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Nursing Practicum PaperMarie WendtFerris State UniversityAbstractStepping into leadership positions as a new nursing administrator is challenging. A learning practicum provides the nursing leadership student with a formal process for strengthening skills which require developing. This practicum paper identifies the author’s deficiencies in nursing administration skills and developed a structured learning practicum for developing them. Through project development of a nurse manager orientation at a mid-Michigan hospital, the author identifies activities which encourage the development of needed skills to accomplish the deficit in four identified American Nursing Association (ANA) Scope & Standards for Nursing Administrator competencies. Theoretical frameworks and evidence based literature was reviewed to substantiate activities included in the learning plan. Preceptorship by an executive nurse and structured evaluation using Bloom’s taxonomy were identified as key components to assess success. Keywords: Competency, development, leadership student, nursing administrator, nurse leader, nurse manager, orientation, practicum, standardsNursing Practicum PaperStepping into leadership positions as a new nursing administrator is challenging. Preparing for such a role through academia bestows the rationale and theory for successful decision making. Performing a learning practicum in a clinical setting allows the novice leader opportunity to demonstrate teachings in a structured format. This paper provides the detail of how the author will personally improve nursing administrator skills and abilities of four self-selected American Nursing Association (ANA) Scope & Standards for Nursing Administrator competencies, with guidance from a preceptor at MidMichigan Health (MMH)-Midland by initiating a project for nurse manager orientation. It will also review best practice literature, provide a structured learning plan and an evaluation method for achieving the stated goals contained within the learning plan. The ANA Standards that are being exercised for the learning practicum are #4, Planning: The nurse administrator develops a plan that prescribes strategies and alternatives to attain expected outcomes, Standard #5, Implementation: The nurse administrator implements the identified plan, Standard # 8, Education: The nurse administrator attains knowledge and competency that reflects current practice, and Standard # 9, Professional Practice Evaluation: The nurse administrator evaluates own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations (American Nurses Association [ANA], 2009, p. 28, 29, 36, 37).Learning PlanIn an effort to successfully improve administrator skills a learning plan was developed, based upon the four ANA standards. The overall learning project centers on creating a nursing specific orientation plan for nurse managers at MMH, while featuring the standards that the author sensed were areas that needed to be strengthened for herself. The learning plan’s competencies and learning outcomes were determined in reference to the ANA Scope & Standards for Nursing Administrators and the American Organization of Nurse Executives (AONE). The ANA standard, Professional practice evaluation was selected to help the author understand professional practice in leadership procedure and decide the focus of the project for the practicum learning plan. Planning and Implementation were chosen for the reason that previous leadership experiences did not allow her to devote herself to formal processes to be successful with project development and execution. Education was chosen, as the author needs to understand the most recent best practices in order to lead others in their understanding and foster buy in from the team for the project completion and success. Evidence based practice (EBP) was utilized from sources within the last five years to support the activities to achieve the learning outcomes. The learning practicum will take place September through December 2015. It is the author’s expectation that the learning plan will structure the learning and development of the skills needed to be a successful leader. To view the learning plan please see appendix A.A Review of the LiteratureAn examination of the literature was performed to determine best practice activities to develop the learning plan and support the practicum. According to the ANA, the nurse administrator is defined as a nurse who coordinates and influences the efforts of others in a designated department (2009). The question must be asked, how does the nurse prepare for such a role in order to be successful? As there are varying degrees of preparation, including in some instances very minimal, the novice nurse manager’s ability to effectively lead in today’s healthcare system has long been in question. Since nurses are familiar within their clinical work areas, oftentimes highly skilled bedside nurses have been promoted with the thought that a good staff nurse equates a good nurse manager. However, newly appointed nurse managers have demonstrated a lack of skill in regards to the competencies set forth by the ANA Scope and Standards of Practice for Nursing Administration and the AONE. This literature review sets out to determine the educational gaps for new nurse managers, as well as seeking innovative opportunities for achieving the author’s improvement in nurse manager competencies of planning, implementation, education and professional practice evaluation.Electronic databases utilized for the traditional literature review included: CINAHL, Cochrane, OVID, Pubmed, and Google Scholar. Keywords employed included: competency, coaching, development, leadership, mentoring, nurse leader, nurse manager, orientation, and role development. A total of 45 evidenced based articles were retrieved. Fifteen articles were selected for review of the topic. There were limited articles within the last five years which incorporated intra-hospital based orientation programs for middle leadership. Therefore, one additional article was included from the last six years to be able to compare and contrast internal and external programs. Current Issues in the LiteratureFor the learning practicum it is important to compare and contrast research outcomes related to nurse manager skill development. Within the last decade, there have been efforts set forth to delineate the educational needs for the nurse manager in an effort to define a competent leader. The ANA Scope and Standards of Practice for Nursing Administration were published in 2009, and