Journal of Nursing Education

Major Article 

Triad Mentoring Model: Framing an Academic–Clinical Partnership Practicum

Diana Martinez Dolan, PhD, RN; Pamela Willson, PhD, APRN, CNE

Abstract

Background:

The triad mentoring model was developed to frame the implementation of innovative student-centered academic–clinical partnerships for online graduate students in nursing leadership and administration practicums.

Method:

The nurse leader and faculty member jointly mentored each student to achieve the academic program's objectives through clinical learning experiences that were relevant and important to the clinical organization. Partnerships with nurse leaders within the student's locality were sought, and capstone practicum projects were developed and implemented during four courses.

Results:

Both formative and summative results were obtained from all members of the triad team throughout the practicum courses. The processes undertaken to establish, implement, and evaluate the student-centered academic–clinical partnerships identified project modifications throughout the course of study.

Conclusion:

Implementation of the triad mentoring model created academic–clinical partnerships that promoted a fusion of evidence-based practice, quality improvement, and clinical knowledge that produced positive outcomes for the health care setting and student learner. [J Nurs Educ. 2019;58(8):463–467.]

Abstract

Background:

The triad mentoring model was developed to frame the implementation of innovative student-centered academic–clinical partnerships for online graduate students in nursing leadership and administration practicums.

Method:

The nurse leader and faculty member jointly mentored each student to achieve the academic program's objectives through clinical learning experiences that were relevant and important to the clinical organization. Partnerships with nurse leaders within the student's locality were sought, and capstone practicum projects were developed and implemented during four courses.

Results:

Both formative and summative results were obtained from all members of the triad team throughout the practicum courses. The processes undertaken to establish, implement, and evaluate the student-centered academic–clinical partnerships identified project modifications throughout the course of study.

Conclusion:

Implementation of the triad mentoring model created academic–clinical partnerships that promoted a fusion of evidence-based practice, quality improvement, and clinical knowledge that produced positive outcomes for the health care setting and student learner. [J Nurs Educ. 2019;58(8):463–467.]

The American Association of Colleges of Nursing (AACN, 2016) report Advancing Healthcare Transformation: A New Era for Academic Nursing outlined the strategic directive for academia to partner with health care facilities to address the most current workforce issues and challenges. Prior work has demonstrated that jointly developed academic–clinical partnership models improve patient outcomes while providing nursing students with real-world learning experiences (Clevenger & Cellar, 2018; Dobalian et al., 2014; Xippolitos, Marino, & Edelman, 2011). Faculty envisioned student clinical practicum outcomes that would include being prepared for the next leadership role, applying leadership competencies within the workplace environment, and developing a leader mentor network. The challenge was to develop clinical practicums that would be unique for each graduate nursing student while meeting the objectives of the curriculum. Therefore, our overarching aim was to facilitate student growth by partnering with community nurses and health care leaders so our distant learners could participate in real-world learning experiences that academic–clinical partnerships provide.

In developing academic–clinical partnerships for a newly launched online master's degree in Leadership and Administration in Nursing (LAN) program, a framework was needed that captured the faculties' student-centered pedagogy. This article describes the application of a student-centered mentoring framework—the triad mentoring model—and how we built a unique student academic–clinical partnership for each online graduate student.

Program Development

The five LAN program objectives guided curriculum development, including clinical practicum experiences. The Essentials of Master's Education in Nursing (AACN, 2011) and the American Organizations of Nurse Executives' (AONE, 2015) AONE Nurse Executive Competencies were incorporated. Tables 12 display the program objectives and a crosswalk of AACN and AONE competencies by course.

Master's Leadership and Administration in Nursing (LAN) Program Objectives

Table 1:

Master's Leadership and Administration in Nursing (LAN) Program Objectives

Leadership and Administration in Nursing Program Crosswalk With the American Association of Colleges of Nursing's (AACN) The Essentials of Master's Education in Nursing (2011) and the American Organization of Nurse Executives' (AONE) AONE Nurse Executive Competencies (2015)

Table 2:

Leadership and Administration in Nursing Program Crosswalk With the American Association of Colleges of Nursing's (AACN) The Essentials of Master's Education in Nursing (2011) and the American Organization of Nurse Executives' (AONE) AONE Nurse Executive Competencies (2015)

