Shaping future nurse leaders through shared governance

The progression of five professional nurses from shared governance council chairs to unit director positions and the progression of three nurses from shared governance council chairs to clinical nurse specialist roles in an 18-year period provide compelling evidence of the impact shared governance has provided in the development of future nurse leaders in our organization. The collective wisdom of those who have lived this experience suggests that the opportunities inherent in these clinical nurse leadership roles make this a logical progression, including getting noticed and nudged, developing an understanding of the big picture, developing a results orientation, and substantial skill acquisition.     

Intentional Modelling: A Process for Clinical Leadership Development in Mental Health Nursing

Clinical leadership is becoming more relevant for nurses, as the positive impact that it can have on the quality of care and outcomes for consumers is better understood and more clearly articulated in the literature. As clinical leadership continues to become more relevant, the need to gain an understanding of how clinical leaders in nursing develop will become increasingly important. While the attributes associated with effective clinical leadership are recognized in current literature there remains a paucity of research on how clinical leaders develop these attributes. This study utilized a grounded theory methodology to generate new insights into the experiences of peer identified clinical leaders in mental health nursing and the process of developing clinical leadership skills. Participants in this study were nurses working in a mental health setting who were identified as clinical leaders by their peers as opposed to identifying them by their role or organizational position. A process of intentional modeling emerged as the substantive theory identified in this study. Intentional modeling was described by participants in this study as a process that enabled them to purposefully identify models that assisted them in developing the characteristics of effective clinical leaders as well as allowing them to model these characteristics to others. Reflection on practice is an important contributor to intentional modelling. Intentional modelling could be developed as a framework for promoting knowledge and skill development in the area of clinical leadership.     

A cognitive learning model of clinical nursing leadership

Cognitive modeling of competencies is important to facilitate learning and evaluation. Clinical nursing leadership is considered a competency, as it is a "complex know-act" that students and nurses develop for the quality of care of patients and their families. Previous research on clinical leadership describes the attributes and characteristics of leaders and leadership, but, to our knowledge, a cognitive learning model (CLM) has yet to be developed. The purpose of our research was to develop a CLM of the clinical nursing leadership competency, from the beginning of a nursing program to expertise. An interpretative phenomenological study design was used 1) to document the experience of learning and practicing clinical leadership, and 2) to identify critical-learning turning points. Data was gathered from interviews with 32 baccalaureate students and 21 nurses from two clinical settings. An inductive analysis of data was conducted to determine the learning stages experienced: awareness of clinical leadership in nursing; integration of clinical leadership in actions; active leadership with patient/family; active leadership with the team; and, embedded clinical leadership extended to organizational level and beyond. The resulting CLM could have significant impact on both basic and continuing nursing education.     

Reflection: an educational strategy to develop emotionally‐competent nurse leaders

Aim This paper explores educational strategies for nurses that focus on reflectivity and promote the development of self‐awareness, relationship and communication skills and ability to lead with presence and compassion in the midst of change. Background Today nurses move rapidly from carefully‐controlled educational experiences to a fast‐ paced clinical world of increasing patient complexity amid calls for improved quality of care. Making the transition to clinical competence and leadership in practice requires a strong sense of self and emotional intelligence. Evaluation Pedagogies that integrate theoretical and data‐based textbook learning with experiential learning and reflection are a foundation for the development of emotionally‐ and intellectually‐competent leaders and requires new ways of assessing learner outcomes. Key issues Reflection is a key instructional strategy for preparing transformational nurse leaders for interdisciplinary settings where they lead patient care management. The remarkable global spread of reflection in nursing education, practice and research follows an emphasis on developing self‐awareness as a leadership strategy for improving individual and organizational performance. Conclusions Empirical, experiential and anecdotal evidence suggests that reflection has the potential to prepare emotionally‐capable nurse leaders. Implications for Nursing Management As educators create more reflective and nurturing learning environments, they will promote the development of emotionally‐competent nurse leaders who will, in turn, inspire individual and organizational growth and positive change in society.     

