A Leader's Challenge: Using E-Learning/Flipped Classroom Instructional Techniques to Build Graduate Nursing Student Leadership Skills

Monday, 9 November 2015: 1:45 PM

Teresa L. Barry Hultquist, PhD, MSN, BSN, APRN-CNS, PHCNS-BC1
Deanne Ernesti, MSN, RN1
Suhasini P. Kotcherlakota, PhD, MSc, MSEd, BSc, .1
Susan Waters, MS2
(1)College of Nursing, Omaha Division, University of Nebraska Medical Center, Omaha, NE, USA
(2)Information Services, University of Nebraska- Omaha, Omaha, NE, USA

Background: Healthcare organizations need employees with leadership skills who can successfully navigate politically delicate situations, determine alternatives, prioritize action steps, and develop best practices directed towards issue mitigation and resolution.  Faculty are dedicated to ensuring that education is current and relevant for today’s nurse leaders, based on authentic situations occurring in the healthcare environment.  The e-learning module was developed for nursing administration / leadership students, but could have broader application for any leader.  The design of this module included four sections: 1) content (reading/resource) review, 2) interactive online scenario, 3) assessment of the student’s choices, and 4) flipped classroom dialogue and practice in skill application.  Upon completion, students can assess and apply best leadership practice skills of Political Savvy, Priority Setting, and Problem Solvingin politically delicate situations. 

Content Review: The content review consists of readings and resources for students to develop their understanding of the content and context of politically delicate situations.  Learners construct meaning based on their previous experiences and match new information against existing knowledge.  For example, students may have seen employees that exemplify an organization’s mission statement and values, but also have noticed some employees and teams with vested interests who defend their own needs and sabotage change efforts.  In the content review, students learn that employees who are competent in the skill of Political Savvy accept that some employees’ behaviors do not match the organization’s mission and values.  Students can develop skills to deal with these individuals within the organizational constraints (e.g. time, resources).  Using Problem Solving, leaders must analyze and determine what the issues really are in a given situation, rather than drawing premature conclusions about the problem and best course of action.  In addition, the work environment may have many priorities which might exceed available resources, so using Priority Settingwithin available finite resources is an important leadership skill. 

Interactive Online Scenario: The interactive online scenario provides an authentic leadership situation that students might encounter in a healthcare organization today.  Students are asked to watch, interact and immerse themselves in the online simulated gaming environment scenario. This immersion allows students to establish meaningful connections between their experiences and the content they’ve just reviewed.  Students play the part of the Quality and Risk Manager and watch leaders (avatars) interact in a 23-bed Critical Access Hospital in a town of 2,500 people.  Students are asked by the Chief Executive Officer (CEO) to investigate recent troubling employee survey findings.  Leaders they encounter include the Chief Nursing Officer (CNO), the Mayor, the Human Resources Manager, and a Charge Nurse.  Students click on characters or objects (i.e. computer screen, telephone) to move through the scenario. Students view the scenario as many times as they wish.

Assessment of Student Choices: After watching the scenario, students are asked to complete an assessment where they need to reflect on the content they’ve reviewed and synthesize main issues in the scenario to choose priority actions to take (whom to talk to and what questions to ask) based on the content they’ve learned and the scenario they’ve seen.  The assessment contains three individuals to “talk” to (the CNO, The Human Resources Manager, and the Charge Nurse), and each individual has three scripted questions available to choose.  Students may only “talk” with two of three individuals. They are able to ask two questions of the first individual; and one question of the second individual.  Once the question is selected, the leader’s response is displayed. 

As an example, the students can ask the Human Resources Manager, “What turnover rate do we have?” The Human Resources Manager responds by saying “The turnover rate has tripled in the last 2 years”. Or students may choose to ask the CNO, “Are 10 of our staff so unhappy that they are considering leaving our organization?”  The CNO responds by saying “Just let them go, there are plenty of other staff out there that really want to work.” 

Rationale for the questions indicate the best evidence (developed by expert nurse leaders based on the assigned learning content) that supports both the priority of both the individual and question chosen (best, second best, or least desirable).  Scoring of student choices/priorities is captured in the online learning environment, based on the order and choices made by the students. 

Flipped Classroom: In this module, the flipped classroom session includes the use of distance technology, students as leaders of the discussion/dialogue, and student developed synthesis of best practices in nursing administration/leadership.  Flipped classrooms are designed to provide content prior to a synchronous class so the students come prepared to engage in collaborative learning.  The synchronous flipped classroom is done via distance technology (IP video, VIDYO or Adobe Connect) since students live in a variety of states and communities.  Students lead the discussion on experiences with the e-learning portion of the module, applying the knowledge and skills they learned in the content review and the online scenario sections.  They debate the merits of the actions they each took in the assessment based on the scenario they viewed and the readings about best practices they completed.  For example, they dialogue as a group about which person they chose to talk to or questions they chose to ask, and how those choices fit with the readings about best practices/ skilled level of that competency (political savvy, priority setting or problem solving).  They compare and contrast the online scenario with experiences they have had as leaders, develop a consensus of best practices, and discuss how they can incorporate the skills they are now honing into their practice.  Students then apply these best practices to other written clinical scenarios during the flipped classroom session. 

Assessment Results:Data from module implementation in Spring 2014 and 2015 are included.  Seven students completed the module in 2014, and seventeen completed the module in 2015.  Student leadership experience ranged from None (n=12, 50%), Less than 2 years (n=4, 16%), 2-5 years (n=3, 13%), 5-10 years (n=3, 13%) and 10+ years (n=2, 8%).  Student’s initial (first) assessment results indicated 78% (n=18 of 23) students talked to the “best” individual as their first or second choice.  One student experienced a scenario deployment issue and completed the assessment without reviewing the scenario; those results are not reported.  Twelve of the twenty-three students (52%) chose to talk to the least desirable individual during the first assessment.  

Based on the first individual (best, second best or least desirable person) chosen, thirteen of twenty three (57%) chose the best question to ask that individual, either in their first or second question.  In the initial year, students were able to complete the assessment twice, and four of seven students chose to complete the assessment a second time (some indicated they wanted to try to improve their score, and some said they made completely different choices to see more of the questions because they were curious about what other options included).  Based on student feedback, in 2015, students could complete the assessment as many times as they wished.  The number of times the assessment was done in 2015 ranged between 1 and 15, with an average of 4 times. 

Student comments included:

“I found it to be interesting and challenging. As a Director in a rural community hospital, I can relate to receiving a voicemail from the CEO or CNO that says I need information about why these scores are so low by tonight.” 

“The point of the scenario was being politically savvy, so when you pick the CNO, the scenario basically tells you that, politically, this isn't a good choice because it makes the CNO defensive and unhelpful. I suppose that's a big part of being a good leader, learning who to approach, how and when to approach them, and what questions to ask to get the information/help you need without ruffling feathers.”

“Overall, this is a very neat concept and I look forward to doing the next one.”

“I really enjoyed the e-learning activity; it reinforced my knowledge of leadership skills and improved my confidence for next time.  I also appreciated doing something different other than the same reading and then discussion board postings.” 

Conclusions/Recommendations: This project promotes student’ control and active application of content within the interactive scenario, the assessment and the flipped classroom.  Application of skills within a simulated setting promotes student confidence in their ability to construct meaning and match new information against existing knowledge. During the flipped classroom discussion, students could make meaningful connections and utilize leadership skills they can transfer to their leadership roles.