provide detail for what competence means for the nurse leader. In addition to this, the AONE provides competencies related to communication, knowledge, leadership, professionalism and business skills ("AONE Nurse Executive Competencies," 2005). Despite having access to these competencies, many organizations are unprepared for operationalizing them when attempting to develop new leaders. At the same time, novice leaders are expected to be proficient in them. The learning practicum will demonstrate competence in accordance with the ANA Scope & Standards of Nursing of Planning by developing and implementing an orientation process for new nurse managers that will better prepare them for the role.The lack of structured nurse manager orientation models or programs is consistently defined in the literature. Literature further confirms the promotion of unprepared bedside nurses to leadership roles. Unlike staff nurses who fill general orientation classes in healthcare organizations and often have structured processes, the nurse manager is usually hired independent from others. Resources to hold formal in-house education classes are costly for the few managers in number (Omoike et al., 2011). In addition to this, organizations that do have general orientation programs for leaders they are not specialized for nurse manager’s unique requirements (Fennimore & Wolf, 2011). The learning practicum supports the opportunity to focus on the economic and financial management as set forth by the AONE when planning and developing the new orientation plan for the few nurse managers in number. The literature points to the need for improved educational models for novice nurse managers in order to successfully lead in today’s healthcare environment. Over the last decade there has been significant changes in healthcare which signify great challenges for the unprepared novice nurse manager, including patient acuity, reimbursements and digital technology (Fennimore & Wolf, 2011). According to the ANA Scope & Standards of Nursing Administration, nurse leaders are expected to be competent in economic influence for the decisions they make in their role (2009). If this is not achieved it could have significant impact on the reimbursements for the departments, as well as the organization in which they lead.Another financial consideration for achieving nurse leader competence is the return on the investment of nurse manager specific programs for healthcare organizations and retaining qualified manager. This can be justified with the reduction in staff turnover, which have direct and indirect costs equaling approximately $85,000 in 2007 (Fennimore & Wolf, 2011). Other possible returns on investment from successful completion of formal leadership courses are improvements in patient quality and reimbursement outcomes (Fennimore & Wolf, 2011). During the practicum the author will determine financial impact and turnover rates of nurse managers at MMH in an effort to gain support for the cost benefit during program development. Aside from the financial pressures, the role of the nurse manager is one of the most difficult in healthcare. The role is seen as stressful and for one in constant flux (Digman et al., 2012). It has been identified that unprepared nurse managers often lead by trial and error (McCallin & Frankson, 2010). Therefore, it is vital for the novice nurse manager to develop the necessary knowledge, skills and attitudes to lead successfully. There appears to be no consensus on how to do this. However, there are benefits for healthcare to incorporate such programs. As, effective leadership for nursing middle management has been shown to improve safe patient outcomes and quality of care (Vitello-Cicciu, Weatherford, & Gemme, 2014). Despite this, there is an obvious absence of adequate preparation for nursing managers, lacking structure to develop and mentor the set forth competencies (Fennimore & Wolf, 2011). Structured programs are needed to prevent this disparity. The learning practicum will focus on demonstrating the ANA standard #8 of Education for facilitating educational offerings based on best practice of preparation for nurse managers. According to the AONE, it is the responsibility of the nurse leaders to collaborate and maintain academic relationships regarding the future of nursing and healthcare (Nurse executive Competencies, 2005). The learning practicum will also provide this opportunity by seeking the prospect to collaborate with local colleges and universities in developing and providing the needed education.Although academic institutions are now incorporating competency teachings into curriculums, new nurse managers generally do not have this education prior to accepting a leadership position. When the bedside nurse accepts the role of the nurse manager, the expectation is that they immediately become project manager, an expert in human resource management, budget expert, quality analyst, risk manager, compliance manager, mentor and role model (McCallin & Frankson, 2010). According to Shirey et al., these unrealistic expectations can lead to damaging results for healthcare (McCallin & Frankson, 2010). Fortunately, the administrator expectation concepts are often included in curriculums in advanced nursing and business degrees. However, advanced nursing degrees are not usually required for nurse managers in many organizations (Omoike, Brooks, & Loyd Storfjell, 2011) which adds to the disparity. It has been reported in 2003, 84% of nurses who hold executive positions in the United States have Masters Degrees, whereas, 31% of nurse managers have attained them (Digman et al., 2012). According to the Coalition of National Nursing Organizations, these Master’s Degree programs encompass the fundamental competencies for leadership (Digman et al., 2012). This further demonstrates the need to develop orientation programs for when they step into the managerial role.Literature FindingsThe learning practicum includes conclusions from evidence based sources. It can be said that leadership development programs hypothetically improve novice nurse manager skill with competencies set forth by the AONE. In an effort to demonstrate this concept the Organization of Nurse Leaders of Massachusetts and Rhode Island developed a nurse manager orientation program which comprised of four classes over a two month period. Faculty were recruited from the Organization of Nurse Leaders national chapter and employed group sessions, case studies, project management, mentoring, reflecting and journaling (Vitello-Cicciu et al., 2014). Qualitative data demonstrated nurses