- Email: [email protected]
Development and implementation of a Clinical Leadership continuing education certificate program
Development and Implementation of a Clinical Leadership Continuing Education Certificate Program Barbara Jo Foley, RN, PhD, FAAN, and Elizabeth K. Woodard, RN, PhD
As nurse administrators and other hospital and health administrators have studied ways to ease the nursing shortage, retention of current nursing staff has become critical. The literature has shown that the nurse manager is a key component in this retention process, yet nurse managers are often thrust into the role without formal leadership or management preparation. It was in this context that the continuing education (CE) program at the University of North Carolina at Chapel Hill School of Nursing began discussion of offering a nurse manager CE certificate program for new 36 Nurse Leader
nurse managers. CE certificate programs are mini-curricula programs that provide education in a particular study interest and are conducted over a span of 3 to 6 months. All content areas within certificate programs June 2005
relate to each other and are deemed critical knowledge for a particular skill, position, or practice area. Academic credit is not awarded with such a program, but a certificate is provided to each participant who successfully completes the program.
Table 1. Clinical Leadership Certificate Program Requirements Clinical Leadership Institute I—5 Days (Classroom)
DEVELOPMENT OF THE CERTIFICATE PROGRAM After much discussion with nursing administration faculty and review of similar courses being offered nationally, a work group identified the content and the teaching format for the program (Table 1). In short, the CE Certificate in Clinical Leadership is designed to prepare clinical personnel to assume and grow in the role of clinical manager. The requirements are to complete two Institutes in Clinical Leadership and a management project. The certificate program has been endorsed by the North Carolina Nurses Association and the North Carolina Hospital Association. Based on their recommendations, the program is offered to all clinical middle managers; including those in lab, x-ray, pharmacy, and so on, not just nurse managers. The work group noted that these clinical managers work very closely with nurse managers, and they also needed leadership/management education. Clinical Leadership Institute I is a 5-day sequential, immersive workshop designed around the basic principles of clinical management. Attendees are expected to participate in class discussion and interactive learning exercises. After this intensive week, the managers return to their employing agencies and begin a management project. The purpose of this project is to facilitate the application of selected principles and concepts presented in the Clinical Leadership Institute I. During Institute I, the managers identify a topic for the project with assistance from the institute faculty. Ideally, the project will be completed before beginning Institute II, which occurs 3 months later. If the manager is not able to complete the project by the start of Institute II, he or she is asked to give a status report on the project and describe a plan for completion and evaluation. The project is supervised by us, the Institute faculty, who review the initial proposal and provide evaluative feedback throughout the implementation and evaluation of the project. We expect the project to offer the manager an opportunity to address, with expert support and feedback, a specific need in his or her work environment. The project is supported through the manager’s review of current literature, development of a proposal, implementation of the project, and evaluation of its effectiveness. Members of the Institute faculty are available for consultation and guidance, usually via e-mail, during the 3-month interim. The managers are encouraged to acknowledge that some projects do not deliver the desired outcome—a reality in the constantly changing health care environment. Still, we expect managers to present the project so that they and others may learn from the experience and discuss how the project might be handled differently in the future. In our June 2005
Day 1 Contemporary Styles of Leadership Understanding Organizational Culture Negotiating the Contemporary Health Care Organization Leadership Styles for a Diverse Workforce Professional Communication: The Way Work Gets Done Day 2 The Power of Valuing People: Human Resource Management Ethical Issues in Clinical Leadership Establishing and Maintaining Trust Managing and Motivating People: A Generational Approach Developing Effective Teams Retention and Recruitment: The Key Role of the Clinical Leader Day 3 Fighting the Battle of the Budget U.S. Health Care Environment: The Economic Perspective Methods of Health Care Reimbursement Budget 101: Basic Cost Concepts Budgets as Institutional Plans Operating Budgets at the Patient Unit Level Capital Budgets Slicing the Pie: How To Make Program Decisions with Limited Resources Day 4 Quality: Creating a Climate of Clinical Excellence Current Issues in Health Care Quality Evidence-Based Practice as an Incentive for Change Demystifying Quality Improvement Tools The Change Process and Quality Improvement Creating a Quality-Focused Work Culture The Change Process and Quality Improvement Day 5 Strategies for Managerial Challenges Delegation Managing Conflict Managing from the Middle Making Effective Presentations Management Project—3 Months (Independent Study) Clinical Leadership Institute II—2-Days (Classroom) Presentation and discussion of the management projects
experience, the “failed” projects are powerful teaching tools for everyone attending. The last requirement is attendance and participation in Clinical Leadership Institute II. This 2-day workshop is designed to reinforce the principles learned in Institute I after the managers have had an opportunity to apply them in their practice setting. It is during Institute II that the manNurse Leader 37
It is during Institute II that the managers present their projects and receive feedback and guidance from their peers and Institute faculty.
