Our Nursing Leadership faculty has spent many hours in curriculum meetings discussing clinical experiences and exploring strategies which will enhance the students' application of nursing leadership concepts. Obviouely, nursing educators cannot meet the leadership learning needs of baccalaureate nursing students alone. Only through collaboration with nursing service can we teach leadership skills and enhance the development of effective leadership styles. This article describes the use of clinical resource persons as one strategy for reinforcing the nursing leadership concepts taught in the corequisite nursing leadership theory course.
Traditionally, the clinical learning opportunities in our nursing leadership practicum course were derived from providing direct care to a group of patients. Direct care leadership learning experiences were oftentimes inadequate; they were not only unpredictable in their occurrences, but they were also inconsistent from student to student. These observations led the faculty to conclude that an experience in which students only provide direct care to a group of patients is not sufficient for developing beginning nursing leadership skills. Based on this belief, we searched the literature to determine if other nursing educators had reached this same conclusion and to identify alternative strategies we could adapt.
We found a variety of articles in which others reported their attempts to reconcile similar dilemmas. Vance (1985) uses a consciousness raising assignment in which students' leadership skills were further developed. The Action Project she describes enabled the students to apply skills, knowledge and raised consciousness in a variety of situations. Excellent as the ideas are, they were not intended to be a part of a clinical leadership course.
Several articles expounded on the positive benefits that occur with the use of mentors who share experiences, broaden professional contacts, and assist neophytes to develop their own value systems. Darling (1984; 1985; 1986) has written extensively on the value of mentors. However, use of a mentor is most beneficial with professional nurses who maintain the mentor relationship for various time periods based on the needs and rewards experienced by both mentor and mentee. Again, this is a valuable and proven strategy, which is useful for leadership development; but not applicable to a one semester, undergraduate nursing course whose purpose is to begin the development of leadership skills.
Bentz (1985) describes the use of staff preceptors to assist senior nursing students ease the role transition to staff nurses. In this experience, students imitated the behaviors of their preceptors as a way to develop their professional socialization. This process eased the transition and reduced the conflict frequently felt by new graduates, by bridging the gap between student and staff roles. Walters (1981) also described the use of preceptors. Both Bentz and Walters were concerned with role transitions and professional socialization, not undergraduate students and experiences, which would serve to facilitate their learning leadership skills.
Brandt and Craig (1985) describe a strategy designed for students to observe leadership in action and to analyze and assimilate leadership/management theories. Interestingly, the nursing students were assigned to various community leaders rather than nurse leaders. Windsor (1987) reports findings from a research project that "students progressed in their professional socialization by observing nurses and participating in nursing functions" (p. 151). Windsor's research was conducted with nursing students in order to determine how the students perceived their clinical experiences.
As exciting as these innovative ideas are, none really offered a model that we could adapt or apply in our undergraduate nursing leadership practicum course. We did, however, develop and redirect some ideas from our reading and personal experiences to plan one component of our course; that of pairing students with leaders, called "resource persons."
Description of the Practicum Course
The focus of the nursing leadership practicum is on the role of the nurse leader who utilizes effective communication, motivation, leadership, and conflict resolution techniques/strategies to manage others. Students enrolled in this five-semesterhour senior course participate weekly in both direct and indirect care leadership activities. During the direct care leadership component, the students provide direct care to a group of patients for eight hours. These direct care experiences allow them opportunities to utilize leadership skills in managing nursing interventions for a group of patients. The students coordinate and collaborate with other health professionals in making decisions and planning strategies for health promotion, maintenance, and/or restoration. The seven-hour indirect care leadership component consists of: a 2.5 hour per week learning experience with a previously selected resource person, a pre and postresource experience conference, and completion of a clinical learning module. (For a description of these activities see Spickerman, Lee and Eason, 1988.) These indirect care activities provide additional opportunities for the student to develop leadership and management skills applicable for the beginning nurse leader.
The Resource Persons
To broaden the students' exposure to the various roles and leadership activities of selected nursing leaders, students are assigned to different clinical resource persons each week. The resource persons are nurse leaders in their respective areas. Some are administrators, such as nursing administrators, supervisors, and head nurses; some are clinical educators. Others fill a variety of roles: nurse clinicians; clinical nurse specialists; and support personnel, such as those in quality assurance, discharge planning, risk management and other special projects. All are leaders. Some have many years of professional experiences, while others are beginning their professional careers.
