Clinical leadership and pre-registration nursing programmes: A model for clinical leadership and a prospective curriculum implementation and evaluation research strategy

AimTo present for wider debate a conceptual model for clinical leadership development in pre-registration nursing programmes and a proposed implementation plan.BackgroundGlobally, leadership in nursing has become a significant issue. Whilst there is continued support for leadership preparation in pre-registration nursing programmes, there have been very few published accounts of curriculum content and/or pedagogical approaches that foster clinical leadership development in pre-registration nursing. A doctoral research study has resulted in the creation of an overarching model for clinical leadership.DesignA multi-method research study using theoretical and empirical literature 1974–2015, a focus group, expert opinion and a national on-line survey.DiscussionA conceptual model of clinical leadership development in pre-registration nursing programme is presented, including the infinity loop of clinical leadership, an integral curriculum thread and a conceptual model: a curriculum-pedagogy nexus for clinical leadership. In order to test out usability and evaluate effectiveness, a multi method programme of research in one school of nursing in Australia is outlined.ConclusionImplementation of the proposed conceptual model for clinical leadership development in pre-registration nursing programmes and a programme of (post-doctoral) research will contribute to what is known about curriculum content and pedagogy for nurse academics. Importantly, for nursing students and the profession as a whole, there is a clearer expectation of what clinical leadership might look like in the novice registered nurse. For nurse academics a model is offered for consideration in curriculum design and implementation with an evaluation strategy that could be replicated.     

Education purchasers’ views of nursing as an all graduate profession

The issue of whether nursing should be an all graduate profession is one of the most important questions currently facing the nursing profession. The literature indicates that there are differing views on this issue but that there is little research on the performance of graduate nurses in practice. Purchasers of education have played an increasingly significant part in nurse education since the advent of Working Paper 10 (WP10) (DOH 1989). Purchasers hold the resources for nurse education and can now decide whether to commission for diploma or degree level student nurses, therefore they will have a major influence on the outcome of this debate. The aim of this paper is to discuss the views of the purchasers of education about this issue. A purposeful sample of 34 key stakeholders involved in commissioning and contracting for education was selected and asked for their views on whether nursing will or should become an all graduate profession. Key areas that were focused upon were the problems that might emerge from an all graduate nursing profession, the advantages of graduate level nurses within the NHS, what graduateness is and what it might mean for nursing. The results indicated that purchasers were convinced of the importance of nursing graduates but only as part of the workforce. Alternative ways of increasing the percentage of graduates rather than in pre-registration education were preferred with pathways of education linked to continuing professional development. Significantly, the participants were able to articulate the attributes of a degree level education for clinical practice including leadership, assertiveness, and reflective, critical skills.     

Education purchasers' views of nursing as an all graduate profession

The issue of whether nursing should be an all graduate profession is one of the most important questions currently facing the nursing profession. The literature indicates that there are differing views on this issue but that there is little research on the performance of graduate nurses in practice. Purchasers of education have played an increasingly significant part in nurse education since the advent of Working Paper 10 (WP10) (DOH 1989). Purchasers hold the resources for nurse education and can now decide whether to commission for diploma or degree level student nurses, therefore they will have a major influence on the outcome of this debate. The aim of this paper is to discuss the views of the purchasers of education about this issue. A purposeful sample of 34 key stakeholders involved in commissioning and contracting for education was selected and asked for their views on whether nursing will or should become an all graduate profession. Key areas that were focused upon were the problems that might emerge from an all graduate nursing profession, the advantages of graduate level nurses within the NHS, what graduateness is and what it might mean for nursing. The results indicated that purchasers were convinced of the importance of nursing graduates but only as part of the workforce. Alternative ways of increasing the percentage of graduates rather than in pre-registration education were preferred with pathways of education linked to continuing professional development. Significantly, the participants were able to articulate the attributes of a degree level education for clinical practice including leadership, assertiveness, and reflective, critical skills.     

