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Opportunities in Chaos

Leveraging Innovation to Create a New Reality in Nursing Education

Williamson, Kathleen M. PhD, RN, MSN; Nininger, Jami DNP, RN; Dolan, Scott PhD, RN; Everett, Todd PhD, MBA; Joseph-Kemplin, Mitch MA

Author Information
Nursing Administration Quarterly: April/June 2021 - Volume 45 - Issue 2 - p 159-168
doi: 10.1097/NAQ.0000000000000464
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Abstract

THE GLOBAL pandemic caused by coronavirus disease-2019 (COVID-19) has been a disruptor in higher education. Pandemic responses necessitated nationwide closures of colleges/universities in mid-March 2020. Campus closures impose a tremendous impact on higher education institutions financially, straining available resources as institutions work to support the new reality of teaching and learning in a remote environment while concurrently shifting full organizational operations to virtual means. Within nursing education, academic leaders have been required to navigate the challenges of ensuring continuity in the delivery of quality learning experiences and the achievement of learning outcomes in new contexts complicated by the elimination of clinical agency access and the disruption of clinical experiences. Further, the immediacy of the pandemic context has required faculty and students to adapt swiftly to the use of existing and new technologies in the remote delivery of course content. In a matter of days, faculty found themselves needing to conquer unfamiliar technologies to deliver lessons synchronously and learn evidence-based teaching strategies relevant to student engagement in a virtual environment.

Amid disruptions, leadership plays a critical role mitigating and navigating initial impacts of change. It also holds responsibility for cultivating hope and opportunities that can emerge from the process of change. To work through the disruption of the educational system and capitalize on the opportunities for transformational change, the leadership team of one organization utilized Trinity Health's Change Methodology1 based on Winning Teams and Winning Cultures.2 Through a reflection on this transformational process, the authors will share the successes and lessons learned on how collaborations and the use of innovative strategies have helped cultivate a new reality for nursing education in this era of a global pandemic.

BACKGROUND

Mount Carmel College of Nursing (MCCN) is a private college located in upper northeastern edge of the mid-west region of the United States. It is part of the Mount Carmel Health System (MCHS), which is a member of Trinity Health. At its core is academic excellence, respect, compassion, social responsibility, and diversity. MCCN is proud of its student-centered philosophy and is focused on an engaging curriculum. During the pandemic, the dedicated faculty have continued to provide excellence in nursing education that encompasses the best of compassion, commitment, and competence. However, the college faced and continues to face many pandemic-related challenges, as it navigates the process of reopening and the need for ongoing remote delivery for the 2020-2021 academic year.

Academic nursing leaders have been confronted with challenges of balancing the impact of the pandemic responses in the face-to-face classroom, as well as in laboratory and clinical learning. Additional challenges include ensuring the safety of the college community, and supporting alternative educational delivery formats with assurance that desired learning outcomes and professional competencies are attained. The challenges faced by these leaders are unprecedented. However, there is opportunity in crisis.

Transformational change is a radical shift from one state of being to another.1 Although the disruptions imposed by the pandemic have certainly ignited change, the transformation of nursing education imparted by the disruption will only occur if opportunities that emerge from the change are leveraged and sustained. Academic leaders are positioned to capitalize on innovative strategies and models of education that emerge as a result of disruption. Importantly, academic leaders hold responsibility for setting a vision and empowering stakeholders to engage in the shared goal of reimagining a new reality in nursing education made possible through the disruption.3–6

CHANGE METHODOLOGY

Leadership in nursing education demands competency in communication, relationship development, professional role modeling, and business acumen that accompanies knowledge of the changing context of health care and higher education. Effectiveness in setting and executing a vision for nursing education must accompany the academic leaders' skill in navigating uncertainty using resourcefulness and effective decision-making in the face of competing and shifting priorities.3,5 Importantly, academic nursing leaders' ability to embrace innovation and use of the best evidence as the foundation for strategy stand foundational to the ability to lead effectively in times of uncertainty and change.4,6

The pandemic has been and continues to be a catalyst for change in higher education igniting major paradigm shift—forcing the reorganization of priorities that necessitate an innovative spirit and design thinking strategies to challenge assumptions that permit the creation and implementation of a new reality. During this time of unprecedented disruption, the Change Methodology1 has provided the framework to assist college leadership in navigating during this complex and dynamic crisis. The framework consists of 7 elements/phases (see Figure 1): current reality, mindset shift, practice, integration, sustainment, assessment, let go!