To provide the students with a variety of learning experiences, approximately 100 resource persons are selected to assist our 60 students to accomplish their learning objectives. Weekly scheduling of the students requires a great deal of preplanning on the part of the faculty, as well as ongoing coordination with the resource persons. The resource experience schedule is given to both resource persons and students at the beginning of the semester. Students, therefore, are able to look ahead and plan their strategies for meeting the course objectives. Since the primary focus of the resource experience is on collecting data regarding roles, responsibilities, and functions of nurses who are in positions of leadership, the resource persons are asked to assume their usual activities during the time the student is with them.
The Preresource Experience Conference
In the hour prior to meeting with their resource person, the students meet in a group conference with the faculty. During this conference, each student states two or three learning objectives he/she has previously identified as those applicable for the present resource experience. These objectives may be based on the resource person's area of expertise, special interests or learning needs the student may have identified, and/or the recent topics discussed in the corequisite nursing leadership theory course. The faculty and other students suggest additions, deletions or revisions in the student's stated learning objectives. This enhances both individual and group learning experiences.
The Resource Experience
The students share their individual learning objectives with the resource persons, and what they plan to learn during the resource experience. This strategy allows students to take an active role in their learning; a prime consideration for adult learners (Knowles, 1975). The objectives provide direction for both the student and resource person.
The hours spent with resource persons offer unlimited opportunities in which the student may observe and/or participate in the leadership and management processes. The situations encountered are commonplace for leaders in busy health care centers today. However, as the situations manifest reality for the inexperienced student, the lectures and assignments become meaningful and significant. Students sometimes realize they are not the only learners; that even after graduation and years of experience, nurse leaders must continue to learn. Learning with leaders who are willing to share their own ongoing professional development with students is an outstanding experience itself. See the example below that describes a situation one student experienced during the time spent with her resource person.
The Postresource Experience Conference
During the postresource experience conference, the students share their learning experiences in their clinical groups. This allows peers to learn from experiences of others, to analyze the experiences, and to anticipate alternative strategies and outcomes. With assistance from the faculty, students apply theoretical nursing leadership and management concepts to these "real-world" experiences. Lively, interactive discussions between the students and faculty help students conceptualize problems in a more comprehensive manner, transfer and synthesize knowledge, and self actualize their academic and practical knowledge development. Adherence to strict confidentiality is imposed in the postresource experience conference, for many resource persons include students in confidential discussions.
An Example Resource Experience
On one given day (2.5 hours), one students resource person was a supervisor responsible for several surgical units. During the morning, one of the supervisor's head nurses came to the office to discuss a recent problem and its resolution. The problem centered around a part-time nurse's work schedule. The part-time nurse assigned to work the afternoon shift had previously become very angry when the time schedule was posted. Instead of immediately confronting the head nurse about the problem, the part-time nurse did nothing; rather, she avoided the problem. Later, the following weekend, the part-time nurse failed to report to work as scheduled or to notify anyone of her intended absence. In actuality, change of shift time arrived, with no afternoon relief nurse. The situation left a staff nurse responsible for finding a nurse to relieve her for the afternoon shift; a rather impossible task at 4 PM on Saturday afternoon.
One of the course requirements calls for the student to write a paper in which he/she "Appli ies] one theory of management to a situation in the administrative or clinical component of nursing" (course syllabus, East Carolina University, 1986). The situation is restricted to one encountered by the student that the student believes adversely affects nursing practice. The just cited example seemed to meet all the requirements for one student in the class.
After describing the situation, the student must explain and apply a management theory that could be used to effectively manage the situation. In this situation, the student chose to use the Managerial Grid Theory developed by Blake and Mouton. In this theory, concern for people (staff) and concern for production (hospital services) can be plotted on a 9 ? 9 grid in which the ? and y axis represent independent dimensions (Blake, Mouton and Tapper, 1981). Initially, the student defined a "concern for people" as the supervisor's concern for the part-time staff nurse whose behavior had precipitated the incident. "Concern for production" (hospital services) was seen as the time schedule that the head nurse had developed and posted. The student's analysis and application were good; however, considerably more learning occurred as the student and teacher further discussed and analyzed the situation.