expressed behavior changes in the areas of self-awareness, self-regulation to manage, being emotionally aware of others, seeking diverse feedback, engaging in active listening, and having crucial conversations (Vitello-Cicciu et al., 2014). This study expressed the belief that nurse managers experienced positive behavior changes after attending a structured orientation program. The number of participants were few and the responses were anecdotal in nature. Larger studies are needed to display repetition in results. In addition to this, a more structured evaluation process elicited from nurse manager’s supervisors would add value to the study results. One distinction that is made in the most current literature is the need to collaborate with outside entities to develop nurse manager orientation and competency development. This appears to show strength in today’s economically challenged healthcare organizations. Having a collaborative concept shares the expense for the greater good of all. The University of Pittsburgh Medical Center (UPMC) Leadership Development for Nursing Middle Managers program enlisted nurse executives, faculty from the university and graduate prepared human resource experts to teach five full day sessions over two months (Fennimore & Wolf, 2011). It is beneficial to have experienced presenters from university faculty, human resources whom are graduate prepared, and internal nurse executives (Fennimore & Wolf, 2011). The curriculum included activities such as reading evidence based literature, self-assessments, lecture, group discussions, and assignments to apply and reflect learned material (Fennimore & Wolf, 2011). Structured reflection can take many forms such as centering, journaling, and affirming (Chinn & Kramer, 2008). Managers who completed the course self-reported an increase in understanding 15 pre-determined taught competencies, six months after the program completion (Fennimore & Wolf, 2011). Managers also indicated the topics as being the most valuable to their success included finance, conflict management, emotional intelligence application, and strategies to engage staff (Fennimore & Wolf, 2011). The results of this study also indicated a verbalization from the few participants of improved behaviors and knowledge after attending the program. Again, the results are self-reported and subjective in nature. A more objective evaluation is needed to confirm nurse manager commentary.In 2010, in another small qualitative study of structured interviews with nurse managers, three themes emerged. These themes include role ambiguity, business management deficits, and role overload (McCallin & Frankson, 2010). The analysis of the themes lead to three conclusions. First, leadership training should be offered to staff nurses who possess potential role advancement attributes. Second, organizations must provide financial resources to provide in house training for specific nurse management. And last, there should be ongoing mentorship in a supervisory manner (McCallin & Frankson, 2010). These arguments point to the need for organizations to improve in house nurse manager orientation programs and begin leadership training to staff nurses who show future promise. There needs to be further studies to compare in house versus collaborative ventures for orientation programs. Other literature supports the findings for organizations to provide internal orientation programs for new nurse managers. It is essential to focus on the leadership competencies which correlate leader outcomes that are effective (Macphee, et al, 2014). In this study leadership development focused on impacting relationships within the workplace to positively impact outcomes (Macphee, et al, 2014). The education consisted of a four day workshop and included lecture and interactive strategies for novice leaders (Macphee, et al, 2014). The study identified knowledge gaps related to leadership outcomes and educational opportunities of empowering behaviors to enhance them (Macphee, et al, 2014). The outcome of the study displayed that empowering behaviors are teachable and are demonstrated one year after the four day workshop (Macphee, et al, 2014). This study was limited by its small group of participants in the control group. Duplicate studies with a substantial control group are needed to solidify results. Earlier bodies of work appear to support an in house orientation program. In 2009, Virginia Commonwealth University Health System in Richmond VA’s program concentrated on elements of leadership, retention, clinical management, coaching, mentoring, human resources management, fiscal management, performance improvement, and evidenced-based practice through classroom teaching and competency checklists (Hawkins, Carter, & Nugent, 2009). In this orientation program new nurse managers did not take responsibility of the department until the orientation is complete in order to remain focused on the learning opportunities (Hawkins et al., 2009). Anecdotally, the results reflected improvements in nurse manager satisfaction reporting. There was no formal results from this program. However, there were lessons learned to update the program, with no tangible results of its effect. In reviewing the literature, there is consensus that any strategy to improve nurse manager competencies must be innovative in nature. Again, collaborative efforts with academia is one method to such innovation (Digman et al., 2012). Another innovative method is simulation. Leadership development program participants can benefit from more engagement than didactic sessions or computer based programs with simulations (Radovich et al., 2011). Since simulation has been successful in other applications such as aviation, placing nurse leaders in lifelike situations promotes behavioral aspects of understanding content (Radovich et al., 2011). One pilot program aimed to develop and implement a leadership development program employing three video recorded simulation scenarios, post simulation debriefing, and re-participation of the three simulations (Radovich et al., 2011). Participants reported to have a better understanding of how their communication, both verbal and non-verbal are perceived (Radovich et al., 2011). Participants also felt they had an improved ability to have crucial conversations in difficult situations (Radovich et al., 2011). Other literature reviews the benefits of coaching versus mentoring. Even if the novice nurse manager is fortunate to attend a leadership development program, there is still a need for ongoing guidance and in the moment learning. Peer preceptors