of lifelong learning does not exist, and students and teachers may have different perspectives on it. Mature students may be more self-directing than school-leavers, and learning styles and readiness to learn need to be assessed when judging the appropriateness of using self-directed learning approaches. However, there are many potential benefits, including increased confidence, autonomy, motivation and preparation for lifelong learning.     

Understanding partnerships in developing disabled entrepreneurs through participatory action research

Purpose. The paper reports on a community disability entrepreneurship project in Khayelitsha and Nyanga, Cape Town, South Africa. Disabled people, Disabled People South Africa ( a national organization made up by disabled people's organizations), a non-governmental organisation and occupational therapists from the University of Cape Town collaborated with the focus to achieve economic empowerment of disabled people though the establishment of micro-enterprises.

Method. Participatory Action Research strategies, which informed and monitored the effective development of the community disability entrepreneurship project, were carefully integrated with the existing principles of community development.

Results. The participatory action research process provided an opportunity for shared learning and development. This article reports on the challenges and strategies faced by disabled people in the quest to establish themselves as entrepreneurs. The challenges that were identified through analysis from the experiences of participants were starting with nothing, lack of capacity and complexity of establishing working relationships. The strategies used were building group identity and developing capacity together. Indicators of positive outcome that emerged from an inductive content analysis are presented and discussed.     

Understanding partnerships in developing disabled entrepreneurs through participatory action research

Purpose.?The paper reports on a community disability entrepreneurship project in Khayelitsha and Nyanga, Cape Town, South Africa. Disabled people, Disabled People South Africa ( a national organization made up by disabled people's organizations), a non-governmental organisation and occupational therapists from the University of Cape Town collaborated with the focus to achieve economic empowerment of disabled people though the establishment of micro-enterprises.

Method.?Participatory Action Research strategies, which informed and monitored the effective development of the community disability entrepreneurship project, were carefully integrated with the existing principles of community development.

Results.?The participatory action research process provided an opportunity for shared learning and development. This article reports on the challenges and strategies faced by disabled people in the quest to establish themselves as entrepreneurs. The challenges that were identified through analysis from the experiences of participants were starting with nothing, lack of capacity and complexity of establishing working relationships. The strategies used were building group identity and developing capacity together. Indicators of positive outcome that emerged from an inductive content analysis are presented and discussed.     

Factors affecting the programme completion of pre-registration nursing students through a three year course: A retrospective cohort study

Students who leave pre-registration nurse education having failed to complete remain a concern for higher education institutions. This study identifed factors influencing completion using a retrospective cohort analysis to map student characteristics at entry against Year 3 completion data. The study was set in a nursing faculty in a higher education institution in northern England. Data were collected between 2009 and 2014 with five cohorts of students participating (n = 807).Multinomial logistic regression was used to model the dependent variable Progression Outcome with categories of; completion and non-completion (academic and non-academic reasons). Predictors included cohort, programme, branch, gender, age on entry, ethnic group, disability status, domicile, change of home postcode, change of term-time postcode, entry qualifications, previous experience of caring, and dependents.Age on Entry and Domicile or alternatively Dependents and Domicile emerged as statistically significant (p < 0.05) in the multivariable analysis. Older students were less likely to be lost from the programme, as were students who lived locally at all times and those with dependents.There is currently little reliable, consistent information on nursing student attrition, progression and completion. This study contributes to the evidence base by identifying some of the factors that may contribute to successful programme completion.     

An action research approach for developing research and innovation in nursing and midwifery practice: building research capacity in one NHS foundation trust

The National Health Service in the United Kingdom is committed to a process of reform centred on quality care and innovative practice. Central to this process is the need for research capacity building within the workforce. The aim of this study was to develop an infrastructure for research capacity building within one National Health Service Foundation Trust. Using an Action Research methodology, sixteen individuals were purposefully selected from a population of nurses and midwives to participate in the study. This nonprobability sampling method enabled the researchers to select participants on the basis of who would be most informative about existing research capacity building structures and processes within the Trust. Data were collected in the form of semi-structured individual interviews with each participant. The main findings were that research activity was not embedded in the culture of the organisation, and initiating and undertaking change was a complex process. As a result, a range of structures and processes which were considered necessary to enable the Trust move forward in developing capacity and capability for research were developed and implemented. This paper reports the first two stages of this process, namely: the findings from the pre-step and an outline of how these findings were used to create an infrastructure to support research capacity building within one NHS Foundation Trust Hospital in the United Kingdom.     

Clinical nursing research priorities in Australian critical care: a pilot study

The aims of this research project were to identify areas for research in Australian critical care nursing with potential for improvement in patient care, and to advise nursing research policy and priorities with relevance to areas of patients'needs Research participants represented a national sample of clinical nurse specialists (CNSs) and clinical nurse consultants (CNCs) The Delphi method was used to obtain the most reliable consensus of the specialist nurses, and over 238 research priorities were identified initially In the final phase of the research nine high priorities were identified The findings of this study suggest directions for clinical nursing research in critical care     

Job rotation in nursing: a study of job rotation among nursing personnel from the literature and via a questionnaire

AIMS: To obtain information on job rotation among nursing personnel from the literature and via a questionnaire. BACKGROUND: A nursing career no longer means a series of steps leading up a hierarchy. It has become more like a process of individual growth, involving improvement of employee expertise and skills. Job rotation in connection with career development in a Finnish hospital is considered essential, and participating in job rotation is one requirement for newly vacant nursing posts. METHODS: Describing job rotation by means of reference to literature, and studying a survey on attitudes of ophthalmic nurses (n = 84) to job rotation. RESULTS: There has been little theoretical or empirical research on job rotation. In this study, one in three had participated in job rotation that was most often considered a positive experience. Self-development was rated substantially useful, but fewer were interested in participating in various kinds of developmental activities. CONCLUSION: Employee's motivation is the foundation of successful development activity, e.g. job rotation.     

Puzzling practice: a strategy for working with clinical practice issues

In this paper we aim to share the evolution of innovative ways to explore, 'unpack' and reframe clinical issues that exist in everyday practice. The elements of these processes, which we call 'puzzling practice', and the techniques associated with them, were delineated over a two year period by the four authors using action theory based processes. The authors have evolved several different frameworks for 'puzzling practice' which we draw on and use in our practice development work and in our research practice. This paper pays attention to a particular form of puzzling practice that we have found to be useful in assisting individual clinicians and teams to explore and find workable solutions to practice issues.
The paper uses a semi-fictitious example of 'Puzzling Practice' gleaned from our experience as practice development facilitators. In this example 'puzzling practice' uses seven different elements; naming the issue; puzzling the issue; testing the puzzle exploring the heart of out practice; formulating the puzzle question; visualizing the future; and generating new strategies for action. Each of the elements is illustrated by the story and the key foundations and ideas behind each element is explored.