Academic nursing leadership in a rural setting: Different game,same standards

The call for transformation of nursing education and practice continues to be a national priority. The American Association of Colleges of Nursing recommends enhanced partnerships between academic nursing and academic health centers to advance nursing and healthcare. For academic leaders in rural settings, the context of health and healthcare means that these partnerships are vastly different from academic health centers. The purpose of this article is to describe the context of nursing education and practice in regions that are predominantly rural. The challenges and opportunities for rural academic leaders as they respond to calls for transforming the education of the future nursing workforce are described from the perspective of resources, recruitment and retention of faculty, clinical education and faculty practice, scholarship, and fundraising. Meeting rural health workforce needs is a national imperative and a priority of academic nursing leaders in rural settings.     

Creating an education and research consortium. Framework and development

Today's schools of nursing and clinical organizations providing nursing care need to synchronize their efforts to maximize one another's achievements. This article describes how complementary goals of two or more organizations can be achieved through mutual efforts, and briefly details the process of consortium development and the role of leaders in this process. Interorganizational collaboration examples are discussed at two institutions in two different regions of the country, and the authors offer a number of ways that nursing education and practice can work together to meet their overlapping needs, attack the nursing shortage, and move nursing education and practice toward evidence-based care.     

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.     

Authentic leaders creating healthy work environments for nursing practice.

Implementation of authentic leadership can affect not only the nursing workforce and the profession but the healthcare delivery system and society as a whole. Creating a healthy work environment for nursing practice is crucial to maintain an adequate nursing workforce; the stressful nature of the profession often leads to burnout, disability, and high absenteeism and ultimately contributes to the escalating shortage of nurses. Leaders play a pivotal role in retention of nurses by shaping the healthcare practice environment to produce quality outcomes for staff nurses and patients. Few guidelines are available, however, for creating and sustaining the critical elements of a healthy work environment. In 2005, the American Association of Critical-Care Nurses released a landmark publication specifying 6 standards (skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition, and authentic leadership) necessary to establish and sustain healthy work environments in healthcare. Authentic leadership was described as the "glue" needed to hold together a healthy work environment. Now, the roles and relationships of authentic leaders in the healthy work environment are clarified as follows: An expanded definition of authentic leadership and its attributes (eg, genuineness, trustworthiness, reliability, compassion, and believability) is presented. Mechanisms by which authentic leaders can create healthy work environments for practice (eg, engaging employees in the work environment to promote positive behaviors) are described. A practical guide on how to become an authentic leader is advanced. A research agenda to advance the study of authentic leadership in nursing practice through collaboration between nursing and business is proposed.     

Advancing the clinical nurse leader model through academic-practice-policy partnership

The nursing profession is tasked with identifying and evaluating models of care with potential to add value to health care delivery. In consideration of this goal, we describe the Clinical Nurse Leader (CNL) initiative and the activities of a national-level CNL research collaborative. The CNL initiative, launched by the American Association of Colleges of Nursing in collaboration with education and healthcare leaders, has delineated CNL education curriculum and practice competencies, and fostered the creation of academic-practice-policy partnerships to pilot CNL integration into frontline nursing care delivery. The partnership has evolved into an Agency for Healthcare Research and Quality affiliate practice-based research network, the CNL Research Collaborative, which links research, policy, education, and practice stakeholders to advance the CNL evidence base. We summarize foundational CNLRC research to explain CNL practice, quantify CNL effectiveness, and bring clarity to how CNLs can be implemented to consistently influence care, quality, and safety.     

The academic nursing practice dean: an emerging role

This article describes the contributions of academic nursing practice to nursing education; delineates the role characteristics and competencies needed by academic practice deans; and provides examples of the challenges and issues academic practice deans face related to nursing education, research, and practice. While schools' missions vary from a strong focus on education to multiple emphases on education, research, and practice, academic nursing practice has the potential to facilitate achievement in each of these areas. Academic nursing practice deans play important roles in advancing the missions of their schools through the clinical practice activities within the schools. Strong academic nursing practice programs can serve as catalysts for the development and refinement of new models of care delivery and for the development of future nursing leaders who are comfortable with innovation.     

