Journal of Nursing Education

Syllabus Selections: Innovative Learning Activities 

Creating Leadership Skills in Fundamental Courses

Cynthia O'Neal, MSN, RN

Abstract

In today's health care environments, baccalaureate nurses must be prepared to use essential leadership skills to manage and coordinate teams of care. They can expect to collaborate with other disciplines, set standards, monitor outcomes, and delegate to multiskilled health care workers in a variety of settings (Fralic, 1999). However, in a study conducted by the National Council of State Boards of Nursing, Inc., newly graduated baccalaureate nurses felt unprepared to supervise care provided by others and to effectively participate within a health care team (Smith & Crawford, 2003). To strengthen leadership skills in nursing students, an innovative strategy to teach basic leadership skills to beginning nursing students was devised. Using Mezirow's Transformational Learning Theory, which supports experience as integral to adult learning (Mezirow, 1991), an environment was created for students to lead their peers during clinical experiences.

Nursing students were placed in a nursing home setting during their clinical rotation for a course equivalent to a nursing fundamentals course. After several weeks, when students began to feel more comfortable with the clinical setting, the role of student resource leaders was implemented. For this role, a student was assigned to be in charge of helping his or her peers prioritize the morning activities, assisting with tasks requiring more than one person, and identifying students who were available to help other students. The student resource leader was available to answer basic questions from other students such as, “Do you know where extra soap is kept?”

The student leader was also responsible for a checklist that summarized all of the required paperwork and tasks. The leader checked each student off on the list after asking the student whether a particular piece of paperwork or task had been completed (e.g., bowel movement log, diet sheet, intake and output log, activities sheet, report to the nurse). In addition, if the facility staff needed vital signs taken on clients who were not assigned to students, the list was delegated to the student resource leader, and the leader was advised that he or she could delegate such tasks to other students. The responsibility for completion of the delegated task remained with the student resource leader.

The leader role was rotated each clinical day, and the leader was given a lighter patient load on the day of assignment. The clinical instructor remained responsible for all of the many obligations inherent in being a clinical instructor, including oversight of documentation.

This model has been implemented in several different nursing homes, with various groups of students in two nursing programs. In some settings, it is more appropriate to have a student leader for each hall, depending on facility structure and number of students.

The role rotation was very well received by the students. They became more independent and learned about both delegation and responsibility. Often, students became more diligent in completing required tasks and paperwork so their peer (the student leader) did not have to ask them more than once. And certainly after the students were the leader, they internalized the checklist. Students who were leaders later in the semester needed to remind their peers of required paperwork and tasks fewer times. The students came to view themselves as a team and exhibited enhanced leadership qualities. In addition, students became comfortable with working as a team and leading each other.

Due to time limitations, not all students served as a student resource leader during the semester, nor was it appropriate for all students to do so. Students who demonstrated mastery of fundamental skills early in the clinical experience and who presented themselves as conscientious and responsible were selected for the…

In today's health care environments, baccalaureate nurses must be prepared to use essential leadership skills to manage and coordinate teams of care. They can expect to collaborate with other disciplines, set standards, monitor outcomes, and delegate to multiskilled health care workers in a variety of settings (Fralic, 1999). However, in a study conducted by the National Council of State Boards of Nursing, Inc., newly graduated baccalaureate nurses felt unprepared to supervise care provided by others and to effectively participate within a health care team (Smith & Crawford, 2003). To strengthen leadership skills in nursing students, an innovative strategy to teach basic leadership skills to beginning nursing students was devised. Using Mezirow's Transformational Learning Theory, which supports experience as integral to adult learning (Mezirow, 1991), an environment was created for students to lead their peers during clinical experiences.

Nursing students were placed in a nursing home setting during their clinical rotation for a course equivalent to a nursing fundamentals course. After several weeks, when students began to feel more comfortable with the clinical setting, the role of student resource leaders was implemented. For this role, a student was assigned to be in charge of helping his or her peers prioritize the morning activities, assisting with tasks requiring more than one person, and identifying students who were available to help other students. The student resource leader was available to answer basic questions from other students such as, “Do you know where extra soap is kept?”

The student leader was also responsible for a checklist that summarized all of the required paperwork and tasks. The leader checked each student off on the list after asking the student whether a particular piece of paperwork or task had been completed (e.g., bowel movement log, diet sheet, intake and output log, activities sheet, report to the nurse). In addition, if the facility staff needed vital signs taken on clients who were not assigned to students, the list was delegated to the student resource leader, and the leader was advised that he or she could delegate such tasks to other students. The responsibility for completion of the delegated task remained with the student resource leader.

The leader role was rotated each clinical day, and the leader was given a lighter patient load on the day of assignment. The clinical instructor remained responsible for all of the many obligations inherent in being a clinical instructor, including oversight of documentation.

This model has been implemented in several different nursing homes, with various groups of students in two nursing programs. In some settings, it is more appropriate to have a student leader for each hall, depending on facility structure and number of students.

The role rotation was very well received by the students. They became more independent and learned about both delegation and responsibility. Often, students became more diligent in completing required tasks and paperwork so their peer (the student leader) did not have to ask them more than once. And certainly after the students were the leader, they internalized the checklist. Students who were leaders later in the semester needed to remind their peers of required paperwork and tasks fewer times. The students came to view themselves as a team and exhibited enhanced leadership qualities. In addition, students became comfortable with working as a team and leading each other.

Due to time limitations, not all students served as a student resource leader during the semester, nor was it appropriate for all students to do so. Students who demonstrated mastery of fundamental skills early in the clinical experience and who presented themselves as conscientious and responsible were selected for the role. Students with inadequate clinical skills were not selected for the role but did benefit from the peer leadership and modeling. Students who were slower to master organizational and fundamental skills stated that they learned more by working with a peer leader because their anxiety was decreased.

An issue with implementing the role of student resource leader is that some students may cling to the leader, hoping to camouflage their skill level from the instructor. Overall, most students reported they felt more independent and responsible than members of their peer groups who did not have this experience.

References

  • Fralic, M.F. (1999). Nursing leadership for the new millennium: Essential knowledge and skills. Nursing and Health Care Perspectives, 20, 260–265.
  • Mezirow, J. (1991). Transformative dimensions of adult learning. San Francisco: Jossey-Bass.
  • Smith, J. & Crawford, L. (2003). Report of findings from the practice and professional issues survey spring 2002. Chicago: National Council of State Boards of Nursing.
Authors
Cynthia O'Neal, MSN, RN

cynthia.oneal@ttuhsc.edu

Texas Tech University Health

Sciences Center

 

10.3928/01484834-20041101-07

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