XXX University uses the term “extraordinary” in its purpose and vision statements. In order to better understand this term and its potential impact on curricula, operations, and evaluation processes, a team conducted a search of the literature for descriptions of extraordinary nurses. Very few studies were located that examined what might constitute “extraordinary” in nursing and the potential impact these nurses have on other nurses, the workplace, and patient outcomes. Lefton (2012) conducted a content analysis of extraordinary nursing behavioral descriptors collected from 2,195 DAISY award nomination applications. Lefton identified 22 behaviors associated with extraordinary nursing, most prevalent being those pertaining to compassion, professionalism, positivity, and an energetic productivity. These behaviors may result in improved work environments and patient outcomes (Burston & Stichler, 2010; Copanitsanou, Fotos, & Brokalaki, 2017; Stalpers, Van Der Linden, Kalijouw, & Schuurmans, 2017). Lefton, however, did not include employers’ perspectives in her analysis. This poses a gap. Since employers constitute an essential community of interest, their perspectives serve as vital input for schools of nursing as curricula are developed and revised to best prepare nursing graduates.
XXX University surveyed employers of its graduates with an online tool asking them to identify descriptors gathered from the literature that best match their perceptions of extraordinary nurses. Completed surveys were received by 133 employers (nearly a 20% response rate) representing public and private sectors across all organizational types (i.e., hospital, outpatient care, long-term care, home care, and academics). An exploratory factor analysis yielded 9 factors that accounted for 72% of the variance of an initial conceptual model. These findings will be disseminated elsewhere.
This presentation summarizes a collateral qualitative study which was conducted concurrently in order to expand on these findings. Specifically, the objectives of the qualitative study were to discern patterns of descriptors of extraordinary nurses and the impact these nurses have on the work environment and patient outcomes from the perspectives of employers. The study’s general aim was to use the findings to explore how curricula and student assessment rubrics might facilitate and measure the preparation of extraordinary nurses.
Data were collected from open ended survey questions that solicited employers’ perspectives on a) how extraordinary nurses approach their care and interactions with others differently than typical nurses, and b) how extraordinary nurses impacted others. Employers were also asked how schools could better prepare extraordinary nurses. Data were analyzed using a content analysis approach to generate codes and synthesis themes (Patton, 2002). When possible, constant comparison methods were used to examine subtle similarities and differences among respondents in order to refine codes. Codes were then reviewed in light of the quantitative findings of the related study, the findings from Lefton (2012), and general literature descriptions of nursing care.
Thirteen codes were generated from the descriptions of extraordinary nurse characteristics, from which three synthesis themes were discerned that summarized patterns in these nurses: “The Pervasively Curious Critical Thinker”, “The Relentless Difference-Maker”, and “The Servant Leader”. Six codes were generated from the descriptions of the impact these nurses have on others, from which one synthesis theme emerged: “At Ease, All is Good”. Explanations and illustrations of these themes will be shared in this presentation. Employers also provided a varied list of actions schools should take to prepare students to become extraordinary. A summary of these responses will also be provided.
Findings from the study provide faculty a mental picture of extraordinary nursing from which they can more holistically review expected student behaviors and competencies in experiential learning activities. Furthermore, discussion of the findings with students may provide them a more accessible understanding of the type of nursing practice to which they should aspire than might be provided by individual words or phrases. The findings, however, represent only a first step in the study’s general aim to rethink curricula and performance measurement. The themes likely describe nurses more typical of the proficient or expert-level nurse (Benner, 2001). Also, recommendations on how schools might better prepare extraordinary nurses were concise and in need of deeper probing. A follow up study is currently underway using focus groups of nurse preceptors, mentors, and coaches who work directly with new graduate nurses. This study will explore the themes further in order to identify how these themes manifest in the new graduate.