Jeremy R. Cannon, RN
Clinical Practicum II Synthesis PaperJeremy R. CannonFerris State UniversitySummer 2015AbstractThis Clinical Practicum Synthesis supports that the student is competent in four of the American Nursing Association Scope and Standards of Practice for Nursing Administrators. The registered nurse pursuing a Master’s of Science in Nursing (MSN) degree with an emphasis in Administration uses this document to support achievement of the academic standards expected for this graduate degree. This student’s practicum has a particularly strong focus on leadership and teamwork. Keywords: MSN, administration, leadership, teamwork, graduate nurse competenciesClinical Practicum II Synthesis PaperIt will be the responsibility and duty of nursing professionals to be active leaders in healthcare as we transition through this uncertain time of healthcare reform. Having a Master of Science in Nursing will be the educational foundation from which leaders will build as they step into these leadership roles. This practicum synthesis represents the first block of the foundation. This practicum was performed at Munson Medical Center (MMC) in Traverse City, MI under the direction of Ms. Christa Kiessel, APRN-BC. Ms. Kiessel holds the position of Director of Oncology Services at MMC and has been tasked with project of bringing all of the areas oncology physician practices under one roof. The new Cancer Center is set to open in March of 2015 and it is her responsibility to ensure all oncology services are able to be provided for patients, therefore creating a positive patient experience. The purpose of this paper is to explain how the MSN student utilized the practicum time to demonstrate competency in the four ANA Scopes and Standards of Practice identified during NURS712; Standard 11: Collaboration, Standard 15: Leadership, Standard 14: Resource Utilization, and Standard 13: Research (ANA, 2009). These competencies will be discussed individually and provide structure for this paper. This practicum was designed using the Clinical Practicum II Proposal as the framework for the experience. This document can be found under Appendix A. Issues and concerns that arose during the practicum will be identified with each of the ANA Standards of Practice as well as the strategies that were implemented to prevent them from being detrimental to the overall experience. This practicum was mostly guided by Lewin’s Change Theory as well as Orlando’s Process Discipline Theory and the objectives are all supported by current literature. The evaluations signed by the MSN student’s preceptor will provide evidence of meeting the practicums requirements. ANA Standards of Practice for Nursing AdministratorsStandard 11: Collaboration.Standard 11 of the ANA Scope and Standards of Practice for Nursing Administrators (2009) states collaboration is a necessary competency for nursing leaders. To demonstrate competency in Standard 11: Collaboration, the student was to model an interdisciplinary process with other members of the healthcare team. (ANA, 2009, p.39). An example of this kind of collaborative multidisciplinary effort was when Ms. Kiessel led a discussion about implementing a Tumor Board for physicians to discuss complex patients and provide feedback about the treatment plans. Research performed by Heale, Dickieson, Carter and Wenghofer (2014) realized nurse practitioners, such as Ms. Kiessel, serve in important leadership roles within these teams. The multidisciplinary team voiced concerns about certain participants in the audience monopolizing the conversations. Ms. Kiessel allowed all members of the team to openly discuss the challenges they foresaw. She did an excellent job of alleviating the concerns by enforcing meeting rules. The MSN student participated in the discussion and suggested the meeting rules are openly discussed at the beginning of every Tumor Board. This idea was driven by Lewin’s Change Theory and his unfreezing, changing, freezing philosophy (Schein, 1995). Letting go of the open dialogue and having more structure represents the unfreezing component of Lewin’s Theory. The repetition and enforcement of these rules is the changing aspect of his theory. The freezing component of Lewin’s Change Theory is evident when this respectful dialogue becomes part of the cultural norm. Because of the leadership of Ms. Kiessel, the communication amongst this group will improve, theoretically leading to a reduction in patients overall cost of care (Musanti, Okeefe, and Silverstein, 2012). One of the biggest challenges a nursing leader faces with accomplishing this objective is reducing the authority gradient. Ms. Kiessel was able to flatten the gradient by allowing everyone participating to speak openly but was able to reel them in when they started to get off topic. This allowed everyone to have an equal voice and prevent