are often assigned to look after a new manager. However, assigned preceptors for novice leaders are often consumed with the demands of the role and offer minimal time to the new manager (DeCamli, Kirby, & Baldwin, 2010). The author will utilize a mentor in the form of a formal preceptor for the duration of the practicum project for guidance and support.Theories for Nurse Manager DevelopmentWhen developing a learning plan it is important to include models with proven success. Patricia Benner’s model from Novice to Expert presents an appropriate theoretical framework for educating nurse managers when dealing with experiential learning. According to Benner, the nurse has the capability to attain meanings with direct involvement in a given circumstance (Chinn & Kramer, 2008). For the learning practicum, this concept will be utilized by the immersion process. The author will be in the role of the experienced bedside nurse and considered a novice when transitioning to the new role of nurse leader, attempting to become proficient with the four standards identified in the learning plan. It is this process that will enable the ability to gain the experience to apply learned concepts through Benner’s five levels of skill acquisition include novice, advanced beginner, competent, proficient, and expert (Abraham, 2011). Also attributed to Benner’s theory is that learning is secured through repetition and over time (Abraham, 2011). The practicum will empower the author to experience such repetition. Academic didactic teaching and best practice review alone is not optimal for nursing administrator competency demonstration of skills and abilities. The literature points to the importance of having opportunities for the novice nurse manager to practice strategies reviewed in curriculums (Fennimore & Wolf, 2011). The learning practicum in a sense, provides a leadership simulation opportunity in a real healthcare organization. According to Benner, performing the task to demonstrate competence of defined criteria in the real world is essential for measurement (Conley, Branowski, & Hanley, 2007). This type of practice within the practicum can assist the learner with understanding the results of learned behavioral concepts. According to Radovich et al, simulation of the complex issues related to the nurse manager role can also provide an interactive method to acquire needed leadership skills including the various aspects of effective communication (Radovich et al., 2011). Transformational Leadership is an additional theoretical framework for the novice nurse leader in this practicum. This framework for leadership is applicable to the learning practicum of development of nursing leadership competencies, as it connects the drive of the follower to the common intentions of the leader (Northouse, 2015). With transformational leadership there is a sense of bonding with respect and trust between the leader and the team encouraging buy in (Avolio & Yammarino, 2013). It is with this leadership style that will enable the author to assist the team reach their fullest potential (Northouse, 2015) with the practicum project. When the leader becomes engaged with the people, the parties involved become motivated (Northouse, 2015). This newly engaged team will ultimately help the longevity of the project after its completion. Literature LimitationsIn an attempt to determine its validity for the learning practicum, the literature findings were examined to review any limitations. For this process it is important to look for sources which conduct systematic research with randomization of participants to provide Level V and VI evidence which is considered to be reliable (Fineout-Overholt, Melnyk, Stillwell, & Williamson, 2010). The literature available provided qualitative and descriptive evidence. One weakness in the literature is that each of the studies were performed in single organizations with minimal participants. Another weakness, is that the majority of the most recent literature weighs heavily on academic institutions to bridge the gap of current curriculums in collaborating with various healthcare organizations to provide joint orientation programs. What is requested for curriculum content at one organization may not be important to another. A project between several organizations could be studied to gain numbers in experienced educators including nurse executives, human resources and academic educators. It is interesting that none of the literature mentioned actual nursing educators for leadership development. This could be in part due to the downsizing of education departments within healthcare organizations. Evaluation is essential to understand the effects of program outcomes at its completion. Many of the literature sources relied heavily on self-reporting of perceptions from the individual novice nurse managers. None of the articles confirmed an increase in physically demonstrating an improvement in nursing leadership competencies by means of a direct supervisor. Application would be of benefit in evaluating a true understanding and utilization of the competencies trained. Literature Review ConclusionAfter reviewing the literature many things has been ascertained. Novice nurse managers are often unprepared for leading in today’s healthcare system. Despite competency development within the last decade from the ANA and the AONE, healthcare organizations lack structured orientation programs specific to nurse managers. Earlier studies suggest providing in house competency based orientation programs improves nurse manager knowledge and behaviors. While more recent studies, point to collaborative efforts with outside entities such as Universities to provide these types of programs. All literature points to innovation as being key to ensuring novice nurse managers are prepared in today’s economic limitations. There are no evidence based bodies of work which compares different types of orientation programs against one another. Current studies have limited numbers of participants and provide subjective outcomes. More research is needed to determine the most cost effective and comprehensive style of program to provide to new nurse managers. Results from larger future studies should be objective in nature. Healthcare stands to benefit when nurse managers are adequately prepared for this challenging role. Practicum SettingThe learning practicum will take place at (MMH)-Midland. This organization is a 240 bed, acute care, not for profit hospital that is headquarters of the (MMH) System in Lower Michigan. MMH is also affiliated with the University of Michigan