The student's conceptualization of the problem changed so that "concern for people" involved many more aspects of the situation than just the part-time nurse. It also included a head nurse, who had the responsibility to staffa unit, but had experienced a major problem when a staff nurse chose to take matters into her own hands instead of following usual protocol when conflict arose. "Concern for people" also expanded to include the charge nurse and her dilemma as well as the staff nurses who had "to cover" by working overtime because of their coworker's inappropriate behavior. Ultimately, "concern for people" also included those patients who were dependent on the nurse for vital services. "Concern for production" (hospital services) became the provision of nursing care for the assigned patients - the task for which health care facilities and their nursing staffs exist.
This one brief encounter (conference between supervisor, student's resource person, and the head nurse ) lasted less than 30 minutes; yet the learning that occurred is beyond measure. In this one-to-one learning experience, the student observed two leaders analyzing a problem that had occurred. The supervisor hoped to prevent similar situations and to enhance the head nurse's skills in some of her roles, such as schedule maker, performance appraiser, and counselor. Analysis of the situation helped the student appreciate, among other things, the facts that 1) managerial problems are often much more complex than they initially appear; 2) utilization of decision making theory and tools result in better decisions being made; and 3) research findings and theoretical concepts are applicable in day-to-day situations experienced by nurse leaders and managers.
Summary and Conclusions
The faculty maintain close contact with the resource persons and are aware of their interaction with students on a weekly basis. Faculty and resource persons exchange observations, assessments, suggestions and problems they have either anticipated or experienced. The resource persons report that as students gain from the experiences, so do they. In particular, resource persons state interactions with students have stimulated them to increase their own clinical inquiry.
A head nurse, functioning as a resource person, recently told the members of the Nursing Curriculum Committee she wished she had had such a course seven years ago when she was a senior in the program (S. Collier, personal communication, October 1987). She further elaborated that the learning opportunities she sees students experiencing today would have been invaluable to her and her peers as they began their professional nursing careers.
We, the authors, believe individual learning opportunities with nurse leaders as resource persons is a unique, invaluable experience for nursing leadership students. These interactions provide a variety of learning opportunities sufficient for undergraduate students to develop beginning leadership skills, while also narrowing the education-practice gap. These experiences enhance the students' orientation to "real-world" nursing leadership and management. Students recognize the uniqueness of this teaching-learning strategy and value the time spent with resource persons. They frequently report never dreaming "that such problems have to be dealt with." They agree that learning with resource persons provides an essential ingrethent for reinforcing the theoretical concepts of nursing leadership and putting classroom lectures into action.
The favorable responses we have had from both students and nursing leaders indicate that we have found an answer to our many years of exploring strategies to enhance the student's application of nursing leadership concepts. Using resource persons to reinforce these concepts certainly is our answer! Resource persons, who so willingly and freely give of their time, are the enablers of these learning experiences. They give because they value and believe. We believe this strategy enhances the development of leadership skills and leadership styles in baccalaureate nursing students. Ultimately, regardless of the nursing role assumed by the student, soon to be graduate, this experience provides a knowledge base that can be applied to direct and indirect care activities.
- Bentz, C.Y. (1985). Students in transition: Imitators of role models. Journal of Nursing Education, 24(7), 301-303.
- Blake, R.R., Mouton, J.S., & Tapper, M. (1981). Grid Approaches for Managerial Leadership in Nursing. St. Louis: C.V. Mosby.
- Brandt, M.A & Craig, R.M. (1985). Follow the leader: A learning exercise. Journal of Nursing Education, 24(4), 139-142.
- Darling, L.A.W (1984). What do nurses want in a mentor? Journal of Nursing Administration, 14(10), 42-44.
- Darling, L. A. W. (1985). Mentors and mentoring. Nurse Educator, 10(6), 18-19.
- Darling, L. A. W (1986). Self-monitoring Strategies. Nurse Educator, 11(1), 24-25.
- Knowles, M.S. (1975). Self-Directed Learning - A Guide for Learners and Teachers. Chicago: Association Press.
- Spickerman, S., Lee, B. T, & Eason, FR. (1988). Use of learning modules to teach nursing leadership concepts. Journal of Nursing Education, 27(2), 78-82.
- Vance, C. (1985). On becoming a professional nurse. Nurse Educator, 10(3), 20-25.
- Walters, CR. (1981). Using staff preceptors in a senior experience. Nursing Outlook, 29(4), 245-247.
- Windsor, A. (1987). Nursing students' perceptions of clinical experiences. Journal of Nursing Education, 26(4), 150-154.