Let's get critical!
The article published in the August issue, “A Critical Look at Critical Thinking” by Susan J. Bodin, EdD, RN-BC, posed a thought-provoking question as she proposed the existence of a link between staff members' perception of the transformational leadership behaviors of the unit leader and their critical thinking skills. As a unit director in an acute care facility for the last 12 years, I've seen changes in leadership and staff, and I've often wondered why some units appear to be functioning at a much higher level of critical thinking than others. In the study conducted by Bodin, there was no relationship determined, but the proposition was made that organizational dynamics can prevent a leader from developing to his or her full potential. I believe the opposite is also true: A positive organizational dynamic can enable a manager to develop to his or her full potential.
In 2005, the Institute of Medicine reported that nursing leaders must provide a positive work environment to ensure patient safety. We now know that transformational leadership behaviors do this. According to Bodin, 43% of the nurses surveyed believed that enabling them to act was the most important behavioral dimension of transformational leadership. When a nurse knows that the professional decisions he or she makes using critical thinking skills will be supported by leaders, it makes for a more confident and productive work environment.
Clinical ladder transformation
I'm writing in response to the article “Which of These PATHS Is Right for You?” by Lori Maloy, MSN, RN, in the July issue. As an assistant nurse manager in an academic medical center that has a clinical ladder, I agree that the reevaluation of clinical ladders within an organization is necessary because concerns with finances remain at the forefront of healthcare and quality outcomes are closely monitored by all stakeholders. Traditional clinical ladders maintain a strong correlation with educational preption, which can hinder clinical advancement for some qualified nurses. With the Professional Advancement Through High Performance and Skill (PATHS) program, the opportunity for all employees across different disciplines to advance within the organization is a great way to increase innovation, promote positive quality outcomes, and save money. The four optional tracks—evidence-based practice (EBP), practice improvements, resource management, and staff development and education—are all areas that consistently need evaluation for improved outcomes.
Rural healthcare settings often use less EBP than urban hospitals. The clinical ladder within rural hospitals is often based on the traditional clinical ladder, with a component for advancement based on level of education. Most nurses within the rural setting hold an associate's degree in nursing and lack the training to effectively utilize EBP in their daily practice. The implementation of PATHS is a method to potentially increase the use of EBP in the rural healthcare setting.
Nurse leaders in the rural setting must look at ways to increase professional development. The opportunity for employees within different disciplines to collaborate and develop innovative projects would be beneficial within the rural healthcare setting. As a nurse leader, I'm an advocate for a clinical ladder within healthcare and agree that PATHS has the potential to save money and also improve quality care in both rural and urban healthcare settings.
Amy Leleux, BSN, RN-C
Rebecca Crane, BSN, RN, CRRN