Figure 1.
Figure 1.:
Change Methodology.1 , 2

Current reality

The first phase of the Change Model1,2 requires an assessment of current reality.1 This phase includes: gathering data to understand the current reality; identifying the change; identifying key stakeholders; creating the team; building the case for change; creating strategy for engagement in the process of change; and creating a communication plan.1,2,7 Most planned change facilitators can devote calculated amounts of time to this step to build the foundation for change.1 However, given the dynamic situation presented by COVID-19, the possibility of an extended period for planning was absent. Initial pandemic response demanded a rapid shift to remote education prompted by campus closure—impacting not only the way faculty at the college taught, but also the manner in which students learned. Understanding the currently reality and initial impacts of the pandemic disruption were critical to the leadership team's ability to support and manage the rapidly shifting impact of change.

The key characteristics of the first phase of the Change Methodology, which include building the case for change and creating the team, were imposed by the reality of the pandemic context. On March 10, 2020, the Governor of Ohio recommended that all higher education institutions to suspend face-to-face classes and go to remote learning. This meant that the leadership and faculty teams had approximately 3 to 5 days to plan and launch a new format of learning that would support the continuity of instruction for students. The majority of work to be completed would require faculty to shift from traditional forms of teaching (being in the classroom with students [face-to-face]) to the new standards of remote education (synchronous, remote video conference).

A call for reform in nursing education is not a new phenomenon.8 Yet, many faculty members continue to teach through traditional approaches reflective of their own learning experiences involving reading assignments and lectures.9 Additionally, in conventional approaches, didactic material covered in the face-to-face setting is then applied and reinforced in the clinical and laboratory settings.10 However, when confronted with the cancelation of face-to-face coursework and clinical-based experiences, faculty would need to innovate in order to facilitate learning in a way that permitted students to achieve program and course goals and objectives.

The current reality for our organization was similar to the reality of organizations and nursing programs nationally. At the time of the pandemic response, 72% of faculty within the college reported that they had no experience with teaching either a hybrid or online course. Nationally, 73% of faculty reported no prior online or hybrid teaching experience at the start of the pandemic.11 Our organization, fitting national trends, has demonstrated a slow evolution in the transformation of nursing education since the call for radical change,12 and long-standing resistance to the adoption of e-learning strategies as foundational to the process of education.13

To facilitate the rapid adaption of remote delivery for all aspects of education programming, our organization made the decision to temporarily suspend all classes. The pause provided faculty an opportunity to engage in targeted professional development, facilitating comfort and competence in the transition to the alternative delivery platform. The cancelation of courses would also allow college leadership to bring the faculty together as a team, empowering them to use their collective strengths in the planning and support of the shared vision to provide academic excellence in service to students. This approach and strategy aligned with essential elements of the first phase of the Change Methodology,1 creating a task plan and executing a communication plan. Initial planning processes began with a meeting of the entire college community. The meeting provided the leadership team with an opportunity to share information pertinent to the rapidly changing context, outline initial structures for planning, and engage faculty and staff in the assessment areas of strength and weakness and strategy identification for moving education and business operations to remote delivery. Of particular concern in the changes that would be forthcoming, would be the decision on how laboratories and clinical experiences would be actualized in this remote environment.

