The Journal of Continuing Education in Nursing

Leadership and Development 

Teasing Leadership Development Out of Clinical Scenarios

Michael R. Bleich, PhD, RN, FAAN

Abstract

Staff development professionals increasingly use clinical simulation, case studies, and nonsimulated, real-time clinical performance for strengthening clinical judgment and corresponding action when training clinicians. Leadership competencies can also be strengthened and reinforced during these educational opportunities. Through debriefing and peer evaluation, clinical scenarios are rich with leadership development opportunities.

J Contin Educ Nurs. 2015;46(3):105–106.

Dr. Bleich is Maxine Clark and Bob Fox Dean and Professor, Goldfarb School of Nursing at Barnes-Jewish College, St. Louis, Missouri.

The author has disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Michael R. Bleich, PhD, RN, FAAN, Maxine Clark and Bob Fox Dean and Professor, Goldfarb School of Nursing at Barnes-Jewish College, 4483 Duncan Avenue, Mail Stop 90-36-697, St. Louis, MO 63110; e-mail: mbleich@bjc.org.

Abstract

Staff development professionals increasingly use clinical simulation, case studies, and nonsimulated, real-time clinical performance for strengthening clinical judgment and corresponding action when training clinicians. Leadership competencies can also be strengthened and reinforced during these educational opportunities. Through debriefing and peer evaluation, clinical scenarios are rich with leadership development opportunities.

J Contin Educ Nurs. 2015;46(3):105–106.

Dr. Bleich is Maxine Clark and Bob Fox Dean and Professor, Goldfarb School of Nursing at Barnes-Jewish College, St. Louis, Missouri.

The author has disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Michael R. Bleich, PhD, RN, FAAN, Maxine Clark and Bob Fox Dean and Professor, Goldfarb School of Nursing at Barnes-Jewish College, 4483 Duncan Avenue, Mail Stop 90-36-697, St. Louis, MO 63110; e-mail: mbleich@bjc.org.

Professional development educators face many challenges in scheduling and creating learning opportunities for clinicians. Obstacles faced by many clinicians include time away from the clinical unit, thus placing care burdens onto their peers; the perception of having too many mandatory educational sessions to meet regulatory standards and skills validation; and hesitation to take time away from personal and family obligations to participate in educational offerings outside of their usual work hours. Whatever the barriers, professional development educators try to make learning opportunities relevant, timely, animated, interesting, and flexible. Is it possible to offer clinicians fewer educational programs yet achieve high quality and impact primary and secondary competencies? Can leadership competencies be included in clinical programs? The answer is, “Yes.”

It is not a new idea to thread secondary content into educational programs. An annual review of infection control practices and principles (the primary content) might be designed to link regulatory standards, decision making, a review of populations vulnerable to infectious disease, and more. The wise educator thinks through ways of infusing knowledge and practice into learning opportunities with intention. However, rather than validating only the select primary competencies (such as a review of hand washing and the use of protective devices), additional secondary competencies can also be emphasized. For instance, the educator might weave managing patients with chronic conditions, decision making tied to outbreaks, and public health and community referral source content into the program, which could enrich and add value to the learning experience. By adding secondary content, the educator provides context and relevance to the primary focus, improving clinical care.

The preceding example serves as a stimulus for adding leadership content into course or program offerings of a clinical nature. This can work especially well for instruction that is case based, simulated, or present in real-time clinical practice learning. For instance, the primary focus of a class addressing congestive heart failure and the latest clinical treatments could also thread leadership competencies that are the drivers for the teamwork and outcomes management aspects of care—a subject too often implicit, rather than explicit. Educators take note: How you contextualize and focus on important secondary learning competencies optimizes course outcomes and creates efficiencies in program planning. Leadership competencies are ideal to include in program design as secondary learning outcomes.

Designing Leadership Competencies into Clinical Reviews

A straightforward starting point in threading leadership competencies into clinical courses is through job role and job function analysis, which strengthens interprofessional comprehension. In a class on heart failure management, learners view a video showing a patient with stage 4 congestive heart failure, who was hospitalized for difficulty breathing and generalized weakness. After reviewing the pathophysiology and the latest trends in clinical management strategies, the educator shifts to the secondary purpose—to strengthen leadership competencies. The educator asks, “Which disciplines comprise the acute care team? How did their roles actualize? Is this different than how they might have been idealized?” A series of further questions serve as probes to deepen the conversation:

  • “Which discipline served as the dominant voice in representing the team to the patient and family?” (The competency focus is on communication and the use of power and influence.)
  • “How were clinical decisions made? Was input from the health team included in decision making? In what way was input solicited? Who made the decisions?” (The competency focus is on varying types of decisions and authority.)
  • “In clinical care, what are unknown factors that could change the patient’s trajectory? Is the team considering the potential for changing conditions?” (The competency focus is on leading by principle and adapting to that which is unknown.)
  • “How inclusive were the dominant care providers to involve and engage the patient in the care plan? Did the family’s preferences come to light at any point in time?” (The competency focus is on patient-centered care and respect.)
  • “What were the driving principles behind the plan of care? Were any explicit? Were there implicit principles at play? Was the potential for ethical dilemmas apparent in any manner?” (The competency focus explores varying perspectives attributed to health care disciplines.)
  • “What did you notice about the personal traits at play in the clinical scenario: age, sex, height, weight, demeanor, race, culture, or other style factors? Did any of these traits dominate, shift, or create challenges to the clinical care being delivered?” (The competency focus is on leadership trait analysis.)
  • “What were the incentives that drove the care team to excellence? If care was breached or uncoordinated, what structural barriers led to the lack of cohesion?” (The competency focus is on intrinsic and extrinsic motivation.)

I could continue, but this list can be applied to nearly any clinical debriefing and has direct ties to key leadership principles.

Leadership Principles

Of the many leadership theories available, situational and contingency theory offers the strongest support for this approach. Clinical management requires knowledge of the situation at hand and requires consideration of contingent possibilities for clinical care dynamics. The mission, purpose, and goals of care are a starting point for using theory in teaching leadership—in this case, at the clinical, rather than at the organizational, level of application. The traits of individual practitioners and how they work in groups encompasses group dynamics, resplendent with opportunities to discuss the critical messaging needed for safety and quality, critical conversations between and among clinicians to ensure care coordination, and conflict management and resolution.

The organizational structures that are delineated in a care delivery model (when one formally exists or as played out as part of normalized operations) determine whether the model adds or detracts from care—or both. In contingency scenarios, leaders modify and adapt structures and human capital to benefit the patient, rather than having the patient adapt to structures. This is yet another opportunity for clinicians to take an active role in designing and improving the care delivery system and processes that compose the patient experience.

Summary

Specific leadership programs can be developed that will enhance leadership self-awareness and skills development. There are important benefits to these development opportunities for clinicians, but leadership development can be a secondary competency that is tied to clinical programs. The advantage to this approach is that it places leadership at the point of care. Intentionally designed, there may be cost savings to adding secondary content to already existing programs. Further, leadership is no longer confined to job roles in management, such as being a head nurse or unit manager, thus reinforcing that leadership is linked to competencies required of all professional nurses.

10.3928/00220124-20150220-13

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