What Lies Beneath? The Underlying Principles Structuring the Field of Academic Nursing in Ireland

This article reports the findings of a structural analysis of the field of academic nursing in Ireland and considers the implications of the field's current structure for its present status and future trajectory in the academy. Six years after preregistration nursing education transferred to the higher education sector, tensions continue to exist concerning the status and legitimacy of academic nursing and of those who profess to profess it. The languages of legitimation of senior nursing academics and national nursing leaders (n = 16) were elicited and subjected to a critical discourse analysis. Respondents' languages were analyzed in terms of the settings of four underlying structuring legitimation principles: autonomy, density, specialization, and temporality. Academic nursing in Ireland was found to be structured by low autonomy, high density, and weak specialization. I conclude that academic and professional leaders in Irish nursing need to urgently consider how academic nursing can reconfigure its relationships with clinical nursing, increase its intellectual autonomy, enhance its internal coherence and cohesiveness, strengthen the epistemic power of its knowledge base, and critically evaluate the ways in which past practices inform its present and whether and to what extent they should shape its future.     

Policy analysis and advocacy in nursing education: the Nursing Education Council of British Columbia framework

Academic nursing leaders play a crucial role in the policy context for nursing education. Effectiveness in this role requires that they work together in presenting nursing education issues from a position of strength, informed by a critical analysis of policy pertaining to the delivery of quality nursing education and scholarship. We describe a collective process of dialog and critical analysis whereby nurse leaders in one Canadian province addressed pressing policy issues facing governments, nursing programs, faculty, and students. Consensus among academic nurse leaders, formalized through the development of a policy action framework, has enabled us to take a stand, at times highly contested, in the politicized arena of the nursing shortage. We present the components of a policy action framework for nursing education and share examples of how we have used a critical approach to analyze and frame policy issues in nursing education for inclusion on policy agendas. We believe our work has influenced provincial and national thinking about policy in nursing education is the foundation of our conclusion that political presence and shared strategy among academic nursing leaders is undeniably critical in the global context of nursing today.     

Finding common ground in public health nursing education and practice

Preparation of the public health nursing (PHN) workforce requires public health nurses from academia and practice to collaborate. However, a shortage of PHN clinical sites may lead to competition between schools of nursing for student placements. The Henry Street Consortium, a group of 5 baccalaureate schools of nursing and 13 local health departments in the state of Minnesota, developed a model for collaboration between PHN education and practice. This paper describes the development process--the forming, storming, norming, and performing stages--experienced by the Henry Street Consortium members. The consortium developed a set of entry-level core PHN competencies that are utilized by both education and practice. It developed menus of learning opportunities that were used to design population-based PHN clinical experiences. In addition, the consortium created a model for training and sustaining a preceptor network. The members of the Henry Street Consortium collaborated rather than competed, used consensus for decision making, and respected and accepted different points of view. This collaboration significantly impacted how schools of nursing and local health departments work together. The consortium's ability to retain its relevance, energy, and momentum for both academic and agency partners sustains the collaboration.     

Preparing nurses for the 21st century: reenvisioning nursing education and practice.

Significant advances in biomedical science and in the complexity of health care, coupled with a worsening nursing shortage and numerous reports of unsafe and inadequate patient care, have prompted concerns about both nursing education and nursing practice. Beginning in 2000, the American Association of Colleges of Nursing (AACN) made a thorough study of nursing education, regulation, and practice issues. Input and consultation were sought from AACN members, nursing practice leaders, regulators, and other health professionals. Results of this work indicated the need for a new nursing professional, the clinical nurse leader, who could effectively coordinate, manage and evaluate care for groups of patients in complex health systems. Master's-degree education is proposed for piloting the preparation of clinical nurse leaders. Close coordination with nurse executives and administrators to develop the new education program and new models for care delivery is planned. Critical components of the pilot testing will be evaluation of the patient and nurse outcomes associated with the use of clinical nurse leaders and focused work to develop a new legal scope and credentials for them.     