Health System, which provides access to evidence based research outcomes, policy and procedure. Of note, the health system has a strong nursing leader in the chief executive officer (CEO) position, Diane Postler Slattery RN Ph.D. She is a strong proponent for advancing nursing practice with the financial decision making incentive to do so. This is unique for a healthcare organization to have. The nursing department is governed by a chief nursing officer, four nursing directors, ten nurse managers and numerous supervisors. The nurse managers will be the focus of the project, but will open up the project to nursing supervisors as well. This site was chosen because the author had previous experience within the leadership team and a good understanding of the different departments in which the practicum will evolve. Preceptor SelectionFor the selection of a preceptor for the learning practicum, a meeting was scheduled with the Vice President and Chief Nursing Officer. Jan Penney, RN, MSN is a veteran nurse with a long career in leadership and an excellent role model. She has vast experience as a leader as she has been in the role of nurse manager, director and her current role. She has been in her current role for 3 years and is the driving force of progressing the role of nursing at MMH for over 10 years. Mrs. Penney has been instrumental with improving quality and safety within the organization during this time. She is currently advocating for MMH to adopt a nursing philosophy and improving the organization’s culture of safety. It was decided that, despite her elevated level within the organization, she be the preceptor for the proposed practicum. Mrs. Penney will be the student’s direct liaison for each step of the practicum plan. Because she is the VP of nursing, she will be instrumental with knowing the venues that will be beneficial for the author to be a part of. She leads a monthly nursing managers and directors meeting, which includes ancillary department leaders. These leaders will all be essential for the student to be in contact with in various forms throughout the practicum. This preceptor has demonstrated many attributes of a good preceptor. This includes being a great communicator, very knowledgeable in the identified areas for the practicum, and is motivated in seeing the success of the venture with the student (The Effective Preceptor). She has accepted the responsibility of being an active observer over the practicum, and has a good assessment of the student’s skills and abilities as a nursing leader. To view the preceptor/agency agreement please see appendix B. Evaluation ProcessThe evaluation process for lifelong learning is essential to determine if one has achieved the goals and learning objectives set forth.? This is true for the learning practicum as well. It is important to ensure that the evaluator is able to objectively evaluate one individual against another in a fair and consistent manner.? When the evaluation process is based on measurable learning outcomes, the learner is able to determine the steps necessary to achieve them.?Bloom’s Taxonomy is one such method in determining educational objectives.? It is important for the learner to move through the six categories of cognitive skills which include; knowledge, comprehension, application, analysis, synthesis, and evaluation ("A model of learning objectives," 2015).? This approach can be closely linked to Patricia Benner’s model of learning from novice to expert (Abraham, 2011), as one must acquire the knowledge as a novice then move through the stages of application, analysis, and synthesis before becoming an expert.Closely related to Blooms Taxonomy and Benner’s Learning Theory, is the Office of Human Resources at the National Institutes of Health’s evaluation descriptors.? These five descriptors include fundamental awareness, novice, intermediate, advanced and expert (2009).? These descriptors were utilized in the development of the evaluation tool for the learning practicum.?To view the learning practicum evaluation please see appendix C.ConclusionTransitioning into a nurse administrator position can be a challenge. Simulating real life learning opportunities via a structured learning practicum can help novice managers overcome these challenges. With the guidance of a preceptor, the author will utilize evidence based practice strategies to initiate a nurse manager orientation project to assist with improving skills and abilities. The learning practicum will take place at MMH from September through December of 2015, and focus on activities to achieve outcomes for four ANA Scope & Standards of Nursing Administration including; planning, implementing, educating and professional practice evaluation. This will be evaluated using Bloom’s taxonomy at the mid-point of the practicum, as well as at the conclusion.ReferencesAbraham, P. J. (2011). Developing nurse leaders: A program enhancing staff nurse leadership skills and professionalism. Nursing Administration Quarterly, 35(4), 306-312. Nurses Association. (2009). Nursing administration scope & standards of practice. Silver Spring, MD: Nursebooks.A model of learning objectives. (2015). Retrieved from resources/effective-practice/revised-blooms-taxonomy/Avolio, B. J., & Yammarino, F. J. (2013). Transformational & charismatic leadership: The road ahead (2nd ed.). Bingly, WA, UK: Emerald Group.Chinn, P. L., & Kramer, M. K. (2008). Integrated theory and knowledge development in nursing (7th ed.). St Louis, MO: Mosby Elsevier.Conley, S. B., Branowski, P., & Hanley, D. (2007). Nursing leadership orientation: A competency and preceptor model to facilitate new leader success. Journal of Nursing Administration, 37(11), 491-498.DeCamli, P., Kirby, K. K., & Baldwin, C. (2010). Beyond the classroom to coaching: Preparing new nurse managers. Critical Care Nurse, 33(2), 133-138.Digman, D., Duffield, C., Stasa, H., Gray, J., Jackson, D., & Daly, J. (2012). Management and leadership in nursing: An australian educational perspective. Journal of Nursing Management, 20(), 65-71. , L., & Wolf, G. (2011, May). Nurse manager leadership development: Leveraging the evidence and system-level support. Journal of Nursing Administration, 41(5), 201-210. , E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010, July 20). Evidence-based practice step by step: Critical appraisal of the evidence: part I. American Journal of Nursing, 110(7), 47-52. , A., Carter, K., & Nugent, M. (2009). Nurse manager orientation. AACN Advanced Critical Care, 20(1), 55-70.Macphee, M., Dahinten, V. S., Hejazi, S., Laschinger, H., Kazanjian, A., McCutcheon, A., ... O’Brien-Pallas, L. (2014). Testing