Initial planning for remote operations and educational delivery was informed by the assessment of available resources. Initial planning involved the shift of face-to-face lectures to a synchronous learning format utilizing resources available through the current learning management platform, and technologies already available to faculty, while also identifying and leveraging a variety of resources and emerging technologies, to support faculty and student learning. Knowing that the majority of faculty within the college had little experience in distance delivery technologies and methodologies, creating structures and resources to support faculty competency and comfort in remote delivery emerged as an area of priority. The faculty who currently taught in the online environment quickly emerged as mentors supporting and collaborating with faculty teams across the college to support the pivot to remote delivery. The college's instructional designer harnessed the expertise of those emerging as mentors, to formalize faculty support teams and “drop-in” clinics to support the transition. Importantly, the faculty mentors and the collaborative teams also serve as ignitors of transformational change toward a new reality in education.

Effective and transparent communication is a cornerstone in change management.1,3,14 Notably, in national surveys15,16 assessing pandemic impacts, regular communication regarding the planned change has been elemental to bolstering faculty engagement. Frequent, relevant, and consistent communication through a variety of means was an essential element in support of the rapidly changing situation that pandemic responses imposed. Training sessions and meetings permitted faculty to exchange ideas, work with one another to problem solve, and voice concerns to college leadership. Additionally, regular emails and a daily “videolog (vlog)” provided by the Academic Dean kept the college community abreast of pertinent information needed to navigate the dynamic situation and its impacts.

There has been a shift in the current reality; the impacts of the pandemic are not temporary, and will have changed education communities. As a part of this transition, communications and responses must strategically shift from a focus on urgencies perceived as temporary solutions to a focus on the sustainable innovations and creative strategies that have emerged from the process of change. Varied communications with the college community continue. However, communications with and among the college community are shifting to a focus on strategy and planning for the future.

Communication, planning, assessment, and the formation of teams evolve, as the current reality evolves, which cultivates a foundation where new possibilities can be considered, and opportunity can be found in chaos. Disruption evokes change. However, the determination of whether the disruption drives positive sustainable change or lasting negative impact is determined, in part, by mindset shifts associated with the process of change, and one's ability to capitalize on the opportunities that emerge from the disruption.

Mindset shift

The second phase in the Change Model is creating an opportunity for insight—mindset shift.1 This element is a unique practice that is part of the culture, change, and engagement leadership of Trinity Health.1Mindset shift occurs by creating opportunities for insight in the face of change.1,2 Driving our team's ability to see opportunity in the face of disruption would mean that the leadership team would need to do 2 things: (1) assess the current impact of the disruption on the organization and (2) capitalize on the opportunities provided by the force of change.16 Assessing the existing student, faculty, and infrastructure strengths and priority needs during initial pandemic impacts drove response strategy, as the college community strived to continue programming mitigating interruption in students' progress within its programs. Moving all educational delivery and business operations to remote implementation was a monumental task. In fact, what was accomplished in a matter of a few short days would have taken years to accomplish under typical conditions. Leveraging the momentum for change and the innovation that occurred through this change represents a critical opportunity.

Mindset shift is a necessary element of sustaining innovation that emerges from disruption.1 As such, to facilitate new perceptions, leadership approaches must promote opportunities for stakeholders to consider how the realities of change can positively impact the future of the enterprises' educational and business operations. Transformational mindset shift for the college community will occur when individual team members gain insight about the positive impacts of change for them personally, for their teams, and for their students. To use the momentum of change as a catalyst for future change, the leadership team has had to facilitate opportunities for the faculty and staff to reflect on how responses to the pandemic have driven innovation, creativity, and collaboration across the college—motivated through shared vision for academic excellence and service to students.