certain personalities from becoming dominate in the decision making process. The second objective that was identified to demonstrate competency for Standard 11: Collaboration was that the student must partner with others to enhance health care and employee satisfaction through interdisciplinary activities (ANA, 2009, p.39). During the practicum the student had an opportunity to participate in a group that was assigned the task of developing the new call center for the Cancer Center. Ms. Kiessel led this meeting of technical professions (information systems staff, communications staff) as well as staff that currently work as administrative professionals at the surrounding physician offices. She solicited their advice by personally asking each participant what their vision for the call center was. Many of the ideas stem from existing processes that were found to not be very efficient. The MSN student suggested the utilization of Versus Real Time Location Services technology to assist with the process of patient throughput. Instead of having to utilize the call center, staff members will be able to navigate the patients through the cancer center. Call center staff will be able to focus on receiving external calls. The new technology will allow multiple healthcare disciplines to be informed where the patient is during their visit (labs, diagnostic tests, infusion therapy, etc.). Research by Dixon and Panteli (2010) also states communicating through technology and face to face communication complement each other and produce better team results than when used separately. Patients in this example communicated where they were at in the experience through technology, therefore not monopolizing the time of the rest of the healthcare care. This allows the healthcare team to be physically present when needed and to stay on task with other patients, thus preventing interruptions in the patient throughput. This was a bold idea presented by the MSN student because it was a different approach to the utilization of the call center. The idea to utilize technology this way was well received by the group participants. There was apprehension by the MSN student to present this idea as it was quite the deviation from the organizations usual process. Speaking with confidence allowed an idea come to fruition that could have easily been brushed off. Standard 14: Resource Utilization.The ANA Scope and Standards of Practice identifies Standard 14: Resource Utilization as an essential competency for the MSN prepared nurse. Standard 14 states the nursing administrator considers factors such as safety, effectiveness, and the impact of practice in the planning and delivery of nursing (ANA, 2009, p.42). In order to demonstrate competency the MSN student must promote activities that assist others in becoming informed about costs, risks, and benefits of plans and solutions (ANA, 2009, p.42). This was accomplished while collaborating with Ms. Kiessel during a meeting about changing the engagement of frontline staff for the new Cancer Center. Employee engagement is important to high reliability organizations as they depend on staff to openly report safety concerns. The executive director of oncology services, Kathy LaRaia, was seeking ideas about how to let staff know that leadership truly cares about the employees of the new Cancer Center. The MSN student suggested to focus on safety as there is a strong correlation between safety and employee engagement, going on to explain how in previous leadership positions, the student was able to improve overall engagement by emphasizing the importance of a safe culture. It was suggested that leadership makes weekly rounds to the different floors of the cancer center and round with influence. The rounding with influence concept is utilized as a way for leadership to have conversations with staff that provide direct patient care about safety topics that have been identified as a problem either organizationally or nationally. Kimsey (2010) published an article in AORN Journal describing how a healthcare organization introduced the plan-do-check-act cycle, which improved overall teamwork and created more efficient processes. This same methodology would be considered when implementing this new process. The MSN student is involved in an employee engagement committee at MMC and was able to speak confidently about an available product being introduced. The new product allows for more real time employee engagement statistics instead of a traditional once a year survey. This will allow the oncology leadership team to identify areas that need improvement as they arise, such as staff that feel leadership isn’t concerned about safety, physician interactions, teamwork, etc. Producing this change is another example of the utilization of Lewin’s Theory; unfreezing, changing, refreezing (Schein, 1995). In the outlying