Engaging Head, Hearts, and Hands: Transforming Leadership Development in the Acute Care Setting From Within

Humanistic caring and leadership skills are foundational to nursing practice at all levels of the profession. With the expectation of nurse leaders to emphasize financial acumen over caring practices, is there room in nursing leadership for the art and science of caring? Leading healthcare and nursing organizations in the United States have called for radical nursing education reform to include new pedagogies and new ways of thinking based on current research findings, recommended nurses receive leadership development at every level to transform today’s complex and rapidly changing health care environments; promoting and enhancing caring leadership competencies at all levels of nursing practice. ^{1, 2, 3} In this current health care environment, professional nurses such as charge nurses are often asked to assume frontline leadership roles without the needed leadership competencies and skills to meet important organizational imperatives. ^{4, 5, 7} These frontline nurse leaders are in a unique position to bridge the gap between healthcare organizational realities and human caring by co-creating caring work environments for themselves, staff and patients. However, for healthcare organizations to respond to this call for action, it is imperative to devote educational resources to cultivate and develop caring leadership behaviors of nurse leaders at all levels and reinforce a caring relationship with staff and patients. ⁶ The purpose of this presentation is to share our organization experience integrating a caring science theory based learning environment model to co-create an experiential, transformational learning environment that engages emergent leaders in mutual dialogue, deep reflection, mindful attention and authentic presence. ^4-7 Leadership skills and behaviors related to relationship management, communication, conflict resolution, team building, change management, and self-leadership were woven into the curriculum to help reinforce organizational initiatives and role expectations creating standard work through active daily management. This learning delivery model provided a radical and innovative departure from traditional education models by allowing room for authentic dialogue, reflection and knowledge integration. ⁶ It honored the lived experiences and expertise of each participant, creating a sacred learning environment/safe space that promotes values and role models caring, respect, authentic presence, trust, connection and self-care that complement the organization mission, vision and values.

The presentation delineates and defines the C.A.R.I.N.G. Learning Environment Model six main components: Co-create safe and sacred environment, Authentic Presence, Reflection, Intentionality, Nurture of Self, and Gratitude, and shares examples of transformative learning strategies and tools to incorporate all ways of knowing and being to co-create a C.A.R.I.N.G. Learning Environment for charge nurse development and caring leadership programs in any organization. The presentation will also share details of these two leadership development programs, including pre-and post-workshop intervention results of leadership and caring literacy integration.

For the Charge Nurse Leadership workshop, we have facilitated 29 cohorts for a total of 500 charge nurses participated since January 2014.

Pre/Post Self-Assessment Caritas Literary Results – overall rating increased slightly from 3.67 (pre) to 4.25 (post – 6 months).

• Overall Program Evaluation all cohort = 4.15 (range 3.44 – 4.82)
• Overall Program Evaluation by Topics all cohorts
  • The Science: Managing the Business = 4.17
  • The Art: Leading People = 4.10
  • The Leader Within: Creating a Caritas Leader in Yourself = 4.14
• Overall Post Program Practice Integration for “Almost Every Time/Frequently Use” Scores by Topics (3-18 months)
  • The Science: Managing the Business = 73%
  • The Art: Leading People = 90%
  • The Leader Within: Creating a Caritas Leader in Yourself = 84%
• Pre/Post Self-Assessment Competency Results – overall competency rating increased from advanced beginner–competent (pre) to competent to proficient (post – 6 months) and sustained post 12 and 18 months.

For the Leading with Heart workshop, we have facilitated 4 cohorts for a total of 75 participants since June 2016

• Leading with Heart Pre/Post Program Practice Integration Results demonstrates an increase of practice integration at 3 and 12 months workshop in all key workshop content.

Workshop Content	Pre-Assessment	Post 3 months	Post 12 months
Authentic Listening/Caring Language	69.54%	90.00%	100.00%
Nursing Professional Standards/Code of Ethics	79.12%	80.00%	100.00%
Creating Healing Work Environments	67.40%	100.00%	100.00%
Authentic Presence	80.47%	90.00%	100.00%
Self-Awareness	63.58%	90.00%	100.00%
Self-Renewal/Self-Care	34.07%	73.34%	100.00%

• Leading with Heart Workshop Watson Caritas Self-CARING Scores demonstrate a sustainable increase in five key Watson Caritas Processes at 3 and 12 months post workshop.

Watson Caring Science Survey	Pre-Assessment	Post 3 months	Post 12 months
1. Treat self with lovingkindness	4.50	5.10	6.00
2. Practice self-care as means for meeting own basic needs	4.59	4.90	5.00
3. Have helping and trusting relationships with others	5.69	5.70	7.00
4. Create caring environment that helps me flourish	4.85	5.40	5.00
5. Value own believes and faith, allowing for personal success	5.67	6.40	7.00
Watson Caritas Self-CARING Score	5.06	5.50	6.00