Our reality, not unlike national trends noted through the Changing Landscape of Online Education (CHLOE-5) 2020 survey report,11 was that the majority (72%) of faculty at the college had never taught a hybrid or online course prior to the pandemic. Despite the lack of online teaching experience, faculty were asked to shift their teaching to remote delivery. While change in the immediacy of the pandemic was seen as necessary, motivating faculty to swiftly engage in remote and e-learning delivery to ensure student progression, varied perceptions, technology competencies, and experience levels with distance learning stand to impact seized opportunities for long-term change.13 The current context requires communication, resistance management, stakeholder engagement, and “letting go” to foster shifts in mindset that target seized opportunities in the face of the disruption.1,2

Engaging stakeholders across the college through, transparent communications, intentional experiences, and positive reinforcement support the shift toward collaboration and active partnership in creating a new normal and future for the college.1,2,3,5 As described previously, video communications led by the Academic Dean and the Instructional Designer served as a critical communication tool initially, providing relevant information and support to faculty and staff relating to the rapidly changing context as influenced by the pandemic. The vlogs' later focus was to showcase and recognize faculty innovations. Additionally, the vlogs and other forms of communication provide elements of professional development in support of e-learning strategies that demonstrate effective student learning and engagement. Importantly, the shift in messaging and experiences cultivated through the vlogs' focus on optimism and opportunities that have emerged from the pandemic disruption and their relationship to the shared vision of serving students through innovative academic excellence serve to nudge continued mindset shifts.

Faculty empowerment showed in the use of their collective strengths in service to students and the college supporting a shift in mindset toward the creation of a new future in education.1 Initial support structures also cultivated new opportunities for collaboration among faculty and staff that were outside of typical practices for the organization. For example, faculty across courses collaborated to develop course orientation processes and design elements of the course resources in the learning management system to better support learner transition to remote delivery. Additionally, faculty and staffs' laser focus on the common vision of working together to preserve educational quality in continued service to students in the face of varying degrees of technical competence and online teaching expertise broke down existing barriers and ignited new collaborations and relationships building across the college. Capitalizing on these elements of change by recognizing and drawing insight about the benefits of the newfound relationships is critical to fostering ongoing mind shifts toward the new reality.

Strategies in support of the new reality within the organization are evidenced through faculty and student feedback. Of the faculty who reported no prior online or hybrid teaching experiences, 72% (n = 44 of 61) report that institutional support during the transition to remote teaching was good or excellent. Additionally, by the summer, 2020 semester, 88% (n = 53 of 60) of the faculty respondents reported “comfort” while teaching in the remote environment, with nearly half of the faculty respondents (48%; n = 29 of 60) reporting that they are now “much more comfortable” teaching in the remote environment. Optimism among faculty through this journey has been demonstrated as more than half of the faculty respondents expressed a desire to teach remotely, at least in part, either through the fall or permanently. Notably, relationships with staff and faculty and the quality of instruction have been more highly rated by students during the remote learning as compared to 2019 survey data with some expressing a preference for permanent remote delivery options. The acknowledgment of successful outcomes in courses serves as a supportive rationale for continuing the remote learning structure.

Cultivating focus on opportunity through disruption has become the aim for the leadership team. The mindset shift materializes, as the community focuses less on “getting back to normal,” and instead embraces the process of “creating a new normal.” This shift is an important element of fostering hope, inspiring vision, and promoting team empowerment.15,16 Therefore, the leadership teams' formal and informal communications have had to shift from the focus on current state to emphasis on targeted experiences that leverage and build on the innovation, problem-solving, and the collective strengths of the team showcased through pandemic responses—permitting opportunity for insight by the college community on the positive impacts of a recognizably challenging situation. Shifting the focus and conversation from temporary solutions to learning and the continuity of instruction, to the new way of delivering quality education, provides opportunity to capitalize on the new foundation of collaboration and innovation that emerged from initial COVID-19 response processes.