oncology clinics, leadership is rarely seen (unfreezing), therefore leaving the frontline staff feeling like leadership doesn’t care about their safety. When all the offices come into the new building, leadership will be required to make scheduled rounds and report back issues the staff have identified as a concern (changing). This will become more of a cultural norm as rounding with influence becomes more of an expectation than a trial (refreezing). The second objective identified to demonstrate competency for ANA Standard 14: Resource Utilization was utilizing creativity and innovation in nursing practices to measure safety and effectiveness for interventions and outcomes (ANA, 2009, p.42). The MSN student had the opportunity to participate in a discussion with Versus technology, a vendor that installs real time location services (RTLS) technology at hospitals. These meetings were attended by two Versus representatives, the Executive Director of Oncology Services Ms. Kathy LaRaia, Ms. Kiessel, as well the MSN student and discussions were centered around how to best utilize the new technology in the Cancer Center. Munson Healthcare has a vision of being certified as a Lean hospital in the future. A Lean culture is built off of two main concepts; continuous improvement and respect for people (Graban, 2011). The Versus technology allows for measurement of process by using sensors that are strategically placed throughout the building. When patients, staff, or equipment are identified by a sensor, they then become visible to everyone on a computer screen. The new Cancer Center is projected to be one of the largest oncology centers in Michigan. The MSN student was able to provide insight about the difficulty of finding equipment in the main campus that is being used by multiple departments. It will be necessary that much of the equipment used at the Cancer Center be shared amongst the entire floor. The student was given the task of identifying how other oncology centers in the United States are using this technology. The Versus vendor provided access to recorded sessions from their annual conference in Chicago. The student was able to report back that many organizations are using this technology for asset management and the return on investments paid for the install within a relatively short period of time. Organizations were able to accurately measure how often a piece of equipment was actually in use, therefore better utilizing their resources. Munson Healthcare has agreed to purchase this RTLS equipment and have it installed in the new Cancer Center. Standard 15: Leadership.The ANA Scope and Standards of Practice identifies leadership as one of its core competencies for nursing administrators, stating one must provide leadership in the professional practice setting and the profession (ANA, 2009, p.43). According to Chatalalsingh and Reeves (2014), being immersed as a member of an interprofessional team results in development of leadership skills. One of the objectives of the MSN student to demonstrate competency in leadership was to engage in teamwork as a team builder (ANA, 2009, p.43). This was accomplished in almost every practice setting of the practicum. One of the many opportunities the MSN student had to demonstrate leadership was at the Annual Cancer Summit. The goal of the conference was to inform physician practices throughout the healthcare system about the new cultural expectations before they came under one roof. Many of these practices had their own processes and are reluctant to do things in a new way. Ms. Kiessel engaged the staff to commit to a new way of doing things by presenting with confidence and outlining the value system of Munson Medical Center. She also spoke of a high reliability organization and a commitment to safety. Many of the staff at this Summit served in formal and informal leadership roles and a few gave presentations about what is happening to prepare for the physical move. After all the presentations, the members of the audience were split up into smaller groups and asked to voice comments and concerns. The MSN student sat amongst an area physician, the Vice President of Ambulatory Services, an infusion clinic nurse, and area pharmacist. The group was quiet at first and engaged in small talk. The MSN student switched from the role of student to informal leader and offered insight from previously attended conferences, previous leadership experience, and asked each individual if they were in charge what they would want to see happen. The previous leadership experience gave the MSN student credibility and engaged the group in a focused yet open dialogue. The group concluded that they would like to see others held accountable for poor behaviors.Another objective identified to demonstrate competency in Standard 15: Leadership was to exhibit creativity and flexibility