Most nursing schools include some type of leadership and man- agement course or lessons in the curriculum. These courses may present a single theory of nursing leadership or review a variety of theories. Once aware of the existing theories, a nurse can sub- scribe to whichever best fits her or his personality. A nurse leader should choose the leadership theory that best reflects his or her ideals and can be used effectively. No one rates the theo- ries; each one has pros and cons. Once ascribed to, however, the theory should be reinforced. Followup is often inconsistent, despite senior leaders saying their priority is creating active lead- ers for the future of health care. Senior leaders can help their younger colleagues by inviting discussions of leadership theory, as well as constant review and updating of the theory’s applica- tion in practice.
This chapter’s focus is on the history of nursing education and the evolving role that academia and schools of nursing have on nurse training and leadership development. We know that hav- ing an adequate and competent workforce is vital to positive patient outcomes. Ensuring access to thorough, comprehensive training is the key to preparing nurse leaders.
“Patients are getting the right care overall; however, I am not certain they are getting the right care in the right order.
Staff require the skill set necessary to address the needs of today. Education is complex and a great deal is expected of new graduates. Existing staff have grown up with the tech- nology we currently utilize. We need internships or residen- cies to help with the new graduate transition to the current environment. Academia needs to emphasize the educational needs of their students given the complex environment. The concept of joint appointments with defined criteria and expectation to keep faculty competent in the field is vital.”
–Terry Watne, MS, RN; Administrative Director, Altru Health System, Grand Forks, North Dakota
CASE STUDY
Susan was a bright-eyed graduate nurse who was hired to work on a 10-bed oncology unit. She was excited to land a job at her first-choice hospital, and on the unit where she desired to work. Susan’s interview was brief, lasting only about 15 min- utes. At the time, there were four registered nurse openings on the unit. Susan asked only a few questions because she was so excited to have the chance to apply for a position doing what she loved. Susan was passionate about oncology, because both her grandmother and mother had died from breast cancer in their mid-Forties.
Susan arrived at the hospital for her first day of work and was instructed to go to the auditorium for hospital orientation.
Twenty-two employees attended this orientation, and Susan was one of three graduate/registered nurses in the orientation group.
The rest of the employees were nurse assistants, respiratory care
technicians, a social worker, a new manager, and two physical therapists.
Susan had a brief opportunity to meet the other nursing col- leagues; however, they were hired for and assigned to different nursing units and shifts so she rarely saw them again after that first day. On day 2, Susan was met on the oncology unit by the unit nursing educator. The educator provided “just-in-time” ori- entation, which meant that she gave Susan her locker code, advised her on the location of the bathroom, and provided the codes to access the medication room, the automated medication administration device, and the computerized charting system.
The unit educator provided Susan with an overview of the unit- based policies and procedures document describing the opera- tional scope of the oncology unit.
Gloria, a seasoned registered nurse who had worked on the oncology unit for the past 9 years, was then assigned to Susan as her buddy for the next 2 days. Gloria provided Susan with the best “on-the-job” orientation possible. Susan had a checklist, but Gloria commented, “Oh, I’m aware of that tool, but just follow me, you’ll learn to do your own thing in time.”
Susan observed numerous workarounds occurring over the course of her next 2 days. She adapted to the culture of the unit and before long “became one of them” so that she would “fit in with the group” and not have to deal with colleagues talking behind her back. She wanted to be accepted as part of the staff on the unit.
Susan also observed that the physicians who practiced on this nursing unit were very influential and demanded that care be provided per their direction only. Informally, Susan was told by her colleagues that should not disturb Drs. Miller or Jonah in the middle of the night unless she wanted to be “hung out to dry” the next day when they made rounds. Susan was told to wait until the morning to contact these two physicians for care orders for their patients.
Assessment Questions
1. What gaps can you identify in the processes to which Susan was exposed?
2. What principles would you embrace as a leader for that unit?
3. Was Susan’s experience like your own experience as a new employee? Why or why not?
4. What might the unit leaders do to ensure that Susan has a better experience going forward?
5. What might Susan’s academic program have done to prepare her for her interview and new employee experiences?
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Best Practice
REFERENCES
1. National League for Nursing Web site. Available at: http://
www.nln.org
2. American Nurses Association Web site. Available at: http://
www.ana.org
3. “History of The Rochester City Hospital Training School for Nurses.” Available at: http://www.viahealth.org/body_rochester.
cfm?id=711
4. Varney, H. Yale School of Nursing: A Brief History, p. 5. Available at: http://www.med.yale.edu/library/nursing/historical/shorthist/
NursingHistory.pdf
5. “Columbia University: The School of Nursing Description and History.” Available at: http://www.nursing.columbia.edu/about- school/history.html
6. Campbell, C. (2000). Personal Communication. June 2008.
7. Ross, A. Wenzel, F. J., Mitlyng, J. W. (2001). Leadership for the Future, Health Administration Press, AUPHA Press, Chicago.
8. American Nurses Credentialing Center Web site. Available at:
http://www.nursecredentialing.org/Magnet/FindaMagnetFacility.
aspx
9. “State of the State with Dr. Peter Buerhaus: The Latest Projections of Nursing’s Future.” webinar, presented January 29, 2009. Available at: http://www.concerro.com/webcasts/webcast_
20081218.htm