Practice

Practice is the next phase in the methodology that represents the beginning of the implementation phase of the transformative change process.1 Conventional practices of the “way we have always done it” no longer fit the context of the new reality. The closure of most college campuses predicated the need for institutions providing nursing education to switch delivery style in a tactical and strategic way. The shift to the remote learning platform was not without setbacks and resistance to change for the greater good. The students believed that they were in college for face-to-face instruction that would provide on-demand coaching in the clinical and nonclinical settings. These events were difficult to replicate in this new remote learning venture. The use of applications such as web conferencing software served as a means to deliver content, but it was not effective in gauging entire sections of students' ability to grasp a topic or procedure to be performed at a later date. The introduction of clinical simulation software to stimulate the learning in a virtual clinical scenario also was apprehensively received with concerns relating to its efficacy in promoting desired competencies. The pioneering transition to the new way takes practice and assurance that the students are able to work on critical thinking and judgment to make decisions about care safely and confidently.

Practice is the stage of the Change Methodology1 that focuses on the execution of the implemented change.1 This stage of change not only involves implementation of change but also includes the refinement of the change through continued implementation—driving individual comfort and adaptation to change through practice.1 The institutions that will prevail as a quality provider of education in the new context of nursing education that emerges from the disruption will be those who demonstrate agility through dramatic shifts in innovative methodologies that achieve learner engagement and competency development. The support, resources, and innovation through the evolution of pandemic response lay the foundation for creating the new reality within our organization.

Integration

Integration is the next critical step of the Change Management1 framework. This step of the transformation process solidifies change through organizational structures such as policies, procedures, and strategies. Both integration and practice are elemental to sustainable change.1 The leadership team must engage the college community in the consideration of how the challenges of COVID-19 have cultivated opportunity. The leadership team must also drive active engagement and empowerment of the community in strategy and decision-making aimed toward a structure that supports and sustains openness to new possibilities in ways of “doing” and to a new reality.

The changing culture and response to the COVID-19 pandemic influenced the integration of many technologies and processes, affording the college the opportunity to improve the student experience in the delivery of auxiliary services such as registration, admissions, financial aid, and billing in the absence of in-person activities. The use of video conference software provided a platform to conduct virtual meetings to ensure ongoing contact and interaction with faculty, staff, and students. The successful integration of the use of technical applications such as computerized testing and virtual simulation has streamlined the academic measurement of content mastery and the ability to support student success while ensuring academic integrity.

The pandemic disruption evoked the use of technologies and innovative processes that serve foundational to new “ways of doing” that set the pace for creating a new reality. The use of video conference software provides a means by which relationships with college stakeholders can continue to grow in the context of remote operations. For example, video streaming and video conferencing solutions provide the means to engage alumni nationally, expand program promotion and visibility, and facilitate collaboration among community partners. The formation of a Faculty Fellowship program for the 2020-2021 academic year provides a peer resource group that assists others in increasing their level of competence in teaching modalities continuing the momentum of change. Emerging from early mentoring responses, this program provides lateral support to faculty in the implementation of new technologies/methodologies toward ongoing enhancement of remote and distance deliveries. The creation of the “skillsnasium,” (see Figure 2) coined through the relocation of the skills laboratory to the gymnasium within the organization, serves as an innovative approach to offering deliberate skill practice for students while ensuring the ability to uphold necessary infection control standards.

Figure 2.
Figure 2.:
Boot camp in the “skillsnasium.” In an effort to provide a safe return to the college, safety measures were put in place for all students, faculty, and staff entering the facility. Everyone is required to wear a mask and complete a COVID-19 self-screening check. Personal protection equipment is available along with positioning the various stations within a safe distance, as the students rotated through each station.

Entering our new reality: sustainability, assessment, let go!

Senn and Hart2 espouse that learning is augmented by practice and real-world application. “The added benefit is that when people use elements of the new culture to create real and tangible results, they more quickly adopt the new behaviors.”2(p135) Entering our new world that embraces the need for adaptation, the college community is learning to adjust to new methods of educating our future nurses. The leadership team, when reflecting on our Change Methodology, realize that to drive sustainability, there is a need to “let go” of the old ways, of old thoughts, attitudes, and behaviors—“to make way for insights and new ways of seeing.”1(p20) This process of change is messy: Embracing the future requires embracing a state of rapid technological advancements and changes. While sustainability is often associated with “stability,” stability in the new reality means “change.”