Course Descriptions

The LAN curriculum was developed with four practicums sequenced throughout the 36-credit hour program. The initial practicum (20 clinical hours) was during the first semester while students were concurrently enrolled in Quality Improvement (QI) and Evidence-Based Practice (EBP) for the Nurse Leader courses. The concurrent sequencing of QI and EBP allows students to investigate and develop a QI project with their leader mentor while integrating the EBP research process. The master's students then implemented their QI pilot projects to meet lesson objectives (Table 3). The second practicum (20 clinical hours) was sequenced concurrently with Health Care Finance and Workforce Planning. The course practicum promotes the implementation of financial and budgetary concepts within QI activities and/or capstone proposal development. An exemplar assignment was the development of a business plan including a start-up budget, monthly projected expenditures, staffing matrix, and staffing costs. Practicum learning experiences can guide the feasibility analysis of the QI or capstone projects at the master's level and could be expanded to the Doctor of Nursing Practice (DNP) level by including multiple units or facilities or by moving from local to regional or national implementation.

Master's in Leadership and Administration in Nursing Learning Objectives for Practicum Courses

Table 3:

Master's in Leadership and Administration in Nursing Learning Objectives for Practicum Courses

The final two capstone practicums (80 clinical hours each) provide for a comprehensive synthesis and application of concepts learned throughout the LAN program. Professional accountability, succession planning, and reflective practice are major concepts of the final two program practicum courses. The capstone practicums completion includes the implementation, evaluation, and dissemination of the project. Highlighting the integration of academic–clinical partnerships, within these two capstone practicums, are professional seminars covering preparation for the nurse executive certification examination and EBP dissemination seminars in professional presentation to corporate boards, professional organizations, and writing for publication.

Triad Mentoring Model

The triad mentoring model, displayed in Figure 1, focuses on a partnership with a leader mentor (i.e., chief nursing officer, chief financial officer), a graduate student, and a faculty mentor (i.e., faculty teaching didactic/practicum courses). The triad mentoring model emphasizes the importance of the three people working together to establish mutual goals and learning experiences to ensure future nurse leaders have field expertise in financial and quality improvement skills that support the AONE competencies (AONE, 2015) and the Essentials of Master's Education (AACN, 2011). The core concepts of the triad model were derived from the AONE Nurse Executive Competencies (AONE, 2015) of communication, knowledge, leadership, professionalism, and business skills.

Triad mentoring model: Partnership for education and leadership.

Figure 1.

Triad mentoring model: Partnership for education and leadership.

The triad mentoring model graphic allowed students and mentors to visualize the importance and interconnectivity of each role in the student's educational advancement and the value of real-world concept application in the work environment. Beginning with the program application, the student identified a current mentor in a leadership position. Using standard preceptor processes, that mentor was vetted for licensure, credentials, and facility agreement. The model graphic was used to highlight roles and expectations during the student and leader mentor orientation. A collaboration between the student, faculty mentor, and leader mentor promoted investment and interdependence with each assignment during the development and implementation of projects within the organization. Faculty actively interacted by onsite and virtual meetings with team members. The model helped to define the role expectations and importance of each member of the team regarding the student's leadership development.

Specifically, the student learning experiences are jointly developed by the leader and faculty mentors to address the facilities current workforce (real-world) issues that improve the quality of care and patient outcomes (partnership between mentor leader and faculty mentor). Faculty structure course assignments to the student and leader mentor–specified goals matched to the care setting and leveled by role responsibility, while ensuring that key nurse leader core competencies are met (support and education between faculty mentor and student). To ensure comparability of course assignments for student's individualized projects, the lesson objectives were matched with detailed student instructions for assignment tasks, standardized rubrics were implemented, and concordance among course faculty was achieved. The leader mentor supports the student's leadership development by role modeling, jointly working on projects, providing opportunities to lead change, promoting succession planning, and building organizations (leadership and mentoring between leader mentor and student). The students set group face-to-face meetings with the triad through a faculty clinical site visit or, more frequently, via video conferencing to facilitate course required and optional meetings to ensure understanding and active participation between the triad team members (student is an active recipient of leadership, mentoring, support, and education).

Program Evaluation

The programmatic goal achieved by the academic–clinical partnership practicum courses was for the student to gain extensive knowledge of the health care environment regarding patient safety, quality and performance improvement, delivery models, economics and policy, and governance. The three roles of the triad mentoring model were evaluated using formative and summative evaluations during the practicum courses, which provided for early problem identification and modifications of the student's project throughout the practicum. Additional expert mentors were encouraged during the different practicums to meet all the objectives. For example, a chief financial officer provided business-specific expertise and project management collaboration during the Finance and Workforce planning course.