Academic leadership in nursing: legitimating the discipline in contested spaces

Aim  To investigate the potential of recent conceptual developments in the sociology of education for conceptualising academic leadership in nursing.
Background  During an investigation into the current status and future trajectory of academic nursing in Ireland, academic leadership emerged as a major concern for respondents.
Method  The languages of legitimation of academic leaders were elicited in in-depth interviews and analysed as expressions of underlying legitimation principles.
Results  The concept of legitimation principles provides a way of thinking about how academic nursing is positioned in the health and higher education sectors, how its leaders construct its identity, practices and purposes, and clarifies the proper focus and goals of academic leadership in nursing.
Conclusions  Academic leadership is concerned with legitimating the discipline of nursing as an autonomous, coherent and distinctive professional and academic endeavour. This legitimacy must be secured in academic, clinical and wider contexts in which academic nursing is viewed with ambivalence; leaders must take account of the impact of nursing history on the current status and future trajectory of the discipline.
Implications for nursing leadership  The analytic tools facilitate a better understanding of the internal and external conditions under which academic nursing will flourish, or wither, in contemporary higher education.     

Advancing practice by developing a primary care nursing programme

The discussion of advanced practice in nursing is ongoing, yet the need for practice to advance and develop across the health economy is called for in much of the current literature and government policy. This article considers an educational intervention that set out to advance primary care nursing. The programme aimed to facilitated nurses to understand clients, families and carers in the community setting, to offer a high standard of care, to support specialist practitioner team leaders to work across community nursing disciplines and to make their own career development choices. Advancing practice in this novel primary care nursing programme required change management, collaboration, partnership, leadership and involvement of the staff nurses themselves.     

Nursing Leaders as Visionaries and Enablers of Action

ObjectivesThe engagement of nursing leaders is critical for the future of the cancer nursing profession, quality cancer care, and the overall health care system. The field of cancer care is facing enormous challenges, requiring strong nursing leadership. Cancer nursing leadership is needed to overcome the challenges caused by workforce shortages, restricted resources, historic and ongoing under-recognition of nursing, unsafe working conditions, and unequal access to education. The aim of this article is to contribute to the discussion about how cancer nursing leaders can act as visionaries and support transformation of cancer nursing for the future.Data SourcesAuthor experience, journal articles and organizational position papers were used.ConclusionTo improve the state of cancer nursing and the working conditions of the cancer nursing workforce, nursing leadership practices need to be embraced on all governance levels in clinical practice and academia. When effective and high-quality nursing leadership is enacted, positive outcomes for people affected by cancer, nursing, and health care systems can be achieved. Cancer nursing leadership needs to be supported through nursing scholarship, influencing national and global policies and strategies and by active involvement in national and international health care management.Implications for Nursing PracticeNursing leadership and governance is critical to strengthening the cancer nursing workforce. Strong nursing leadership is required to realize the vision for transforming the health care systems and cancer care. Therefore, collaboration among multidisciplinary leadership, health care organizations, academic institutions, professional organizations, and policy-making structures is warranted.     

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.     

The power of professional nursing practice--an essential element of patient and family centered care

Understanding power and learning how to use it is critical if nurses' efforts to shape their practice and work environments are to be successful. As part of our efforts to develop a Fast-Track BSN-to-PhD nursing program, we met with nurse leaders from six organizations to explore what power means, how nurses acquire it, and how they demonstrate it in their practice. Through these discussions, we identified eight characteristics of powerful nursing practice that, together, form a framework that can guide nurses' efforts to develop a powerful practice and shape the health care delivery settings and academic institutions in which they work. In this article we review recent studies of organizational power and share discussions which helped us better understand nursing power and the ways in which it is manifested. We also reflect on what power means for individual nurses and the profession and discuss how our insights influenced our Fast-Track program.     

Global collaboration in primary health care

The role of nurses in global collaboration in primary health care is explored in this address. The concept of primary care differs in various countries depending on needs, so re-education of nurses parallels these needs. Nursing practice is adapting to shortages of physicians in some areas, but reacting to excess of physicians in Spain for example. Only the United States makes a distinction between primary health care and community health nursing: most other countries emphasize team approach to a greater extent, integrating nutrition, agriculture, social work, education and other fields into nursing practice. One great challenge to international collaboration by nurses is their failure to be more assertive in initiating local and regional health programs. Another obstacle is communication, not only language but also unfamiliarity with professional development in terms of advanced academic education and professional journals. International nursing collaboration can begin by developing strategies for solving the problems of refugees, agricultural migrants, homeless, and marginal people of all kinds. International collaboration could improve primary care, for example the infant low birth weight and mortality in the Black U.S. population, 34th among all nations. The primary health care movement challenges nurses to break through barriers that maintain professional isolation.     