the effects of an empowerment-based leadership development programme: Part 1- leader outcomes. Journal of Nursing Management, 22, 4-15. , A. M., & Frankson, C. (2010). The role of the charge nurse manager: A descriptive exploratory study. Journal of Nursing Management, 18, 319-325.Northouse, P. G. (2015). Leadership: Theory and practice (7th ed.). Thousand Oaks, CA: Sage Publications.Office of Human Resources at the National Institutes of Health. (2009). , O., Brooks, B. A., & Loyd Storfjell, J. (2011). Advancing nursing leadership: A model for program implementation and measurement. Nursing Administration Quarterly, 35(4), 323-332. , P., Palaganas, J., Kiemeney, J., Strother, B., Bruneau, B., & Hamilton, L. (2011). Enhancing leadership orientation through simulation. Critical Care Nurse, 31(5), 58-63. AONE nurse executive competencies. (2005). Retrieved June 23, 2015, from effective preceptor [Monograph]. (Serial No. 050215). Retrieved from , J. M., Weatherford, B., & Gemme, D. (2014, March). The effectiveness of a leadership development program on self-awareness in practice. Journal of Nursing Administration, 44(3), 170-174. AClinical Practicum II Learning Plan Template- M WendtANA Standards of Practice: Specialty roleADMINISTRATIONOutcome Criteria: (taken from the ANA Standards/NLNCompetencies)Activities to Achieve Outcome.Resources needed to be successfulTimeline Standard #4PlanningThe nurse administrator develops a plan that prescribes strategies and alternatives to attain expected outcomes.(American Nurses Association [ANA], 2009, p. 28)Participates in the design and development of multidisciplinary and interdisciplinary processes to address the situation or issue.(American Nurses Association [ANA], 2009, p. 28) Considers the economic impact of the plan.(American Nurses Association [ANA], 2009, p. 28)Develop evidence based orientation plan/policy/ process for nurse manager group using an interdisciplinary approach at MidMichigan Health (MMH). Analyze current policy on nurse manager orientation related to non-nursing departments Revise key educational topics/checklist needed for nurse manager success.Perform Root Cause analysis or FEMA for current/recent orientation deficiencies.Determine common stressors of newly hired nurse managers.2.Develop cost analysis of proposed plan. (Included: the cost of nurse manager turnover). Determine time allotment for orientation. Determine budget availability for outside programs.Calculate cost benefit ratio of orientation/ nurse manager turnover. 1A.Literature on best practice for nurse manager orientation processes.AONE Nurse executive competencies.ANA Administration Scope and StandardsNursing and non-nursing theory for learning & change. (Most likely Benner/ Novice to Expert, Studor, Lewin?)Nursing philosophy (Newly developed Summer 2015)1B.Current orientation policy and tool/checklist1C. List of ancillary non-nursing department’s liason.Current orientation tool/checklist.1D.Meeting with current nurse managers, directors, education department manager, HR representation, and VP of nursing for topics to be included in new process/ identify weaknesses in current process.1E.Meeting with current nurse managers to discuss experiencesLiterature on stressors of the new nurse manager2A.Meeting with human resource. EBP literature for cost of nurse manager turnover and time devoted to orientation process.2BMeeting with Nursing Directors & VP of nursing 2C.Meeting with Nursing Directors & VP of nursing 2D.Meeting with finance department to determine cost/benefit ratios.Sept-Dec 2015Standard #5ImplementationThe nurse administrator implements the identified plan.(American Nurses Association [ANA], 2009, p. 29)Facilitates utilization of systems and community resources to implement the plan (American Nurses Association [ANA], 2009, p. 29)Collaboration with nursing colleagues and others to implement the plan.(American Nurses Association [ANA], 2009, p. 29)anize meetings with in house departments (Physician stakeholder included), as well as possible community entities to determine available resources.2.Determine responsibilities for process completion at the end of 6 months after hire. 1A.Contact person for various departments and organizations.2A.Meeting with stakeholders (Including human resources)Contact person for various stakeholders.Calendars for various stakeholdersSept-Dec 2015Standard # 8EducationThe nurse administrator attains knowledge and competency that reflects current practice.(American Nurses Association [ANA], 2009, p. 36)Seeks experiences and independent learning activities that reflect current practice in order to develop, maintain and improve skills and competencies in nursing administration role.(American Nurses Association [ANA], 2009, p. 36)Maintains professional records that provide evidence of competency and lifelong learning.(American Nurses Association [ANA], 2009, p. 36)1.List learning opportunities for nurse manager education.Determine current offerings for nurse manager orientation at MidMichigan Health2.Construct competency tool utilized for nurse manager orientation to maintain in human resources file. Utilize hospital technology to obtain data regarding nurse manager competencies1A.Collaborate with local universities and colleges.List of yearly state conference offerings for nurse manager conferences1B.Meeting with education department 2A.Tools utilized to document competency from other organizations. 2B. IT liaison Human resource dataSept-Dec 2015Standard # 9Professional PracticeEvaluationThe nurse administrator evaluates own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations.(American Nurses Association [ANA], 2009, p. 37)Interacts with peers and colleagues to enhance own professional nursing practice and role performance.(American Nurses Association [ANA], 2009, p. 37)Takes actions to achieve goals identified during the evaluation process.