Influencing Nursing Leadership Excellence: Pedagogy Enrichment Within an Undergraduate Nursing Leadership Modality

Healthcare organizations and nursing educators recognize the broadening gap between leadership ability of new graduate nurses as compared to actual requirements as they began clinical practice. In spite of nursing programs conveying to healthcare organization not to expect proficient leadership competency in new graduates, hospitals are adamant they are in need of nurses who not only have acquired proficient clinical skills, but those who have documented leadership abilities. Consequently, a recent survey demonstrated that only 25% of nurse managers and 10 % of nurse executives were favorable toward new graduate preparedness related to leadership skill.

Nursing is central to effective leadership in today’s healthcare world. Although not all nurses work in leadership positions, all are leaders within their profession.  As professional nursing practice has become increasingly complex, it is known that leadership skill among nursing is essential to meet practice demands. According to research, patient safety outcomes, staff satisfaction, healthy work environments, and staff turnover have been positively influenced by successful nursing leadership. It is noted that poor leadership among nursing has no place within organizations that are striving for effective change and excellence in patient care. Effective leadership must be present and accounted for in the clinical arena as this is the catalyst to ensure delivery of high standards of patient care.

In efforts to accommodate the nation’s demand for nurses and nurse leaders, universities are increasing enrollments in their baccalaureate programs. Consequently, the increasing enrollment of nursing students presents challenges for academic programs to effectively develop leadership abilities. In spite of the fact that nurses are probably not adequately prepared to assume leadership roles upon graduation, leadership should not be viewed as an optional competency for soon-to-be new graduate registered nurses. However, it is difficult to correlate a particular educational activity and it’s relation to achieving competency, especially with an abstract concept such as nursing leadership. More studies are needed to recognize how students best develop leadership competence and skill.

A southeastern university’s school of nursing defines leadership skill as a core curricular outcome and component within their conceptual framework. Two critical factors identified in their mission are to exemplify excellence in teaching and to ensure graduates are prepared to assume leadership roles in the provision of nursing care. The following is an excerpt from their Conceptual Framework/Vision and Mission Philosophy: 

Leadership skills include ethical and critical decision making, mutually respectful communication and collaboration, care coordination, delegation, and conflict resolution.  These skills are built on an awareness of complex systems and the impact of power, politics, policy, and regulatory guidelines on these systems.  Professional nurses must have a solid understanding of the broader context of health care, including the organization and financing of patient care services and the impact of regulatory guidelines on practice and reimbursement. Professional nursing also requires knowledge of health care policy.  Moreover, professional nurses practice at the microsystem level within a constantly changing health care system. Professional nurses apply quality improvement concepts to minimize risk of harm to patients and providers within a systems framework (p. 2).

As this particular southeastern university’s school of nursing offers a didactic nursing leadership course in the last semester for undergraduate nurses, faculty believe it is vital for nurse educators to integrate leadership theory and best practices in patient safety, quality, finance, and regulatory environments across the curriculum. However, they clearly recognized this course was in need of transformation and strove to enhance course objectives and topical outline.

The American Nurses Credentialing Center (ANCC) serves as an exceptional resource to enhance nursing leadership competency with practicing registered nurses and offers a nursing leadership specialty certifications as a board certified nurse executive (NE-BC). Domains of Practice included within the Nurse Executive certification are 1) Delivery of Care, 2) Legal, Regulatory and Ethical Issues, 3) Healthcare Economics & Environment, 4) Professional Practice, 5) Quality Management/Care Management, 6) Professional Practice Environment, 7) Organizational Leadership, 8) Organizational Systems Management, and 9) Communication/Collaboration. There is a clear relationship between these domains of nurse executive practice and the mission and conceptual framework defined by this university’s school of nursing.

The purpose of this abstract is to demonstrate methodology utilized to enhance a nursing leadership course by mirroring course concepts with the ANCC Nurse Executive domains of practice and to illustrate student assignments and the relationship to providing students with a challenging and interactive learning experience.