Primary health care content in Australian undergraduate nursing curricula

The importance of primary health care PHC is receiving increasing attention. The demand for skilled workers is due to an increased emphasis on community-based care but until recent times pre-registration preparation for nurses, including clinical placements, have focussed on acute care specialties.AimTo systematically review, measure and describe the PHC content in the undergraduate nursing curriculum in Australian schools of nursing over time.MethodsA cross-sectional study of all Australian universities offering undergraduate (pre-registration) baccalaureate degrees was undertaken in February 2017. Curriculum artifacts were retrieved from university websites. A terminology matrix guided retrieval of PHC content.FindingsAll 29 universities offering pre-registration undergraduate nursing degrees in Australia were included in this study. While most universities cite PHC principals as core values underpinning their undergraduate curriculum, only 12 (<2%) of the 694 subject titles had obvious or manifest “primary health care” content and these were mainly offered in 1st and 3rd year. Subject outlines tended to demonstrate more explicit content than subject titles.DiscussionThis study confirms ambiguity in PHC interpretation and nomenclature, and opportunities for undergraduate preparation for nursing roles in the home setting is limited. Prospective undergraduate nurses seeking careers in PHC might be deterred by a lack of manifest PHC content in the public domain, which may or may not accurately represent the actual content provided.ConclusionThe predominance of acute episodic care in both curricula and clinical experiences potentially diminishes the importance of PHC. This study offers some direction for education providers and policymakers wishing to attract and prepare next generation nurses for roles in PHC.     

Extended immersive simulation to develop nontechnical skills: Content analysis of students' views

BackgroundThe purpose of undergraduate nursing education is the preparation of graduates for clinical practice. Despite this focus, graduates are often unprepared for independent practice, particularly in the use of skills such as time management, delegation and critical thinking in clinical situations. This paper reports on students’ views of using extended, immersive simulation to consolidate the use of both technical and nontechnical skills in preparing them for independent nursing practice.AimTo investigate students’ views on the value of extended, immersive simulation in preparing them for independent practice as registered nurses.MethodsCross-sectional research involving content analysis of open-ended survey questions. The study involved comments from 287 final year nursing students conducted at a university in Western Australia.FindingsThemes related to critical thinking, the role of the registered nurse, communication, time management, teamwork and leadership were identified through the content analysis. Students believed exposure to extended simulation facilitated development of the essential skills required to practise independently and helped them prepare for the role of a registered nurse. Many expressed the wish for this type of simulation to be included throughout all years of the nursing curriculum.DiscussionStudents need experience in clinical situations where they are challenged to use multiple skills simultaneously to develop the expertise required of registered nurses. The ability to practise independently, and take responsibility for decisions made in complex ward conditions, is not currently required of students on clinical placements. Simulation is a way to fill this void in nursing education to enable students to experience the full role of a registered nurse.ConclusionBased on our findings nursing students believed that extended, immersive simulation was an effective method of supporting students as they undertake the full responsibilities of registered nurses to enable them to be safe and effective practitioners on commencement of the registered nurse role.     

Science knowledge needed for nursing practice: A cross-sectional survey of Australian Registered Nurses

Background

Nursing practice is underpinned by science knowledge. While the literature is consistent in identifying limitations in teaching science content to nurses, there is a lack of consensus regarding what should be taught and to what level of detail. No studies to date have systematically surveyed registered nurses (RNs) for their perspectives about the science knowledge that should underpin nursing practice.

Nursing students’ evolving professional values: Capturing their journey through co-operative inquiry

Aim/objective and BackgroundDespite a worldwide emphasis in nursing codes of practice that state nurses must uphold professional values to be caring and compassionate, evidence continues to emerge of poor-quality care standards. Existing literature attests to a tendency to deteriorating caring values as students’ progress through their nursing programme. In response, one university in England exposed pre-registration nursing students to a values-based curriculum which embedded Todres et al.’s (2009) Humanising Values Framework.Design and MethodsThis paper describes the later stages of a co-operative inquiry, where students as participants explore their evolving values around person-centred approaches to care as they engaged with clinical practice. Data were collected between 2013 and 2016.Results and ConclusionFindings reveal how students developed their confidence and resilience in the face of situations that challenged their value base by internalising a humanised approach to care. They demonstrated this in practice by using problem-based coping strategies, peer and mentor support. Engagement with a curriculum based on humanistic philosophy encouraged students as participants to feel confident in the practice of person-centred care.     

