Watkins, Stacey MSN, RN, FGNLA; Corley, Donna PhD, RN, CNE; Cleeter, Deborah EdD, MSN; Moe, Krista PhD; Brockopp, Dorothy PhD, RN
Continuing development of nurse leaders within an organization can assist them to increase satisfaction among staff members regarding their roles, diminish nurse burnout, and increase retention.1 Without appropriate skills and knowledge, it's difficult for nurse leaders to design and maintain a positive work environment. Skilled leaders can support the achievement of organizational goals through the retention of knowledgeable, experienced employees and by creating environments that support inquiry and engagement, leading to better patient care and creativity in planning for change and process improvement.
Developing nurse leaders committed to improving care for older adults is the focus of the Geriatric Nursing Leadership Academy (GNLA), an 18-month program offered by Sigma Theta Tau International, The Honor Society of Nursing. The GNLA fellowship is designed to advance nursing practice related to the care of older adults by developing nurse leaders who have strong skills in communication, collaboration, and organization.2 A goal of the program is to develop individuals who can competently lead interprofessional teams. Effective collaboration across disciplines and with members of the community is a measureable outcome of the fellowship. In order to meet specified goals, fellows select expert mentors to guide them through their uniquely developed leadership journey. The 2012–2013 cohort of GNLA fellows was the third cohort since the creation of this fellowship and consisted of 10 nurse leaders from different organizations.
The GNLA fellowship incorporates activities within three domains: (1) individual leadership development; (2) advancing nursing practice through an interprofessional team leadership project; and (3) expanding scope of influence to the organization, community, and profession.2 A number of activities have been designed to address these domains, including attending two workshops. Preassignments, selected readings, and a self-assessment are completed before each workshop. Preassignments for the second workshop, held at the midpoint of the 18-month fellowship, include writing and developing presentations on midacademy reports. In addition to workshops, fellows are required to participate in monthly leadership learning enhancement activities through teleconferencing with fellows, mentors, faculty advisors, previous fellows, and guest speakers. Topics include communication, health policy, personal branding, and business etiquette.
To evaluate the progress of fellows, the Leadership Practices Inventory is completed by each participant at the beginning, middle, and end of the fellowship experience.3 Fellows are also evaluated using other tools, including 360° assessments; guided self-reflection; and formal feedback from supervisors, colleagues, and staff members. 360° evaluations provide baseline data of leadership assessments for fellows to utilize as benchmarks for setting strategies, goals, and actions for desired changes in leadership skills and behaviors over the next 18 months of the GNLA.4 Self-reflection through journaling—an activity highly encouraged by GNLA—serves as an effective tool for fellows to reflect on their own learning and personal leadership behaviors.
Obtaining consistent, constructive feedback from supervisors, colleagues, and staff members on identified specific leadership skills and behaviors from observations provides valuable insight. Feedback from observations facilitates positive and effective leadership behavioral changes. Aggregated information is used to develop a plan, including goals and actions that would enhance the individual's leadership skills and behaviors. Setting and meeting goals is an ongoing and evolving process throughout the 18-month fellowship.
Fellows are guided by the leadership mentors, selected by fellows, and faculty advisors appointed by the GNLA. Mentors, faculty advisors, and fellows discuss their experiences biweekly by telephone for additional support. Fellows also develop formal mentoring relationships within their organizations.
This fellow's leadership mentor was a research consultant and also a professor at a local university. This fellow's faculty advisor was an international leadership consultant and CEO of a consulting firm. Both offered leadership knowledge, expertise, and experiences while also affording opportunities for networking within the organization, community, and profession on an ongoing basis. This fellow was able to gain valuable insight, opinions, advice, and guidance by having collegial relationships with both the leadership mentor and faculty advisor throughout the 18 months of the GNLA fellowship.
As a part of the fellowship requirements, participants design and implement an interprofessional leadership team project related to the care of older adults. Through this project, it was assumed that fellows would improve care for a segment of the older adult population and promote the establishment of collaborative relationships within the organization, community, and profession. Although the number of adults who are age 65 and older is increasing, a lack of formal education for healthcare providers regarding the health needs of this population persists.5,6
The pilot project, conducted by this author, was entitled the Older Adult Knowledge (OAK) Initiatives. The OAK project was completed in two phases. In phase one, a knowledge assessment regarding older adults and their care was administered to nurses in a 383-bed tertiary care Magnet®-recognized facility. In phase two, all findings from phase one were used to develop an intervention to address a knowledge deficit related to the older adult population identified from the survey.
Data on four potential problems related to the care of older adults (dementia, delirium, falls, and pain) were collected using the Geriatric Nursing Knowledge Assessment (GNKA).7 Findings suggested that nurses required more opportunities to learn about managing pain in this population. Based on these findings, an intervention consisting of multidisciplinary pain minirounds was initiated on two progressive care units. These minirounds continued for 3 weeks. The pain minirounds were patient-focused and required healthcare providers (nurses, pharmacists, and members of the integrative care team) to actively participate in developing a care plan that would address patients' needs relative to their pain. Issues related to effective communication among healthcare providers and between healthcare providers and patients were addressed. The pain management knowledge level of RNs working on the unit where the pain minirounds occurred was reassessed at 14 days and at 2 months following implementation of the intervention.
Means, standard deviations, and analysis of variance (ANOVA) were calculated. Means increased each time the GNKA was administered (N = 39, pre-, M = 57, SD = 17.8; N = 19, time 1, M = 65.37, SD = 24.56; N = 13, time 2, M = 73.31, SD = 19.74). Results from the ANOVA weren't significant, perhaps due to the small sample size of individuals who took the GNKA three times (N = 5). Given the pilot nature of this project and the increase in knowledge scores over the three times the GNKA was given, a recommendation was made to repeat the pain minirounds in other areas of the hospital.
GNLA's expectations that fellows expand their scope of influence at the organizational, community, and national levels were met through: (1) developing ongoing relationships with present and previous fellows across the country, (2) attending meetings and working with a local community organization and church that supports older adults, and (3) leading the geriatric care team within the fellow's organization.
During the fellowship experience, fellows arrange and facilitate two GNLA site visits. The first site visit occurs early in the fellowship (within the first 4 months) and is designed to introduce the fellows to professionals who support older adults within their local communities. The goal of the first site visit is to engage organizations and professionals from those organizations to become active participants in the 18-month fellowship.
Site visit two occurs near the end of the fellowship. During this visit, the fellow's progress related to leadership development and project results is discussed at a number of small, purposeful meetings. Attendees include organization staff, executive leaders, local community members, local government officials, schools of nursing representation, and nursing professional organization representation. Conversations regarding the fellow's future as a result of the fellowship are held with the chief nurse executive and other key individuals in administration. A career plan is developed and relationships established with those colleagues who can provide support.
Poster presentations of fellows' projects took place at Sigma Theta Tau International's Biennial Convention in Indianapolis, Ind., in November 2013. This fellow, along with two others, was invited to report on cumulative leadership data for the third cohort of the GNLA and personal experiences as fellows during the 18-month fellowship.
Better leaders emerge
The GNLA experience provides numerous opportunities for participants to grow as leaders. Expectations of fellows include influencing the development of programs, designing and conducting projects, and working with key leaders both within and outside of the fellow's institution. Outcomes related to the 18-month experience include gaining valuable knowledge and skills, designing a career plan, and developing meaningful relationships.
The fellowship enables participants to focus on a given area (such as care of the older adult). With this focus, they're able to learn how to make a positive impact on patient care within the acute care setting, as well as the community. Fellows learn that they can define a goal, devise a plan to reach that goal, and successfully implement their plan in any area they choose.
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