Journal of Nursing Education

Educational Innovations 

Use of a Simulated Administrative Decision-Making Exercise in an Online Master’s Nursing Administration Course

Letty Piper, EdD, RN; Kathleen Czekanski, PhD, RN, CNE

Abstract

To simulate the type of ethical and informed decision making required of today’s nurse executives, a unique role-playing exercise was developed in a graduate Nursing Administration course. This exercise included evidence-based information about the safety issues inherent in 12-hour nursing shifts. It then explored the decision-making process that a nurse executive would follow to weigh the conflicting concerns of safety and staff satisfaction. A blog format was used for a role-playing exercise in which students were assigned various roles, and the assignment was designed to mimic a roundtable discussion. The final step was to assume the role of the chief nurse executive and make a decision regarding the ethical dilemma of staff satisfaction versus evidence-based safety concerns. Students demonstrated an understanding of acknowledging input from others, as well as the ability to synthesize points on a difficult question.

Abstract

To simulate the type of ethical and informed decision making required of today’s nurse executives, a unique role-playing exercise was developed in a graduate Nursing Administration course. This exercise included evidence-based information about the safety issues inherent in 12-hour nursing shifts. It then explored the decision-making process that a nurse executive would follow to weigh the conflicting concerns of safety and staff satisfaction. A blog format was used for a role-playing exercise in which students were assigned various roles, and the assignment was designed to mimic a roundtable discussion. The final step was to assume the role of the chief nurse executive and make a decision regarding the ethical dilemma of staff satisfaction versus evidence-based safety concerns. Students demonstrated an understanding of acknowledging input from others, as well as the ability to synthesize points on a difficult question.

Dr. Piper is Adjunct Faculty, and Dr. Czekanski is Assistant Professor and Director, Graduate and RN to BSN Programs, La Salle University School of Nursing and Health Sciences, Philadelphia, Pennsylvania.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Kathleen Czekanski, PhD, RN, CNE, Assistant Professor, Director, Graduate and RN to BSN Programs, La Salle University School of Nursing and Health Sciences, 4413 Benilde Tower, 1900 West Olney Avenue, Philadelphia, PA 19141; e-mail: Czekanski@lasalle.edu.

Received: August 31, 2011
Accepted: February 15, 2012
Posted Online: March 23, 2012

Interest in our graduate nursing administration program has grown as local hospitals seek Magnet status. With this growth opportunity, our faculty made a decision to convert the graduate Nursing Administration course track to an online hybrid format. This change necessitated innovative strategies to develop students’ leadership skills.

Strategy

A unique role-playing exercise was developed in the first-track course to simulate the type of ethical and informed decision making required of today’s nurse executives. This exercise included evidence-based information about safety issues inherent in 12-hour nursing shifts. The development of 12-hour work shifts arose in response to a shortage of qualified nursing staff and a need to increase nurses’ satisfaction related to work hours, but the long shifts have come under increasing scrutiny due to concerns about how they influence errors related to fatigue (Lorenz, 2008).

The students were assigned two journal articles as baseline information on the topic. The first article by Geiger-Brown and Trinkoff (2010) provided background information about the potential adverse effects of 12-hour shifts on performance, which has included increases in patient care errors, needlesticks, risk of developing a musculoskeletal disorder, and sleep deprivation issues related to extended shifts. The second article (Montgomery & Geiger-Brown, 2010) discussed the difficulty faced if a department moves away from 12-hour shifts. Although acknowledging that patient and staff safety is the paramount concern, Montgomery and Geiger-Brown (2010) addressed the challenge of balancing satisfaction and safety with the need to require organizational and staff support for a culture of safety. They stressed the need for team-building skills at all levels to obtain the required cooperation and concern necessary to address this important issue.

Method

Although initially an online class seemed to be a difficult forum in which to hold a simulated meeting, the blog tool was selected for use to incorporate simulation, leadership, and evidence-based information. The blog, unlike a discussion board, allows for sequential entries that follow the thread of time, not subject. This was important because it mimicked a conversation around a conference table. The students were told which role they would assume and the pretext of the meeting—the safety officer of the hospital had read the scholarly articles describing the dangers associated with working extended hours (Geiger-Brown & Trinkoff, 2010; Montgomery & Geiger-Brown, 2010) and expressed his concern to the chief nursing officer (CNO). The CNO called for a meeting of the safety officer, the human resources director, the nurse recruiter, a nurse manager, and staff nurses of varying ages and family situations regarding the concerns of the safety officer. Each student participant was then required to read the articles prior to the meeting and make an opening statement on the blog according to his or her role’s perspective on the issue. This was done 2 days following receipt of the articles, and each statement was to be a minimum of 500 words.

Five days after the first position statements were posted, the students were required to restate their positions in light of reading (hearing) the comments of the other roles. They were to acknowledge the other roles’ points of view and try to address their concerns. This process was designed to simulate discussion around a conference table and highlighted the team-building skills required in large organizations. These revised submissions were to be less than 750 words and were due on the same day 1 week later. By using the blog format, each student was able to make his or her presentations in full and without interruptions, considering the points raised by others. This exercise was conducted to reinforce the concept that there are often many interpretations of the same literature. It also allowed those students who were not as verbal in class to express their perspectives fully.

Finally, all students were asked to assume the role of the CNO. They were required to design a way in which to address the concerns of the safety officer, as well as to meet the needs of their nursing department. The students were placed in the position of a decision maker who must absorb and synthesize information from many factions. Their responses were graded based on their inclusion of participants’ responses and their understanding of the need for practice based on documented evidence.

The process required both an ethical and operational decision. All of the students were actively working in a 12-hour shift environment, and this exercise tested their basic assumptions. Four students, as CNO, chose to establish a shared governance committee to discuss the issue further; three chose to begin offering 8-hour shifts and rest opportunities during the 12-hour shifts; and one chose to defer a decision while he further researched the issue.

Discussion

This innovative teaching strategy demonstrated both “listening” skills and the importance of restatement and synthesis of ideas in the decision-making process. In our increasingly electronic world of communication, this simulation may soon reflect the norm in organizational communication.

References

  • Geiger-Brown, J. & Trinkoff, A. (2010). Is it time to pull the plug on 12-hour shifts? Part 1. The evidence. Journal of Nursing Administration, 40, 100–102. doi:10.1097/NNA.0b013e3181d0414e [CrossRef]
  • Lorenz, S. (2008). 12-hour shifts: An ethical dilemma for the nurse executive. Journal of Nursing Administration, 38, 297–301. doi:10.1097/01.NNA.0000312785.03341.80 [CrossRef]
  • Montgomery, K. & Geiger-Brown, J. (2010). Is it time to pull the plug on 12-hour shifts? Part 2. Barriers to change and executive leadership strategies. Journal of Nursing Administration, 40, 147–149. doi:10.1097/NNA.0b013e3181d40e63 [CrossRef]
Authors

Dr. Piper is Adjunct Faculty, and Dr. Czekanski is Assistant Professor and Director, Graduate and RN to BSN Programs, La Salle University School of Nursing and Health Sciences, Philadelphia, Pennsylvania.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Kathleen Czekanski, PhD, RN, CNE, Assistant Professor, Director, Graduate and RN to BSN Programs, La Salle University School of Nursing and Health Sciences, 4413 Benilde Tower, 1900 West Olney Avenue, Philadelphia, PA 19141; e-mail: .Czekanski@lasalle.edu

10.3928/01484834-20120323-05

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