The Ascension Health Experience: Maximizing the Chief Nursing Officer Role in a Large, Multihospital System to Advance Patient Care Quality and Safety

Ascension Health is the largest Catholic and nonprofit health system in the United States, encompassing 70 acute care hospitals organized into 34 health ministries. Consistent with its distributed leadership model, Ascension Health has created a Chief Nursing Officer (CNO) Advisory Council to provide strategic direction and thought leadership on major system-level initiatives that impact quality, safety, operational performance, nursing leadership, and patient care delivery. The council fosters systemwide CNO engagement and dialogue through a unique structure of regional CNO work teams called "pods," each of which is chaired by a member of the council. This communication structure has facilitated consensus on major system initiatives at Ascension Health related to clinical goals, patient safety, nursing leadership, and systemwide capital investments. This article describes the history, structure, goals, processes, and successes of the CNO Advisory Council shared governance model.     

Leadership attributes identified by practicing occupational health nurses.

This study examined which theoretical approaches to leadership occupational health nurses perceive as most desirable. The trait approach dominates in North American research literature, with occupational health nurses favoring the more traditional leadership attributes of "visionary," "intellectually creative," and "strong linguistic ability." Australian occupational health nurses identified the managerial character traits of "being well informed," "good communication skills," and "objective decision maker" as most appropriate traits of good leaders. Occupational health nurses need to develop alternative leadership approaches to acquire effective political and organizational strategies in today's competitive environment.     

Shared governance: what it means to those involved

Nurses saw shared governance as both a management philosophy and an organizational structure that changes the organizational culture and belief system. Because of these two aspects of shared governance, its implementation is an evolutionary process in which former roles are examined and new roles are learned. Power shifts during the implementation of shared governance create role conflicts and confusion in the decision domains of staff and managerial nurses. Shared governance is highly valued by participants as a mechanism to enhance commitment to the organization, accountability for nursing practice, and the professionalism of both the clinical and managerial staff. The participants valued the opportunities for growth and development of leadership skills that shared governance provided. While negative perspective were shared, they seemed to be secondary to the overall satisfaction with shared governance. Some of the negative perspectives seemed to relate to the length of experience with shared governance, whereas others seemed to be essential elements of the experience.     

Action learning: a tool for the development of strategic skills for Nurse Consultants?

young s., nixon e., hinge d., mcfadyen j., wright v., lambert p., pilkington c. & newsome c. (2010) Journal of Nursing Management 18 , 105–110
Action learning: a tool for the development of strategic skills for Nurse Consultants? Aim This paper will discuss the process of action learning and the outcomes of using action learning as a tool to achieve a more strategic function from Nurse Consultant posts. Background It is documented that one of the most challenging aspect of Nurse Consultant roles, in terms of leadership, is the strategic contribution they make at a senior corporate Trust level, often across organizations and local health economies. A facilitated action learning set was established in Brighton, England, to support the strategic leadership development of eight nurse consultant posts across two NHS Trusts. Evaluation Benefits to patient care, with regard to patient pathways and cross-organizational working, have been evident outcomes associated with the nurse consultant posts involved in the action learning set. Key issues Commitment by organizational nurse leaders is essential to address the challenges facing nurse consultants to implement change at strategic levels. Conclusions The use of facilitated action learning had been a successful tool in developing the strategic skills of Nurse Consultant posts within this setting. Implications for nursing management Action learning sets may be successfully applied to a range of senior nursing posts with a strategic remit and may assist post holders in achieving better outcomes pertinent to their roles.     

Cultivating a culture of research in nursing through a journal club for leaders: A pilot study

Aim

To describe whether an action learning‐inspired journal club for nurse leaders can develop the leaders' self‐perceived competences to support a research culture in clinical nursing practice.