The Importance of Communication for Clinical Leaders in Mental Health Nursing: The Perspective of Nurses Working in Mental Health

Communication has been identified as an important attribute of clinical leadership in nursing. However, there is a paucity of research on its relevance in mental health nursing. This article presents the findings of a grounded theory informed study exploring the attributes and characteristics required for effective clinical leadership in mental health nursing, specifically the views of nurses working in mental health about the importance of effective communication in day to day clinical leadership. In-depth interviews were conducted to gain insight into the participants’ experiences and views on clinical leadership in mental health nursing. The data that emerged from these interviews were constantly compared and reviewed, ensuring that any themes that emerged were based on the participants' own experiences and views. Participants recognized that effective communication was one of the attributes of effective clinical leadership and they considered communication as essential for successful working relationships and improved learning experiences for junior staff and students in mental health nursing. Four main themes emerged: choice of language; relationships; nonverbal communication, and listening and relevance. Participants identified that clinical leadership in mental health nursing requires effective communication skills, which enables the development of effective working relationships with others that allows them to contribute to the retention of staff, improved outcomes for clients, and the development of the profession.     

Evidence-based practice and evidence-informed practice competencies in undergraduate pre-registration nursing curricula: A document analysis at a university in England

BackgroundIn response to the heightened emphasis on incorporating the best available evidence into healthcare decision-making, healthcare training institutions have been actively incorporating Evidence-Based Practice (EBP), and/or Evidence-Informed Practice (EIP) competencies into undergraduate healthcare curricula. However, there is a gap in the scientific knowledge about the actual contents, as well as the extent of integration of EBP and EIP in undergraduate pre-registration nursing programmes.MethodA document analysis utilising Rohwer et al.’s (2014) framework was conducted to review and analyse the content of EBP and EIP competencies in the 2018/2019 curriculum of the undergraduate pre-registration nursing programme of a University located in England, United Kingdom.ResultsCompetencies relevant to EBP were included in four nursing modules. However, EIP competencies were not included in the curriculum.ConclusionThere is an urgent need for a more structured and holistic way of teaching and assessing EBP competencies through the integration of the principles of EIP, in order to enhance the effective application of evidence into clinical nursing practice.     

Leadership and Mental Health Nursing

This discussion paper argues for the critical importance of successful leadership for effective mental health nursing, observing that nursing leadership has long been regarded problematically by the profession. Using empirical and theoretical evidence we debate what leadership styles and strategies are most likely to result in effective, recovery-orientated mental health nursing. Models of transformational and distributed leadership are found to be highly congruent with mental health nursing values, yet the literature suggests it is a type of leadership more often desired than experienced. We note how the scholarly literature tends to ignore the “elephant in the room” that is organizational power, and we question whether transformational leadership pursued within a specific clinical context can influence beyond those confines. Nevertheless it is within these contexts that consumers experience nursing, effective or otherwise, thus we should advocate what is known about effective leadership wherever it is required.     

An exploration of the influences on under-representation of male pre-registration nursing students

BackgroundWorldwide, men are under-represented in the nursing profession. In Scotland less than 10% of pre-registration nursing students are male. Reasons for this imbalance need to be understood.ObjectivesTo explore the views of male pre-registration nursing students, nursing lecturers and school teachers about this imbalance.DesignMixed methods study using focus groups and online survey.SettingsFocus groups in four locations across Scotland. Online survey sent to teachers across Scotland.Participants and methodsEight focus groups with 33 male nursing students; four focus groups with 21 university and college nursing lecturers; 46 school teachers returned the online survey.ResultsAlthough nursing was considered a worthwhile career with job stability and many opportunities, it was also viewed as not being a career for men. Assumptions about the profession and femininity were challenging for men and use of the term ‘male nurse’ was felt to be anomalous. In some circumstances the provision of intimate care to particular patient groups caused difficulty. Positive encouragement from others, a positive role model or knowledge of nursing from significant others could be helpful. However concerns about low earning potential and negative media publicity about the NHS could be a disincentive. Being mature and having resilience were important to cope with being a male nursing student in a mainly female workplace. Some more ‘technical’ specialties were felt to be more attractive to men.ConclusionsNursing is viewed as a worthwhile career choice for men, but the gendered assumptions about the feminine nature of nursing can be a deterrent.     