Sustainability, then, requires agility and balance through the waves of change. Assessment is a data-driven process that is ongoing to measure the progress of change,1 achieved through relevant and identifiable metrics that monitor and gauge institutional performance. Data gained through various metrics such financial performance, learning outcomes, student satisfaction, and faculty feedback can provide evidence for and a mechanism to drive change that is sustainable. Academic leaders must leverage data to showcase strategy impact, guide decision-making, and measure success that will drive effective change.3

The final phase of the Change Model is to let go! The changes brought on by the pandemic have strengthened the ties that bind the college community, as colleagues work to support the success of students and each other. While the strategies of transparent communication, data collection, technology adaptation are still important, the pace at which they are leveraged can be proactive instead of reactive to a national crisis.

CONCLUSIONS

Higher education has seen a paradigm shift. The storm of change has created a new landscape for nursing education. It is time for academic leaders to transform nursing education using newly founded innovations and strategies, while assessing impact and effectiveness in achieving desired professional competencies. Now is the time to leverage opportunities to upgrade the mode of education delivery and transfer attention to emerging technologies.17 “Higher education institutions thereby need to seize the opportunity to strengthen its evidence-based practices, provide accessible mental health-related services, and make the curriculum responsive to the needs of the changing times”17(pp4-5)

The leadership team's realization is that a lack of diligence will result in failure. When examining change, it is more often than not that change fails when 3 things happen:

1. The organization is complacent, and no one feels a sense of urgency.

2. Leaders do not take time to build a guiding coalition.

3. No one puts forth the effort to work out a vision or develop strategy.18(p166)

The changes imposed by COVID-19 have created significant challenge and opportunity. Organizations of higher education and nursing programs will survive based on their willingness to harness the momentum of change and to embrace this new model of nursing education. Failure to adapt to the change will likely result in the failure of our institutions to better the future of our profession. When developing a strong culture for any change, we must be willing to set realistic goals, build safety within our community, identify vulnerability, and adapt to transformation. By setting a culture and tone for change, we can all rally behind strengthening our organization for long-term success.19

The present pandemic-related chaos creates great opportunities for academic leaders to truly transform nursing education by leveraging innovative strategies. The changes imposed by the pandemic's disruption have catalyzed rapid change and innovation. The disruption has imposed new realities that have called the prior assumptions of nursing education into question—creating great opportunity for considering new possibilities. Maintaining momentum toward a new reality will require the leadership team to assess the ongoing impacts and opportunities of change imposed by COVID-19. Building an open, collaborative community of stakeholders is the foundation for successful evolution in an era of change.

REFERENCES

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3. AONL. Nurse executive competencies. https://www.aonl.org/system/files/media/file/2019/06/nec.pdf. Published 2015. Accessed November 10, 2020.
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15. Fox K, Bryant G, Lin N, Srinivasan N. Time For Class—COVID-19 Edition Part 1: A National Survey of Faculty During COVID-19. www.everylearnereveryehere.org/resouces. Published 2020. Accessed August 29, 2020.
16. Means B, Neisler J. SuddenlyOnline: A National Survey of Undergraduates During The COVID-19 Pandemic. San Mateo, CA: Digital Promise; 2020. https://www.everylearnereverywhere.org/resources/suddenly-online-national-undergraduate-survey/ Accessed September 8, 2020.
17. Toquero C. Pedagogical research, challenges and opportunities for higher education amid the covid-19 pandemic: the Philippine context. Pedagogical Res. 2020;5(4):1–5. https://www.pedagogicalresearch.com. Accessed August 29, 2020.
18. Davis J. Learning to Lead: A Handbook for Postsecondary Administrators. Westport, CT: American Council on Education/Praeger; 2003.
19. Coyle D. The Culture Code. New York, NY: Bantam Books; 2018.
Keywords:

change management; chaos; new reality; nursing education; pandemic

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