though times of change (ANA, 2009, p.43). Every two weeks Ms. Kiessel and other members of the Cancer Center Leadership sit down with the hospitals engineers to discuss the construction of the new building and the expected timelines. The Cancer Center is built about 200 yards from the main campus. It was identified during one of the biweekly meetings that the tunnel that would connect the two buildings would not be available for roughly eight weeks. This posed a problem for a variety of reasons, but most significantly there would be no tube system. The tube system was to be utilized to send blood drawn at the Cancer Center to the laboratory at the main campus. Ideas were solicited amongst the leadership team. The MSN student suggested to rent a golf cart that could travel back and forth during operating hours. This would not be as efficient as the pneumatic tube system but did get blood to the appropriate area in a timely manner. There was a concern regarding finding staff members that could serve as couriers for lab specimens and it was determined that the Return to Work Department could find appropriate MMC staff members to perform the task. By coming up with a creative short term solution, one could conclude that Orlando’s Nursing Process Discipline Theory was implemented. Orlando states that nursing leaders take action based on the customer’s immediate need. The group proactively found a potential gap in the patient care experience and problem solved a solution ahead of time. While the group’s members have changed over time, the MSN student consistently observes their leadership style as authentic. Authentic leaders who communicate honestly and with high ethical standards tend to receive more favorable results (Wong, Laschinger, and Cummings, 2010). Ms. Kiessel has a passion for ensuring oncology patients receive high quality care in Traverse City, MI. The MSN student would only be able to come to this conclusion after hours of observation. Joyce (2010) suggests that day to day observation of leaders will give participants a better understanding of leadership decisions and styles.Standard 13: Research.The final ANA Standard of Practice identified by the MSN student to demonstrate competency was Standard 13: Research (ANA, 2009, p.41). The two outcome criteria recognized by the student to demonstrate competency were performed simultaneously. Outcome one was utilize the best available evidence, including research findings, to guide practice decisions. Outcome two was to formally disseminate research through activities such as presentations (ANA, 2009, p. 41). The MSN student was tasked by Ms. Kiessel to research effective leadership styles and present them at the monthly MMC Management Team meeting. A thorough literature review was done and it was determined that not one leadership style is superior to another; it really is based on who you are trying to lead. The student chose to give a presentation on authentic leadership. Authentic leadership tends to be a driver for follower performance (Leroy, Palanski, and Simons, 2012). The presentation was about 15 minutes in length and in front of roughly two hundred Munson Medical Center leaders (the chief nursing officer, vice presidents, directors, nursing managers, etc.). The MSN student’s presentation was unique in the fact that comparisons were made between authentic leadership and older brother-younger sister relationships. Common characteristics of authentic leaders are self-awareness, balanced processing, relational transparency, and internalized moral perspective (Leroy, Palanski, and Simons, 2012). Ms. Kiessel has demonstrated throughout the practicum the importance of knowing your audience and speaking to what interests them. This presentation was utilized to create a sense of urgency amongst organizational leadership. The MSN student really stressed the importance of moving toward a more influential leadership style and how this style can positively impact employee engagement scores. A blending of Kotter’s Theory of Change and Lewin’s Change Theory were utilized here as the presenter created a sense of urgency for change by highlighting low employee engagement scores, an example of Kotter, and asked to let go of old processes to adopt a different leadership style, an example of Lewin. After the presentation, many leaders commented to the student that they enjoyed the presentation and how breaking down the four authentic leadership characteristics into personal experiences helped solidify the message. Evaluation of PracticumThis practicum experience allowed the MSN student to participate in a variety of different work settings and engage in dialogue with multiple disciplines. Practicum Hour Logs with Ms. Kiessel’s signature provide a timeline of the MSN student’s activities throughout the practicum, as well as how that practicum experience is tied to