Background

Development of clinical research capacity and nurse leaders with the requisite competences are key factors in evidence‐based health care practice. This study describes how nurse leaders at a large regional hospital took part in a journal club for nurse leaders, with a view to developing their competences to support a nursing research culture in their departments.

Methods

A pilot study using a multimethod approach to evaluate the journal club for nurse leaders. Four nurse leaders participated in the journal club for nurse leaders. Content analysis on the data was performed.

Results

Data revealed that participation in journal club for nurse leaders gave the leaders a feeling of increased competences to support nursing research culture in their departments. They stated that the action learning approach and the competences of the facilitator were key factors in this outcome.

Conclusions

An action learning‐inspired journal club for nurse leaders can be useful and meaningful to nurse leaders in developing leadership competences.

Implications for nursing management

As an approach in journal club for nurse leaders, action learning can develop nurse leaders' competence to support a research culture, and thus ensure evidence‐based nursing is practised.     

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.     

Understanding the impact of power in organizations.

Although implementation of Shared Governance appears to have failed, it failed primarily on the surface. Many staff nurses actively involved in the Shared Governance movement not only were empowered but were dramatically affected on a professional level. Several council chairpersons were empowered to assume management roles in the transition back to the hierarchial model--a manifestation of their professional growth and development. At the unit level, several units lobbied the new leadership to allow them to continue to do peer review and unit-based council management of unit governance issues. Three councils lobbied to continue to do their work, although in a modified role, in the reestablished hierarchial structure. The three remaining councils were those of Practice, Quality, and Research. If nurse leaders at any level within the organization are to guide their departments forward while in the throes of the current chaos in health care, they must develop and use their power bases, both formal and informal, as individuals and then as leaders. Russell Coile identifies the need for more clinical expertise (expert power) on the executive team of health care organizations. He predicts that 50% of the executive team will be nurses and physicians and that only health care executives with an MBA or financial backgrounds, who also have well-developed informal power bases with skills in relationship development, facilitation, and networking, will be part of the new system. Those with a diversified informal power base will be most successful in guiding their organization to its destination. The future for nursing leaders is in the sharing of information; it is about embracing diversity and recognizing the contributions others can make that are refreshingly different; it is also about clearly defining a balance in life, because balanced leaders who have found a way to nurture and meet their own needs are better positioned to do the same for others. Ultimately, understanding the impact of power in an organization, regardless of organizational structure, begins with understanding and defining your own power base.     

The Magnet process: one appraiser's perspective

Achieving Magnet designation is a journey to excellence. Although excellence is never quite attained, Magnet organizations have nursing leaders who are able to implement innovative nursing programs that attract and retain nursing's best and brightest. These leaders have raised the bar on excellence and are able to demonstrate performance that is in the upper quartile among benchmarks. Even though financial pressures require astute budgetary skill, these leaders do fund research and education programs, are involved in shared leadership/governance activities, and are thus able to demonstrate fiscal accountability in the process. Nurse leaders in Magnet organizations have a highly engaged professional staff as evidenced by active participation in shared governance activities. These leaders have not only created interdisciplinary approaches to patient care and clinical documentation, acuity, and research but also they have hardwired these activities into the fabric of the organization.     

Preliminary clinical nursing leadership competency model: a qualitative study from Thailand

This qualitative study explored the clinical nursing leadership competency perspectives of Thai nurses working in a university hospital. To collect data, in-depth interviews were undertaken with 23 nurse administrators, and focus groups were used with 31 registered nurses. Data were analyzed using content analysis, and theory development was guided by the Iceberg model. Nurses' clinical leadership competencies emerged, comprising hidden characteristics and surface characteristics. The hidden characteristics composed three elements: motive (respect from the nursing and healthcare team and being secure in life), self-concept (representing positive attitudes and values), and traits (personal qualities necessary for leadership). The surface characteristics comprised specific knowledge of nurse leaders about clinical leadership, management and nursing informatics, and clinical skills, such as coordination, effective communication, problem solving, and clinical decision-making. The study findings help nursing to gain greater knowledge of the essence of clinical nursing leadership competencies, a matter critical for theory development in leadership. This study's results later led to the instigation of a training program for registered nurse leaders at the study site, and the formation of a preliminary clinical nursing leadership competency model.     