(American Nurses Association [ANA], 2009, p. 37)1.Determine what is needed to enhance nurse manager professional practice as leaders.Create and communicate project outcomes in a non-threatening manner2.Develop evaluation process for the completion of the nurse leader orientation process.Measure and analyze performance from learning 1A.AONE Nurse executive competencies. Meeting with Nurse managers/Directors 2B. Transformational Leadership guidelines and literature2A.Local healthcare organization’s evaluation processes.Evidence based practice evaluation methods.2B. Benchmarking of nursing data for turnover rates & magnet designation status Sept-Dec 2015Appendix B Student-Preceptor-Agency- AgreementThe overall objective of this experience is to provide an on-site setting in which a student, with the preceptor (professional employee of a health care agency), can further develop his/her understanding and skills related to an advanced nursing role specialty.Agency name ____MidMichigan Health-MidlandStudent name ___Marie Wendt_______Student Telephone # ___989-529-1957Preceptor name __Jan Penney RN, MSN__ Preceptor’s Title:__ Vice President and Chief Nursing OfficerPreceptor Telephone #____ 989-839-3645 Email_ jan.penney@Agency representative ___Colleen Markel___Agency representative Title _ Manager of Workforce DevelopmentAgency representative Telephone #__989-839-3120 Email___colleen.Markel@The following learning outcomes and activities will be completed by the student during this project/practicum.Develop evidence based orientation plan/policy/ process for nurse manager group using an interdisciplinary approach at MidMichigan Health (MMH). Analyze current policy on nurse manager orientation related to non-nursing departments Revise key educational topics/checklist needed for nurse manager successPerform Root Cause analysis or FEMA for current/recent orientation deficiencies.Develop cost analysis of proposed plan. (Included: the cost of nurse manager turnover). Determine budget availability for outside anize meetings with in house departments (Physician stakeholder included), as well as possible community entities to determine available resources.Construct competency tool utilized for nurse manager orientation to maintain in human resources file. Utilize hospital technology to obtain data regarding nurse manager competenciesDevelop evaluation process for the completion of the nurse leader orientation process.SIGNATURE SIGNIFYING AGREEMENT TO THE TERMS OF THIS PRECEPTOR AGREEMENT:Student _________________________________________ Date ___________________Preceptor(s) _______________________________________ Date ___________________Agency representative _______________________________ Date ___________________Appendix C Learning Practicum Evaluation ToolMarie Wendt RN, BSNFerris State University***CHOOSE ONE***→ Midterm Evaluation _______ October 12, 20115 OR Final Evaluation ______ November 30, 2015Evaluation Key:ScoreProficiency LevelDescriptionN/ANot ApplicableYou are not required to apply or demonstrate this competency. This competency is not applicable to your position.1Fundamental Awareness(basic knowledge)You have a common knowledge or an understanding of basic techniques and concepts.Focus is on learning.2Novice(limited experience)You have the level of experience gained in a classroom and/or experimental scenarios or as a trainee on-the-job. You are expected to need help when performing this skill.Focus is on developing through on-the-job experience;You understand and can discuss terminology, concepts, principles, and issues related to this competency;You utilize the full range of reference and resource materials in this competency.3Intermediate(practical application)You are able to successfully complete tasks in this competency as requested. Help from an expert may be required from time to time, but you can usually perform the skill independently.Focus is on applying and enhancing knowledge or skill;You have applied this competency to situations occasionally while needing minimal guidance to perform successfully;You understand and can discuss the application and implications of changes to processes, policies, and procedures in this area.4Advanced(applied theory)You can perform the actions associated with this skill without assistance. You are certainly recognized within your immediate organization as "a person to ask" when difficult questions arise regarding this skill.Focus is on broad organizational/professional issues;You have consistently provided practical/relevant ideas and perspectives on process or practice improvements which may easily be implemented;You are capable of coaching others in the application of this competency by translating complex nuances relating to this competency into easy to understand terms;You participate in senior level discussions regarding this competency;You assist in the development of reference and resource materials in this competency.5Expert(recognized authority)You are known as an expert in this area. You can provide guidance, troubleshoot and answer questions related to this area of expertise and the field where the skill is used.Focus is strategic;You have demonstrated consistent excellence in applying this competency across multiple projects and/or organizations;You are considered the “go to” person in this area within NIH and/or outside organizations;You create new applications for and/or lead the development of reference and resource materials for this competency;You are able to diagram or explain the relevant process elements and issues in relation to organizational issues and trends in sufficient detail during discussions and presentations, to foster a greater understanding among internal and external colleagues and constituents.(Office of Human Resources at the National Institutes of Health, 2009, table 1)***Please place a check mark in the appropriate box.Standard #4PlanningThe nurse administrator develops a plan that prescribes strategies and alternatives to attain expected outcomes. (American Nurses Association [ANA], 2009, p. 28)Participates in the design and development of multidisciplinary and interdisciplinary process to address the situation or issue(American Nurses Association [ANA], 2009, p. 28)Not ApplicableFundamentalAwarenessNoviceIntermediateAdvancedExpertUtilizes evidence based literature in development of orientation project processActively demonstrates utilization of theory during project processIncorporates newly developed MMH nursing philosophy in planning of process of the nurse manager orientation process.Develops newly structured nurse manager orientation policy.Collaborates well with current nurse manager team well to develop new policy, protocol, and checklist.Collaborates well with current ancillary departments personnel including human resources and educational services.Conducts an effective RCA/FMEA with appropriate stakeholders and utilizes findings to determine gaps in current process.Considers the economic impact of the plan (American Nurses Association [ANA], 2009, p. 28)Not ApplicableFundamentalAwarenessNoviceIntermediateAdvancedExpertEffectively collaborates with finance department in developing cost effective plan.Effectively collaborates with senior leadership (Nursing Directors and VP, Education, Human