specific goals. The Practicum Log supports that the MSN student did meet the 120 hour practicum requirement. This can be found under Appendix B. A midterm evaluation supports the student was actively working toward demonstrating competency in the four ANA Scope and Standards of Practice identified at the beginning of the semester. This document has narrative feedback, thus giving the MSN student an opportunity to make improvements if necessary before the end of the practicum. The final evaluation supports that under the observation of Ms. Kiessel, the MSN student successfully completed all goals and objectives for NURS792. The midterm and final evaluation can be found under Appendix C. These two evaluation tools were developed this way based on supporting evidence. Shipman, Roa, Hooten, and Wang (2012) suggests that the utilization of a rubric with narrative feedback is imperative for students to achieve learning success. A rubric evaluation tool takes the evaluation process and makes it more objective (Issacson & Stacy, 2009).SummaryThroughout this practicum, the student focused on demonstrating competency in four specific ANA Standards of Practice; Collaboration, Leadership, Research, and Resource Utilization. Each ANA Standard was addressed individually and achievement of objectives are supported by current literature and theorists (both nursing and non-nursing). The MSN student was able to actively participate as a member of many multidisciplinary teams. Evaluation tools and other supporting documents have been attached to support that the MSN student’s goals and objectives have been met. ReferencesAmerican Nurses Association (ANA). (2009). Nursing administration: Scope and standards of practice. Washington, D.C.: .Chatalalsingh, C., & Reeves, S. (2014). Leading team learning: what makes interprofessional teams learn to work well?. Journal Of Interprofessional Care, 28(6), 513-518. doi:10.3109/13561820.2014.900001Deering, S., Johnston, L. C., & Colacchio, K. (2011). Multidisciplinary Teamwork and Communication Training. Seminars In Perinatology, 35(2), 89-96. doi:10.1053/j.semperi.2011.01.009Dixon, K., & Panteli, N. (2010). From virtual teams to virtuality in teams. Human Relations, 63(8), 1177-1197. doi:10.1177/0018726709354784Graban, M. (2011). Lean hospitals: improving quality, patient safety, and employee satisfaction. CRC Press. Heale, R., Dickieson, P., Carter, L., & Wenghofer, E. F. (2014). Nurse practitioners' perceptions of interprofessional team functioning with implications for nurse managers. Journal Of Nursing Management, 22(7), 924-930. doi:10.1111/jonm.12054Joyce, P. (2010). Leading and leadership: reflections on a case study. Journal Of Nursing Management, 18(4), 418-424. doi:10.1111/j.1365-2834.2010.01090.xLeroy, H., Palanski, M. E., & Simons, T. (2012). Authentic leadership and behavioral integrity as drivers of follower commitment and performance. Journal of Business Ethics, 107(3), 255-264.Kimsey, D. (2010). Lean methodology in health care. AORN Journal, 92(1), 53-60. doi:10.1016/j.aorn.2010.01.015Musanti, R., Okeefe, T., & Silverstein, W. (2012). Partners in caring: an innovative nursing model of care delivery. Nursing Administration Quarterly, 36(3), 217-224.Schein, E. H. (1995). Kurt Lewin’s change theory in the field and in the classroom: Notes toward a model of managed learning. Systems practice, 8(2).Smith, K. A. (2014). Health Care Interprofessional Education: Encouraging Technology, Teamwork, and Team Performance. Journal Of Continuing Education In Nursing, 45(4), 181-187. doi:10.3928/00220124-20140327-01Wong, C., Laschinger, S., & Cummings, G. (2010). Authentic leadership and nurses' voice behaviour and perceptions of care quality. Journal Of Nursing Management, 18(8), 889-900. doi:10.1111/j.1365-2834.2010.01113.xAppendix AClinical Practicum II Learning Plan Template- Jeremy CannonANA or NLN Standards of Practice: Specialty roleOutcome Criteria: (taken from the ANA Standards/NLNCompetencies)Activities to Achieve Outcome.(sufficient in number, measurable, and realistic to achieve each outcome)Resources needed to be successfulTimeline (Identify semester for now. In NURS 792, you will add in detail and specifics dates)Standard 11: CollaborationThe nurse administrator collaborates with all levels of nursing staff, interdisciplinary teams, executive leaders, and other stakeholders (ANA, 2009, p.39).Partners with others to enhance health care and employee satisfaction through interdisciplinary activities such as education, consultation, management, technology development, or research opportunities (ANA, 2009, p.39). Models an interdisciplinary process with other members of the healthcare team (ANA, 2009, p.39). Collaborate during a patient care planUtilize technology to improve communication therefore improving technologyHeale, R., Dickieson, P., Carter, L., & Wenghofer, E. F. (2014). Nurse