The triad mentoring model roles of leadership and mentoring, support and education, and partnership were formally assessed for each practicum course by leader mentor and student standardized evaluation forms. Further results will be monitored as the program cohorts graduate. The model outcomes will be based on nurse executive board certification rates, job advancement, student retention rates, graduation rates, and employer satisfaction surveys at 1 and 5 years postcompletion of the program. The assessments included (a) the student's clinical site evaluation, (b) the student's leader mentor's evaluation, (c) the leader mentor's evaluation of student competencies, and (d) the leader mentor's evaluation of faculty mentor and school of nursing interactions for each course.

Practicum Outcomes

Students successfully progressed through the LAN program of study by completing practicum courses that included achieving individualized authentic clinical learning activities of nursing leadership. Practicum experiences were diverse regarding the health care environment (e.g., inpatient facility versus outpatient facility, local versus regional implementation). For example, for the QI project objective, the process began by establishing the project need using facility data, gathering the facility's leadership support, designing and implementing the project within the facility and evaluating, and reporting the results to the appropriate organizational leadership.

Course Evaluations

Course delivery using the mentoring model received positive evaluations from both the students and leader mentors. The mean scores of 4.5 to 5 on a 5-point Likert scale for the categories (e.g., course content, objectives met, faculty accessibility and effectiveness, and mentor knowledge) were achieved. The triad mentoring model's interconnectivity of each role and frequent communication may be reflected in these rankings. Continuous tracking and trending of didactic and practicum course evaluations will be conducted, and adjustments will be made after input from the triad is collected. A summative evaluation of the students' completed learning objectives and student and employer satisfaction will be undertaken upon practicum and program completion of the initial cohorts.

Conclusion

The integration and implementation of a triad mentoring model in academic–clinical partnerships promoted the development of innovative student-centered practicums. The valued expertise of the leader mentor partnered with the faculty mentor have facilitated student implementation of nurse leader concepts applied in health care practice. The uniqueness of this innovative process is that the online student practicum requirements match the students' various geographic locations. This model also fosters engagement and a vested interest for student success from the leader mentors, who are community health care administrators. The triad mentoring model has provided a framework that promotes student career growth throughout the LAN program and prepares graduates for the nurse leader role. The collaboration of current research and clinical applications promotes evidence-based care and provides role modeling of nurse leader best practices in the health care environment by working with the agency to provide the students with the opportunity to address actual projects for the organization to meet course assignments. It was a winwin situation for the triad—student, mentor leader, and faculty mentor!

References

  • American Association of Colleges of Nursing. (2011). The essentials of master's education in nursing. Washington, DC: Author. Retrieved from https://www.aacnnursing.org/Education-Resources/AACN-Essentials
  • American Association of Colleges of Nursing. (2016). Advancing healthcare transformation: A new era for academic nursing. Washington, DC: Author. Retrieved from https://www.aacnnursing.org/Portals/42/Publications/AACN-New-Era-Report.pdf?ver=2017-07-13-213115-553
  • American Organization of Nurse Executives. (2015). AONE nurse executive competencies. Chicago, IL: Author. Retrieved from http://www.aone.org/resources/nurse-leader-competencies.shtml
  • Clevenger, C.K. & Cellar, J. (2018). Creating new models of care through academic-clinical partnership. Nursing Administration Quarterly, 42, 305–310. doi:10.1097/NAQ.0000000000000320 [CrossRef]
  • Dobalian, A., Bowman, C.C., Wyte-Lake, T., Pearson, M.L., Dougherty, M.B. & Needleman, J. (2014). The critical elements of effective academic-practice partnerships: A framework derived from the Department of Veterans Affairs Nursing Academy. BioMed Central Nursing, 13, 1–31. doi:10.1186/s12912-014-0036-8 [CrossRef]
  • Xippolitos, L.A., Marino, M.A. & Edelman, N.H. (2011). Leveraging academic-service partnerships: Implications for implementing the RWJ/IOM's recommendations to improve quality, access, and value in academic medical centers. International Scholarly Research Network Nursing, Article ID 731902. doi:10.5402/2011/731902 [CrossRef]

Master's Leadership and Administration in Nursing (LAN) Program Objectives

Objective

LAN graduate students will demonstrate effective oral and written communication across a diverse constituency, including board members, executives, academia, physicians and providers, employees, community members, patients, and families.