Survey of Australian Schools of Nursing Use of Human Patient (Mannequin) Simulation

Rapid adoption of high-fidelity human patient (mannequin) simulation has occurred in Australian Schools of Nursing in recent years, as it has internationally. This paper reports findings from a 2012 online survey of Australian Schools of Nursing and builds on findings of earlier studies. The survey design allowed direct comparison with a previous study from the USA but limited its scope to the pre-registration (pre-service Bachelor of Nursing) curriculum. It also included extra mental health specific questions. Australian patterns of adoption and application of high-fidelity human patient (mannequin) simulation in the pre-registration nursing curriculum share features with experiences reported in previous US and Australian surveys. A finding of interest in this survey was a small number of Schools of Nursing that reported no current use of high-fidelity human patient (mannequin) simulation and no plans to adopt it, in spite of a governmental capital funding support programme. In-line with prior surveys, mental health applications were meagre. There is an absence of clearly articulated learning theory underpinnings in the use of high-fidelity human patient (mannequin) simulation generally. It appears the first stage of implementation of high-fidelity human patient (mannequin) simulation into the pre-registration nursing curriculum has occurred and the adoption of this pedagogy is entering a new phase.     

Perspectives of Australian Nursing Directors Regarding Educational Preparation for Mental Health Nursing Practice

There is an ongoing global shortage of mental health nurses. Within Australia, the principal strategy of offering a postgraduate education programme with various incentives to encourage nurses back to study has not been successful. This has led to the consideration of radical alternatives, including the return to pre-registration specialisation in mental health. The successful introduction of this strategy would require the full support of industry partners. To date, the voice of industry has not been heard in relation to this issue. The aim of this paper is to present the views of an Australian sample of mental health nursing directors regarding the resources and other factors required, should undergraduate specialist programmes in mental health be developed, to ensure they are relevant and likely to be successful. A qualitative exploratory research project was undertaken to explore the perspectives and opinions of industry partners. In-depth interviews were conducted with nursing directors (n = 12) in Queensland Australia. Five main themes were identified: relationships with universities; clinical placement preparation and support; workplace culture; facilitators and preceptors; and practical student learning. Genuine collaboration between the two organisations was considered crucial for delivering a quality programme and providing the required support for students. Transformative leadership could inform this collaboration by promoting acknowledgement of and respect for differences.     

Developing leadership in postdoctoral nurses: A longitudinal mixed-methods study

BackgroundPostdoctoral nurses have an important role in advancing nursing by generating knowledge and building networks in research, practice, and education which requires effective leadership. Therefore, the Leadership Mentoring in Nursing Research programme for postdoctoral nurses was developed.PurposeThis study was to evaluate expectations, experiences, and perceived influence of the leadership mentoring programme on leadership and professional development, professional identity, and research productivity of postdoctoral nurses.MethodsA longitudinal mixed-method study with a concurrent triangulation design was used with data collected through semistructured interviews and online surveys.FindingsThe leadership mentoring programme was found to be valuable by the participants who described strengthened leadership and professional development and development of professional identities. Participants showed increased research productivity and many moved to new/higher positions.DiscussionThe leadership mentoring programme was found to enhance the leadership and professional development of postdoctoral nurses and support them in their academic careers.     

Learning from history: Frances Gillam Holden,a leadership perspective then and now

BackgroundCritical evaluation of leadership styles through a historical lens is uncommon. There could be missed opportunity for current and emerging nurse leaders to critically evaluate the leadership styles of the past in order to discerningly reflect on their own current leadership.AimTo critically examine the work of Australian nurse Frances Gillam Holden as she developed her vision for servant leadership for nursing in Australia in the late 19th century.MethodsExploration of, and critical reflection on, literature outlining Frances Gillam Holden's work.FindingsHolden's work and experience demonstrate the challenges faced by the profession's leaders at the turn of the century as they attempted to negotiate new ‘scientific’ knowledge and integrate this into nursing leadership. An examination of Holden's experience also demonstrates the difficulties faced by Australian nurse leaders during this time and consideration is given to what leadership in nursing looks like in the present day.DiscussionWithin the wealth of historical narratives, along with their complexities, the impact of this knowledge can have a demonstrated effect that can be far reaching and long lasting. This is particularly evident in regard to the role of nurses, nursing, and the development of modern approaches to nursing leadership, particularly with regard to the rise of nurse leaders in the form of ‘e-nurses’ and the use of social media to inform and lead the profession.ConclusionUnderstanding the influence and impact of nursing history, and historical nursing leaders such as Holden, on current leadership practices is being recognised more as contributing to contemporary nursing identity.     