Shared governance--nurses making a difference

AIM: This paper aims to describe how shared governance can be successfully integrated into existing management structures in a large medical directorate. It will show how the shared governance philosophy can lead to the creation of a culture where nurses feel important and valued and also consider its use as a foundation for the implementation of the nursing strategy. BACKGROUND: The hospital adopted shared governance in 1995 with the setting up of councils led by staff nurses. Shared governance advocates claim it broadens involvement of clinically-based nurses in the process of change through devolved decision-making thereby enhancing clinical practice and increasing staff moral and self-esteem. Key issues Shared governance is a cultural change that will develop the leadership and management skills of all grades of staff. Shared governance is not a quick fix for the profession; involvement of all staff needs time, persistence, determination and a strong commitment to training and development. CONCLUSION: The national nursing strategy puts nurses in a position to positively influence health care for the advantage of patients, however, for nurses to grasp this opportunity cultural change is required. This practical example of shared governance demonstrates how it can be used to create a proactive culture, focused on improving patient care. The nurturing and developing of clinically-based nurses provides them with the knowledge and skills to challenge the status quo and lead change. Thus, shared governance is an excellent foundation from which to develop the nursing strategy.     

Flexible education for new nursing roles: reflections on two approaches

Using reflection within a metacognitive model this paper aims to explore and discuss two recently developed approaches to flexible education. The increasing number of new nursing roles coupled with a dramatically changing health care environment determines the need for educational approaches that recognise and value learning in daily practice. By presenting a lecturer’s and a student’s reflections of two such approaches (accredited work-based learning at level 2/3 and the MA Advanced Practice) within one paper we have sought to capture the essence of learning that occurs at the interface between patient care and nurse education at three different academic levels and from two different perspectives. From the lecturer’s perspective, the pivotal role that work-based learning approaches can play in the ongoing development of health care is identified. The importance of collaboration in developing and delivering accredited work-based learning is recognised and the value of reflection in and on practice when facilitating the learning of work-based students has been demonstrated. The lecturer’s development of a facilitative teaching style is argued to be as important as the student’s development of reflective skills in order that education and practice can grow together. From the students perspective, completing the MA Advanced Practice fostered integration between theory and practice, alongside the opportunity for cross-fertilisation of ideas between two traditionally different practitioners of nursing and medicine. This exposed several benefits within clinical practice for the client group that the practice project was aimed at and the development of a more holistic understanding of the clinical experience as it related to individual learning, self-reflection and self-awareness.     

Shared governance and shared leadership: meeting the challenges of implementation

New forms of leadership are required if staff are to be effectively engaged and involved in decision-making and promoting clinical effectiveness. One such mechanism is shared governance and shared leadership to ensure practice is both practitioner owned and organizationally supported. Empowering staff is a great challenge requiring effective planning, preparation and commitment. Establishing the process of shared governance requires effective leadership, implementation of a suitable framework, multidisciplinary working and examination of the organization's structure and culture. This paper discusses the challenges of implementation, preparation of staff, and alignment with the organizational agenda. It emphasizes that shared governance is an ongoing and fluid process, requiring continual assessment and re-evaluation in order to be flexible and responsive to an ever-changing environment. The Christie model provides a sustainable framework for moving practice forward and successful implementation has led to greater coordination of practice development and sharing of best practice.     

