Building the Curriculum
Once assessment is complete, it should be decided which employees should be educated first. The author recommends that the building of curriculum begin at the lowest level of front-line nursing leadership in an organization. This will allow curriculum to be built up to meet the needs of increasing levels of leadership responsibility.
Experience and job function are determinants of levels of education for leaders. The levels, built around Benner’s (1984) novice to expert framework, range from 100 to 600. Table 2 details the framework used for nursing leadership development at the author’s hospital. Experienced nurse managers who are in leadership orientation in a new organization will be designated as novices. They must learn the tasks and expectations of their current role. Leaders must pass through the novice stage of education with each new job or organization.
Table 2: Leadership Development Framework Used by One Hospital
The 100-level curriculum begins with the Nurse Leader Task Resource, a program that demonstrates new leaders’ tasks (e.g., what computer programs to use, what meetings to attend, and other responsibilities). This ensures success of the new leaders.
This level also includes a Grass Roots Initiative program for informal leaders in the nursing department. The Grass Roots Initiative, directed at Nurse Practice Councils, is part of the organization’s strategy to promote shared governance for nursing staff. This intensive program is offered to individual unit practice councils over three 8-hour days. The Grass Roots Initiative teaches staff-level nurses initial leadership skills such as team building and DMIAC (design, measure, improve, analyze, and control) process improvement concepts. DMIAC is a Six Sigma problem-solving methodology. Teams, in cooperation with unit managers, identify three areas of concern on their specific unit directed at patient safety and quality care. Teams choose which area to focus on and begin the process of problem solving using the DMIAC process improvement format. The leadership development department electronically tracks solutions implemented by unit-based teams to ensure their sustainability. If issues arise during the course of implementation, the leadership development department assists the teams in overcoming obstacles to success. Teams achieve success when established metrics are positively affected.
The program designates charge nurses or team leaders as novices at the 200 level. They must understand the organizational culture and therefore require education regarding the organization’s mission, vision, values, and philosophy. Individuals at the 200 level typically want to learn skills to help them handle daily issues in their assigned units. If education does not pertain to their day-to-day work, they will not engage in learning. Those at the 200 level do not relate well to intense theory and broad leadership concepts.
Conflict management, staff assignments, delegation, team building, generational diversity, assertiveness, communication, ethics, and patient satisfaction are topics that most individuals at the 200 level can quickly learn about and apply. The 200-level curriculum is a total of 24 hours. It consists of one 8-hour class per month over the course of 3 months. Thus, this curriculum is available four times a year.
The 300 level is for assistant nurse managers. It consists of one 8-hour class per month over the course of 12 months. This level builds on the curriculum offered at the 200 level. Individuals begin learning responsibilities associated with this level of leadership through didactic education, interaction, and role-playing. Staff development, empowerment, leadership qualities, budgeting and finance, regulation, progressive discipline, physician relations, performance improvement, and cultural diversity are some of the topics addressed. The focus is on leadership skills affecting the day-to-day functioning of units. A team project that addresses identified issues on a unit-based level, which is presented to upper-level leadership, is required.
Level 400 is for nurse managers and assistant nurse managers targeted for promotion to nurse manager. The curriculum builds on previous curricula and also incorporates skills that allow leaders to broaden their understanding of the scope of leadership and effectively interact with other departments and disciplines. Didactic methodologies, role-playing, team games, hands-on experiences, mentoring, and interactive discussions are used. Advanced communication skills, team building, various leadership styles and approaches, advanced budgetary and finance techniques, advanced staff development skills, change management, retention and recruitment skills, and skills for rapidly responding to the changing health care environment are taught. Again, team projects that address issues affecting the system, which are presented to upper-level leadership, are required. These projects may cross disciplines or units.
Level 500 is for directors. At this level, the scope of leadership education is broad. Change management, strategic management, performance improvement, mentoring, and up-to-the-minute changes in health care are addressed.
Level 600 is for executives. Areas of focus include health care delivery, regulation, performance improvement, and finance. At levels 500 and 600, workshops and self-study packets are used for the busy executives.
The nursing leadership development program, in place for less than 24 months, is beginning to demonstrate measurable outcomes. The biggest impact to date has related to nursing retention rates. Although leadership development is not the only entity addressing retention at the organization, training in retention methodologies is the driving force at the unit level. During the past year, the organization has experienced a 4% overall improvement in retention and as much as a 24% improvement in retention in selected units.
There is also a larger pool of nursing staff available for promotion to higher-level positions. Promotion on the basis of seniority or favoritism has been replaced by promotion on the basis of participation in the leadership program. Upper-level management staff frequently contact nursing leadership development staff to inquire about such participation before making hiring decisions. The program has led to a baseline standard for leadership education and ability.
The focus of leadership development is metrics-driven. Therefore, the leadership team, including the informal leaders of the Nurse Practice Councils, is experiencing an increased awareness of the impact of its decisions and actions in relation to patient safety and outcomes. By allowing them to monitor progress, staff can quantify the impact of their patient care decisions. Through projects completed at the 300 and 400 levels, nursing leadership is able to implement and monitor new ideas affecting not only patient care but also staff satisfaction.