Clinical Leadership Skills Acquisition in Nurse Residents Susan Pettorini-D’Amico, DNP, RN

Background There is a shortage of nurses which has led to a shortage of nurse leaders There is also a lack of nurse leadership development programs which affects leadership succession The Institute of Medicine report (2011) has identified nurse leadership as important in realizing health care reform and calls for nurse leadership programs to be developed and used Nurse residency programs can be used to develop clinical leadership skills

Purpose of the Study To measure the ability of a residency program to impart clinical leadership skills to nurse residents Nurse residents should have clinical leadership skills taught to successfully build the next generation of nurse leaders Clinical leadership skills can be further developed into administrative leadership skills thus addressing succession planning

Conceptual Framework Patricia Benner’s Model of Novice to Expert (1984) Dreyfus model of skill acquisition Five levels of skill attainment: novice, advanced beginner, competent, proficient, expert Expertise develops as nurses progress through these stages Nurse residents can been seen as students progressing through these same stages

BENNER’S STAGES AND THE NURSE RESIDENT The nurse resident is an advanced beginner Through clinical rotations and classroom content, the resident advances to a competent practitioner Measuring acquisition of the leadership topics can show that clinical leadership skills have been taught

Research Model Theoretical Diagram

Research Question What is the effect of a nurse residency program on clinical leadership skills acquisition in the new nurse resident?

University Healthsystem Consortium/American Association of Colleges of Nursing UHC/AACN Program Purpose of the program: To aid the nurse resident in completing the transition from an advanced beginner to competent nurse Goals include improving the resident’s ability to think critically, manage patient outcomes and provide clinical leadership at the point of care Curriculum focuses on three main topics: Patient Outcomes, Professional Roles and Leadership

Leadership Topics Patient Care Delivery and Resource Management Communication Conflict Resolution Organization of data

Design A non-equivalent comparison group posttest research design was used to examine the relationship between the independent and dependant variable Independent Variable: The UHC/AACN Nurse Residency Program Dependant Variable: Clinical leadership skills acquisition in nurse residents

Setting A 1500 bed tertiary medical center with two campuses (one which used the UHC/AACN residency program, one which did not) York Street campus: UHC/AACN residency program used Chapel Street campus: No formal program used

Sample Power analysis: 102 subjects needed (power 0.80, effect size 0.5, alpha 0.05). Final sample: 40 (underpowered) Inclusion criteria for York Street campus was only those nurses who have completed the UHC/AACN residency program. Inclusion criteria for Chapel Street campus was any nurse who completed one year as a new nurse graduate in the hospital Excluded from the study was any nurse resident or graduate who did not complete one year of employment at either institution

York Street vs. Chapel Street York Street: UHC/AACN Program Chapel Street: No formal program Year long program Nine months precepted clinical time Three months independent clinical practice Monthly classroom content for one year: Patient Outcomes, Professional roles, Leadership Evidenced-based research project Three months precepted clinical time Monthly meeting for about 3 months Peer to peer support

Instrument Clinical Leadership Survey Developed by Patrick, Laschinger, Wong and Finegan (2011) Measures for clinical leadership skills at the point of care Psychometric testing: Confirmatory factor analysis on each item. Content validity index of 85%. Reliability coefficient equaled 0.86

Procedure Sacred Heart IRB and Yale Human Investigative Committee approval Recruitment via flyers in work areas and at nursing leadership meetings Survey monkey site for survey access

Results Final number of surveys in data set: 44 Number used in data analysis: 40 York Street: n=14 Chapel Street: n=26 Study underpowered

Description of the Sample Characteristics Chapel Street (n =26) Frequency Percentage Gender Female Male 25 1 96.0 4.0 Ethnicity Caucasian Asian Other 24 92.0 3.0 Previous leadership training Yes No 9 17 34.6 65.4 Nursing a second career 4 22 15.4 84.6 Age < 25 > 25 16 10 61.5 38.5

Description of the Sample Characteristic York Street (n =14) Frequency Percentage Gender Female Male 14 100.0 0.0 Ethnicity Caucasian Asian Other 13 1 93.0 7.0 Previous leadership training Yes No 3 11 28.4 78.5 Nursing a second career 4 10 28.6 71.4 Age < 25 > 25 9 5 64.2 35.7

Results of CLS Scores Chapel Street Scores York Street Scores Variable Obs Min Max Mean SD Average 26 3.647 5.000 4.468 0.330 Variable Obs Min Max Mean SD Average 14 3.765 5.000 4.311 0.423

of Chapel Street scores . Normal Distribution of Chapel Street scores Normal Distribution of York Street scores

Results: T-test, Chi-square T-test for mean group scores P= 0.200 (study underpowered) Pearson’s Chi-square test Independent Variable P Value Age < 25 or > 25 P =0.636 Nursing a second career p =0.664 Previous leadership training p =0.646

Discussion First study to use the Clinical Leadership Survey to attempt to measure this concept in this population Study not powered due to small size of the sample No statistical significance found between the means of the two groups Not possible to conclude the residency program did not instill clinical leadership skills

Limitations Recruitment procedure a challenge Homogenous nature of the sample History, maturation and conflicting organizational initiatives Was leadership content of residency program overshadowed by other components? Natural leadership tendency of nurses who work at Level 1 trauma centers?

Implications Nursing Practice: Further research to study which residency programs are successful in building nurse leaders in the clinical arena Nursing Education: Replicate study in a broader scale to be able to inform education about the need to build clinical leadership skills in undergraduate programs

Implications continued Policy: Use this study as a guide to research which residency programs are successful in instilling clinical leadership skills to be able to guide both practice and education

Future Research Use recruitment strategies to gain a larger sample Compare nurses at the beginning and the end of the residency program (one group, pre-test, post test) Compare different residency programs Compare groups of nurses without residency programs to be able to learn best practices

Thank You Questions and Answers