practitioners' perceptions of interprofessional team functioning with implications for nurse managers. Journal Of Nursing Management, 22(7), 924-930. doi:10.1111/jonm.12054Musanti, R., Okeefe, T., & Silverstein, W. (2012). Partners in caring: an innovative nursing model of care delivery. Nursing Administration Quarterly, 36(3), 217-224.Smith, K. A. (2014). Health Care Interprofessional Education: Encouraging Technology, Teamwork, and Team Performance. Journal Of Continuing Education In Nursing, 45(4), 181-187. doi:10.3928/00220124-20140327-01Dixon, K., & Panteli, N. (2010). From virtual teams to virtuality in teams. Human Relations, 63(8), 1177-1197. doi:10.1177/0018726709354784Summer 2015Standard 15:LeadershipThe nurse administrator provides leadership in the professional practice setting and the profession (ANA, 2009, p. 43).Engages in teamwork as a team player and a team builder (ANA, 2009, p. 43). Exhibits creativity and flexibility through times of change (ANA, 2009, p. 43).Participate in daily safety huddleParticipate in creative solution during moment of increased patient censusChatalalsingh, C., & Reeves, S. (2014). Leading team learning: what makes interprofessional teams learn to work well?. Journal Of Interprofessional Care, 28(6), 513-518. doi:10.3109/13561820.2014.900001Joyce, P. (2010). Leading and leadership: reflections on a case study. Journal Of Nursing Management, 18(4), 418-424. doi:10.1111/j.1365-2834.2010.01090.xWong, C., Laschinger, S., & Cummings, G. (2010). Authentic leadership and nurses' voice behaviour and perceptions of care quality. Journal Of Nursing Management, 18(8), 889-900. doi:10.1111/j.1365-2834.2010.01113.xSummer 2015Standard 14:Resource Utilization The nurse administrator considers factors related to safety, effectiveness, cost, and impact on practice in the planning and delivery of nursing and other services (ANA, 2009, p. 42).Uses creativity and innovation in nursing practices to measure safety and effectiveness, for interventions and outcomes (ANA, 2009, p. 42).Promotes activities that assist others, as appropriate, in becoming informed about costs, risks, and benefits of plans and solutions (ANA, 2009, p. 42).Evaluate data submitted to NDNQI for opportunities to improveParticipate in patient care conferenceGraban, M. (2011). Lean hospitals: improving quality, patient safety, and employee satisfaction. CRC Press. Kimsey, D. (2010). Lean methodology in health care. AORN Journal, 92(1), 53-60. doi:10.1016/j.aorn.2010.01.015Summer 2015Standard 13: ResearchThe nurse administrator integrates research findings into practice (ANA, 2009, p.41).Utilizes the best available evidence, including research findings, to guide practice decisions (ANA, 2009, p.41).Formally disseminates research findings through activities such as presentation, publications, and consultation (ANA, 2009, p.41).Present research about the efficiency of Lean principalsPerform literature search for most recent evidence about multidisciplinary team building Dixon, K., & Panteli, N. (2010). From virtual teams to virtuality in teams. Human Relations, 63(8), 1177-1197. doi:10.1177/0018726709354784Deering, S., Johnston, L. C., & Colacchio, K. (2011). Multidisciplinary Teamwork and Communication Training. Seminars In Perinatology, 35(2), 89-96. doi:10.1053/j.semperi.2011.01.009Kimsey, D. (2010). Lean methodology in health care. AORN Journal, 92(1), 53-60. doi:10.1016/j.aorn.2010.01.015Summer 2015References:American Nurses Association (ANA). (2009). Nursing administration: Scope and standards of practice. . Appendix B Double click each of the above documents to view full PDF. Note: Final Practicum Verification Log to be submitted August 12th.Appendix C Double click each of the above documents to view full PDF. Note: Final Evaluation to be submitted August 12th.Appendix DResource ListBellassai, R. J., Glass, C. C., Halderson, P. E., & Schoeberl, J. B. (2014). Leadership Training in Physician Assistant Programs: A Survey of Program Directors.Isaacson, J., & Stacy, A. (2009). Rubrics for clinical evaluation: objectifying the subjective experience. Nurse Education In Practice, 9(2), 134-140. doi:10.1016/j.nepr.2008.10.015Porter-O'Grady, T. (2011). Leadership at all levels. Nursing Management, 42(5), 32-37. doi:10.1097/01.NUMA.0000396347.49552.86Rosenthal, B. (1996). An interactionist's approach to perioperative nursing. AORN Journal, 64(2), 254-260. doi:10.1016/S0001-2092(06)63153-0Shipman, D., Roa, M., Hooten, J., & Wang, Z. J. (2012). Using the analytic rubric as an evaluation tool in nursing education: The positive and the negative. Nurse Education Today, 32(3), 246-249. doi:10.1016/j.nedt.2011.04.007Watson, C. (2008). Assessing leadership in nurse practitioner candidates. Australian Journal Of Advanced Nursing, 26(1), 67-76. ................
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