DNP and PhD scholarship: Making the case for collaboration

BackgroundThe Institute of Medicine calls for meaningful collaboration between doctor of nursing practice (DNP)- and doctor of philosophy (PhD)-prepared nurses to improve health outcomes.PurposeThe purpose of this paper is to answer the questions: 1) how do Colleges of Nursing influence DNP and PhD collaboration for faculty and students? 2) how does DNP and PhD collaboration in an academic setting impact health care practices and patient outcomes?MethodsTwo examples of DNP and PhD collaboration (one faculty and one student) are presented.ResultsShared faculty responsibilities and a supportive organizational culture influenced collaboration between faculty and students. Research and practice roles can complement and strengthen each other while improving health outcomes.ConclusionColleges of Nursing should build processes and culture that encourage faculty and students to collaborate across doctoral programs. Successful intraprofessional collaboration has the potential to positively impact healthcare quality, and outcomes, while advancing the nursing profession.     

Creating a culture of caring: A collaborative academic‐practice approach to clinical education

Strong academic and practice partnerships are needed in the ever‐changing health care environment. Sometimes an invisible barrier exists between clinical practice and academia; academic‐practice partnerships are a way to bridge this barrier. Since 2008a team‐based model of clinical education known as the Culture of Caring (COC) has brought together three academic institutions with a large hospital system to develop a unified clinical experience and curriculum that improves the student, provider, and patient experience. In the COC model the team consists of academic‐practice leaders, clinical instructors, staff nurses, and students. Together they engage in a structured curriculum that is integrated into both the clinical environment and the academic setting. Each week of clinical the students focus on a topic that is paired with journal articles and learning activities that allow the team to engage in learning that is applicable to the clinical practice environment. The learning activities allow students to engage in learning about evidence‐based practice and quality improvement initiatives that are taking place on the unit. The implementation of this collaborative approach to a clinical nursing education model has had a positive impact on the working relationships between the academic partners and clinical practice leaders.     

Interdisciplinary health care training in the USA: lessons learned from a rural training grant program

Abstract

For almost half a century, research has identified that effective teamwork is essential in order to enhance care provision and health outcomes for patients. Although the value of teamwork is well-recognized in healthcare, the historically rooted dynamics of workplace relationships create a myriad of challenges to creating collaborative teams. Understanding the history of interpersonal dynamics between health professionals can provide direction for future interprofessional education and collaboration strategies. The aim of this paper is to provide a historical overview of the social positioning of nursing and medicine in the context of interprofessional collaboration. Few professions work as closely as nursing and medicine. Despite the well-recognized benefits of interprofessional collaboration, these two professions are often socially positioned in opposition to one another and depicted as adversarial. This analysis will seek to advance our understanding of the historical roots between these two professions and their relationships with and among each other in relation to career choice, early socialization and patient care delivery. An exploration of the historical social positioning of nursing and medicine can provide an enhanced understanding of the barriers to interprofessional collaboration and inform future successes in interprofessional education and practice among all health and social care professions.     

A “Co-CREATES” framework to foster a positive learning environment for nursing students’ professional development in Rwanda

AimThe future of the nursing profession in Rwanda in large part depends on the students who join the workforce and the education they have received. Preparing students with the necessary knowledge, values and judgement requires practice settings to be learner-centered. This study aimed at exploring strategies that might improve the current practice-based learning environment.DesignA focused ethnographic approach was used.MethodsNursing students, staff nurses, clinical instructors and nurse leaders from three hospitals and an educational program participated in individual interviews.ResultsFive key areas of improvement emanated from study data: 1) strengthening institutional support; 2) improving school-hospital collaboration; 3) building the capacity of nurses and clinical instructors; 4) restructuring clinical placement; and 5) reviewing the current supervision model. Based on these findings a “Co-CREATES” framework grounded in the actions of collaboration, care, recognizing, empowering, actively engaging, transforming, enhancement and support was developed. The framework offers a collaborative approach that engages every stakeholder in “cocreating” conditions that build positive practice environments which are conducive to preparing students as professional nurses.ConclusionThe positive outcomes stemming from such a collaborative approach can further enhance a positive culture of collaboration in nursing education and practice.