Resources) in understanding financial impact of orientation plan.Applies best practice evidence of financial limitations related to effective nurse manager orientationStandard #5ImplementationThe nurse administrator implements the identified plan. (American Nurses Association [ANA], 2009, p. 29)Facilitates utilization of systems and community resources to implement the plan (American Nurses Association [ANA], 2009, p. 29)Not ApplicableFundamentalAwarenessNoviceIntermediateAdvancedExpertFacilitates meetings with ancillary departments, physician stakeholders and community entities to determine available resources.Arranges consultation with state academic and healthcare institutions to compare leadership education strategiesCollaboration with nursing colleagues and others to implement the plan. (American Nurses Association [ANA], 2009, p. 29)Not ApplicableFundamentalAwarenessNoviceIntermediateAdvancedExpertCollaborates with leaders to determine appropriate and available resources to teach various aspects of the plan.Collaborates with individual ancillary departments to design the implementation strategy.Standard # 8EducationThe nurse administrator attains knowledge and competency that reflects current practice.(American Nurses Association [ANA], 2009, p. 36)Seeks experiences and learning activities that reflect current practice in order to develop, maintain, and improve skills and competencies in nursing administration role. (American Nurses Association [ANA], 2009, p. 36)Not ApplicableFundamentalAwarenessNoviceIntermediateAdvancedExpertAble to list current offerings for nurse manager orientation.Able to list learning opportunities for furthering nurse manager orientation competency understanding.Collaborates with local academic institutions to address gaps in leadership preparationMaintains professional records that provide evidence of competency and lifelong learning. (American Nurses Association [ANA], 2009, p. 36)Not ApplicableFundamentalAwarenessNoviceIntermediateAdvancedExpertConstructs competency tool to be utilized for nurse manager orientation to be maintained in human resources file.Develops new nurse manager evidenced based reference binder.Standard # 9Professional PracticeEvaluationThe nurse administrator evaluates own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations.(American Nurses Association [ANA], 2009, p. 37)Interacts with peers and colleagues to enhance own professional nursing practice and role performance. (American Nurses Association [ANA], 2009, p. 37)Not ApplicableFundamentalAwarenessNoviceIntermediateAdvancedExpertAnalyzes gaps in current nurse manager professional practice at MMHAssembles social support system into the nurse manager orientation process Takes actions to achieve goals identified during the evaluation process. (American Nurses Association [ANA], 2009, p. 37)Not ApplicableFundamentalAwarenessNoviceIntermediateAdvancedExpertConstructs process for evaluating new orientation process/policy using EBPDevelops process for team evaluation of orientation project outcomeEVALUATOR’S general comments:STUDENTS Comments: Student Name________________________ Student Signature________________________________ Date: ________________Evaluator’s Name_______________________ Evaluators Signature _____________________________ Date: ________________Resource ListAbraham, P. J. (2011). Developing nurse leaders: A program enhancing staff nurse leadership skills and professionalism. Nursing Administration Quarterly, 35(4), 306-312. Nurses Association. (2009). Nursing administration scope & standards of practice. Silver Spring, MD: Nursebooks.A model of learning objectives. (2015). Retrieved from resources/effective-practice/revised-blooms-taxonomy/Avolio, B. J., & Yammarino, F. J. (2013). Transformational & charismatic leadership: The road ahead (2nd ed.). Bingly, WA, UK: Emerald Group.Chinn, P. L., & Kramer, M. K. (2008). Integrated theory and knowledge development in nursing (7th ed.). St Louis, MO: Mosby Elsevier.Conley, S. B., Branowski, P., & Hanley, D. (2007). Nursing leadership orientation: A competency and preceptor model to facilitate new leader success. Journal of Nursing Administration, 37(11), 491-498.DeCamli, P., Kirby, K. K., & Baldwin, C. (2010). Beyond the classroom to coaching: Preparing new nurse managers. Critical Care Nurse, 33(2), 133-138.Digman, D., Duffield, C., Stasa, H., Gray, J., Jackson, D., & Daly, J. (2012). Management and leadership in nursing: An australian educational perspective. Journal of Nursing Management, 20(), 65-71. of Nurse Manager Orientation PoliciesExamples of Nurse Manager Orientation ChecklistsExamples of Nurse Manager Orientation Evaluation ToolsFennimore, L., & Wolf, G. (2011, May). Nurse manager leadership development: Leveraging the evidence and system-level support. Journal of Nursing Administration, 41(5), 201-210. , E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010, July 20). Evidence-based practice step by step: Critical appraisal of the evidence: part I. American Journal of Nursing, 110(7), 47-52. , A., Carter, K., & Nugent, M. (2009). Nurse manager orientation. AACN Advanced Critical Care, 20(1), 55-70.Macphee, M., Dahinten, V. S., Hejazi, S., Laschinger, H., Kazanjian, A., McCutcheon, A., ... O’Brien-Pallas, L. (2014). Testing the effects of an empowerment-based leadership development programme: Part 1- leader outcomes. Journal of Nursing Management, 22, 4-15. , A. M., & Frankson, C. (2010). The role of the charge nurse manager: A descriptive exploratory study. Journal of Nursing Management, 18, 319-325.MidMichigan Health Nursing philosophyMidMichigan Health Nurse Manager PolicyMidMichigan Health Nurse Manager Orientation ToolNorthouse, P. G. (2015). Leadership: Theory and practice (7th ed.). Thousand Oaks, CA: Sage Publications.Office of Human Resources at the National Institutes of Health. (2009). , O., Brooks, B. A., & Loyd Storfjell, J. (2011). Advancing nursing leadership: A model for program implementation and measurement. Nursing Administration Quarterly, 35(4), 323-332. , P., Palaganas, J., Kiemeney, J., Strother, B., Bruneau, B., & Hamilton, L. (2011). Enhancing leadership orientation through simulation. Critical Care Nurse, 31(5), 58-63. AONE nurse executive competencies. (2005). Retrieved June 23, 2015, from effective preceptor [Monograph]. (Serial No. 050215). Retrieved from , J. M., Weatherford, B., & Gemme, D. (2014, March). The effectiveness of a leadership development program on self-awareness in practice. Journal of Nursing Administration, 44(3), 170-174. ................
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