Ward management: education for senior staff nurses

The key professional challenges for senior staff nurses relate to managerial rather than clinical issues, but there appears to be a lack of educational preparation for the managerial roles expected of them. An educational service was developed, implemented and evaluated in a specialist paediatric unit to address senior staff nurses' concerns related to managerial aspects of their role. An organisational development model was used to negotiate a work-based learning programme that incorporated practice competencies. This was undertaken at an Agenda for Change implementation site, which enabled the Knowledge and Skills Framework (KSF) to be trialled in practice. The educational programme was evaluated positively and practice competency evaluations highlighted how the KSF dimensions provided a usable and relevant breakdown of managerial and leadership issues. The framework provided a professional development tool for staff wishing to progress their managerial knowledge and skills while under supervision.     

CA8-01: Can the HMORN Transform Itself into a Learning Health Care Network?

Background/Aims The national case for learning healthcare systems was made in a 2006 Institute of Medicine (IOM) workshop. The IOM's vision was healthcare systems where "the process of generating and applying the best evidence will be natural and seamless components of the process of care itself." HMORN members have the potential to model this future, but few of them have yet achieved the necessary levels of integration with their affiliated care and insurance organizations and none fulfill the IOM vision. The Mental Health Research Network (MHRN) proposes to build such integrated relationships with each of its partner organizations and knit them together into a learning healthcare network for mental health in hopes of becoming a model for a future HMORN learning network. Methods Phase I: a lead at each MHRN research group identifies appropriate leaders among their organizational partners and builds bidirectional relationships while identifying their mental health improvement priorities, researchable problems, and questions. Phase II: these new partnerships are formalized through periodic meetings and small projects while developing partnership grant proposals that address operational leaders' priorities. Phase III: we demonstrate the seamless generation and application of evidence within each organization desired by the IOM. Phase IV: we collaborate across MHRN members as a learning network and a template for the HMORN to become a learning healthcare network. Results We are just beginning, building the relationships and trust that will turn into more formal structures in Phase II and shared projects and studies. Each site has a person to coordinate this effort and a list of important mental health affiliated leadership positions. The level of partnership varies from regular meetings at some sites to just beginning conversations at others. This presentation will quantify our progress, describe barriers encountered, and provide concrete examples. Discussion MHRN and HMORN have an opportunity to be leaders in transforming health care by organizing and modeling learning through strategic bidirectional partnerships. If anyone can achieve the IOM vision, it should be us, but the path is unclear and the cultural and historical barriers are many.     

Knowledge is power: using nursing information management and leadership interventions to improve services to patients, clients and users

Aim This paper examines the purpose, role and function of information and information management within health care today. It is set within the context of a specialist forensic learning disability setting. Background Changes in politics, government legislation and reforms of the National Health Service (NHS) have created a need to equip managers with the necessary tools and skills to be able to lead and manage effectively. As such there has been a great emphasis upon specialist training, such as the government-driven Leading an Empowered Organisation courses, for nurse managers and nurses with leadership potential. Yet with the drive to generate a new wave culture within the NHS of inspirational leaders, are we still overlooking a critical and key area which is fundamental in achieving and delivering cost effective, quality health care – the area of information management within health care today? Methods The processes presented in this paper are structured through a strategic nursing management and leadership performance implementation model, the Clinical Nursing Leadership Learning and Action Process (CLINLAP) model, which facilitates work-based learning and capability development in the reality of everyday clinical activities. Through the model, the emphasis is to make clinical goals specific, roles explicit, processes clear and encourage these activities to be carried out within an environment of open relationships. Results The use of CLINLAP model assisted as a management and leadership technology to manage change in the workplace so as to improve services to patients in Yelday Lodge. Structured management and leadership interventions led to observable positive change in information management on Yelday Lodge. Conclusions The conclusion is that sustained quality information could be embedded in nursing practice at Yelday Lodge or elsewhere by evaluating and discussing the different information management approaches within the practice area through the use of structured management and leadership interventions. The use of the CLINLAP model is recommended for use as a model for managing information, knowledge and communication for results within nursing and health care services.