LAN graduate students gain extensive knowledge of the health care environment regarding patient safety, quality and performance improvement, delivery models, economics and policy, and governance.

LAN graduate students will internalize personal and professional leadership skills that demonstrate reflective practice, change management, succession planning, systems thinking, and emotional intelligence.

LAN students will synthesize personal accountability and professional ethics into an advocacy role as a nurse leader.

LAN students will correlate business skills in financial management, human resources, strategic planning, and information management and technology.

Leadership and Administration in Nursing Program Crosswalk With the American Association of Colleges of Nursing's (AACN) The Essentials of Master's Education in Nursing (2011) and the American Organization of Nurse Executives' (AONE) AONE Nurse Executive Competencies (2015)

CourseProgram ObjectivesaAACN EssentialsAONE Competencies
5361 Leadership Science: Performance and Quality Improvement (20-hour mentored project)1, 2, 3, 4III, IV, IX2E, 2G, 2H
5364 Leadership Science: Health Care Finance and Workforce Planning (20-hour mentored project)1, 2, 5II, III, VI, VII1B, 2B, 2C, 2D, 3D
5367 The Leader Within: Professional Accountability, Succession Planning and Reflective Practice I (40-hour mentored project)1, 2, 3, 4, 5I, II, IV, V, VI, VII, VIII, IX2C, 2E, 2G, 3C, 3D, 3E, 4B, 4C, 5D
5368 The Leader Within: Professional Accountability, Succession Planning and Reflective Practice II (40-hour mentored project)1, 2, 3, 4, 5I, II, IV, V, VI, VII, VIII, IX2C, 2E, 2G, 3C, 3D, 3E, 4B, 4C, 5D

Master's in Leadership and Administration in Nursing Learning Objectives for Practicum Courses

Performance and Quality Improvement (20 Clinical Hours)

Analyze information about quality initiatives recognizing the contributions of individuals and interprofessional health care teams to improve health outcomes across the continuum of care.
Use evidence for establishment of standards, practices, and patient care models in the organization.
Direct quality improvement methods to promote culturally responsive, safe, timely, effective, efficient, equitable, and patient-centered care.
Lead quality improvement initiatives that integrate sociocultural factors affecting the delivery of nursing and health care services.
Use evidence-based metrics to align patient outcomes with the organization's goals and objectives.
Monitor and address nurse sensitive outcomes and satisfaction indicators.

Health Care Finance and Workforce Planning (20 Clinical Hours)

Compare and contrast the ways in which health care delivery systems are financed.
Apply business and economic principles and practices, including budgeting, cost/benefit analysis, and marketing, to develop a business plan.
Develop and manage an annual operating budget and long-term capital expenditure plan.
Interpret financial statements.
Educate patient care team members on financial implications of patient care decisions.
Participate in the negotiation and monitoring of contract compliance.

Capstone Practicum I and II (80 Clinical Hours)

Assume responsibility for professional development, including the exploration of role diversification, and lifelong learning.
Integrate concepts of basic organizational and systems leadership with the culture of the organization to coordinate quality patient care.
Integrate theory and research knowledge in the formulation, implementation, and evaluation of nursing leadership/management actions.
Analyze patient-care technologies, information systems, and communication devices that support sate nursing practice.
Integrate knowledge of the social/political forces, economic resources, and regulatory processes that impact health care delivery.
Collaborate with the intradisciplinary/interdisciplinary team to optimize patient outcomes that reflect human caring.
Demonstrate professional values based on moral, ethical, and legal aspects of nursing practice.
Develop succession plans for various nursing management roles.
Design, develop, and implement an intervention/quality improvement/change capstone project with the mentorship of the facility's leadership team.
Authors

Dr. Dolan is Assistant Professor, and Dr. Willson is Graduate Program Director, Leadership and Administration Director, and Clinical Professor, St. David's School of Nursing, Texas State University, Round Rock, Texas.

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

Address correspondence to Diana Martinez Dolan, PhD, RN, Assistant Professor, St. David's School of Nursing, Texas State University, 100 Bobcat Way, Round Rock, TX 78665-8017; e-mail: Dmd173@txstate.edu.

Received: October 03, 2018
Accepted: April 30, 2019

10.3928/01484834-20190719-05

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