Towards nursing leadership for professional and career outcomes of Bachelor of Nursing (Honours) students: A case study

BackgroundWithin Australia and internationally, there is increasing and widespread recognition of the importance of developing nurses’ capabilities in research and evidence-based practice to advance the discipline. Literature is sparse on the contribution of nursing Honours degrees to academic, professional, and industry outcomes in nursing.Aims and objectivesTo critically evaluate the contribution of a Bachelor of Nursing (Honours) degree to individual career development and nursing leadership, the profession, higher education, and the health industry to inform future directions.MethodsThis case study of a longstanding Bachelor of Nursing (Honours) degree uses data collected from multiple sources. The data included university and public records, as well as an anonymous online survey in 2018-19 of all students who had enrolled in the programme since 2004. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Cross-Sectional Studies checklist was followed.FindingsOf the 95 Honours programme graduates, 22.1% (n = 21) progressed to PhD studies, and 33.7% (n = 32) produced one or more publications. Of the 42 participants who accessed the survey, 78.6% (n = 33) had completed the nursing Honours programme, and 21.4% (n = 9) had commenced but did not complete the degree. Insufficient time was the main reason for not completing the nursing Honours degree, and qualitative responses indicated the nursing Honours degree developed student confidence and skills relevant to research and professional practice.DiscussionFindings highlight opportunities for nursing Honours degrees to contribute to individual achievement, best practices in healthcare, development of future leaders in nursing, and discipline-specific research outcomes.ConclusionNursing Honours degrees can offer important benefits to the individual, as well as the profession and the healthcare industry.     

Teamwork,clinical leadership skills and environmental factors that influence missed nursing care – A qualitative study on hospital wards

AimTo explore how nursing teams in clinical inpatient nursing hospital wards perform teamwork to prevent or reduce missed nursing care and how teamwork is influenced by clinical leadership skills and environmental factors.BackgroundEarlier studies on missed nursing care identified teamwork and leadership skills as promising factors in inpatient care that can positively influence quality of care and reduce missed nursing care. The effective use of teamwork in hospitals requires understanding what it is, how it is performed by nursing teams and how it is influenced by clinical leadership skills and environmental factors.DesignA qualitative exploratory study was undertaken between January and March 2021.MethodsA total of 16 registered nurses who worked on various hospital wards, participated in three online focus groups. Data were analyzed with thematic analysis according to Braun and Clarke.ResultsThematic analysis revealed four themes. First, nurses perform teamwork and clinical leadership skills in various ways. Some nurses work in pairs and have common goals, while other nurses work individually. This influences teamwork. Second, nurses are informal teachers, visible in teaching and learning from each other, contributing in constructive teamwork. Third, senior nurses are seen as informal leaders, forming connection between nursing wards and formal leaders, resulting in awareness of each other and the progress of patientcare. Finally, environmental factors influence the performance of teamwork.ConclusionsResults of this study show how knowledge regarding missed nursing care can be increased. Results can be used for developing training programs and embedding education in practice aimed at constructive teamwork, clinical leadership skills and missed nursing care.     

Facilitators of professional socialisation of learners in the clinical learning areas: A qualitative systematic review

BackgroundProfessional socialisation is significant in nursing as it involves immersing learners in the profession so that they adopt the ethical values and conduct of the profession. It is in the clinical learning areas where learners observe and practise those values. The objective of the review was to explore the factors that promote professional socialisation of learners in the clinical learning areas. The problem is the inadequate support for learner nurses in the clinical learning areas. The South African community has lost trust in nurses and that was even acknowledged in the national nursing summit in 2011.ObjectivesTo present a review of the factors that facilitate professional socialisation among undergraduate nursing learners.MethodA systematic review was conducted on literature from 2008 to 2018. The literature search focused on factors that facilitate professional socialisation of learner nurses. A search of databases was conducted in CINAHL, MEDLINE, Google Scholar and Science Direct. The search focused on literature on professional socialisation of learner nurses published from 2008 to 2018. The search resulted in 3035 articles which were further reduced to 13 after further synthesis. Critical appraisal skills programme was used to assess the quality of the studies.ResultsThree main themes emerged. Learner factors, factors in the clinical learning areas and interpersonal factors were identified as the factors that facilitate professional socialisation of learners.ConclusionLearners should have self-motivation and be supported and assisted to develop a positive professional identity. The clinical learning environment should have effective communication that fosters learning. Professional nurses should act as exemplary role models so that learners can emulate the conduct and practice. The review brought to light that the professional socialisation of learners is affected by the learner factors, clinical learning areas and personal factors.