agers present their projects and receive feedback and guidance from their peers and Institute faculty. The managers present what went well as well as what did not go as expected. Faculty and peers then respond to specific issues on which the managers feel they would like assistance. These issues might include such things as conflict with another department, an employee trying to set the manager up for failure, or a supervisor who disrupts the work environment.
EDUCATIONAL TECHNIQUES The School of Nursing planning group discussed what educational techniques might provide the best experience for these clinical managers. We decided that two faculty members would be considered the primary faculty and would remain with the group throughout the two Institutes. The faculty, by virtue of their own immersion, would have the contextual perspective necessary to facilitate comprehension of diverse content and presenters. As it happened, the teaching interest of both of the authors (who made up the primary faculty) was in the human resource area. Therefore, we taught the content on days 1, 2, and 5. Our teaching style is experiential, so we presented the content using our own administrative experiences as well the managers’ experiences. Using this style with humor in a relaxed atmosphere set a warm, friendly tone for the Institute and helped the managers trust the faculty and each other. To facilitate this trust and open dialogue, each course began with a pledge of confidentiality. Thus, the managers could readily share their sometimes painful experiences, and the faculty and other managers could target their comments to these specific issues. The environment for teaching 38 Nurse Leader
was carefully crafted by the primary faculty such that the managers were able to learn as much, if not more, from each other as they did from the faculty. Days 3 and 4 of the Institute were dedicated to the two key issues of budget and quality management. Budget content was presented more traditionally, because there was a wealth of technical content to present. As in every situation, the managers were encouraged to bring budget concerns for group and faculty discussion. The quality day was very interactive, with many group activities. Day 5 covered strategies for handling managerial challenges. Structuring Institute I this way provided a variety of teaching styles over the week.
IMPLEMENTATION OF THE CERTIFICATE PROGRAM We have offered this certificate program nine times over the past 2 years to a total of 142 managers. Four of the nine Institutes were contract programs, meaning that the faculty took the program on the road and offered the course for the clinical managers in a specific agency. We offered the other five Institutes in a central location (open programs) with managers coming from a variety of agencies and other states.
Contract programs We conducted the pilot Institute at a 316-bed acute care facility in a relatively rural community. Of the 24 managers attending, 20 were nurses, one managed the laboratory, one managed transport services, and two were from radiology services. Although we publicized the course as one for new managers, the managerial experience in this group June 2005
ranged from less than 1 year to over 30 years. Subsequently, we offered two contract courses in a 900-bed tertiary care hospital with 19 nurse managers in each Institute, for a total of 38. Once again, there was a wide range of managerial experience. The additional contract course was for a health care system in a rural tourist community. For the first time our attendees included team leaders and charge nurses as well as managers.
Open programs These courses attracted managers from various agencies, ranged in size from 14 to 25, and included both nurses and other clinical managers. The experience range in these courses was also wide, as was the diversity of participants. To date, we have had social workers, quality managers, and dieticians attend, as well as the other ancillary departments previously mentioned.
CLINICAL INSTITUTE I At the beginning of Institute I, we asked the managers to tell us what they hoped to learn in this course. Many answers were quite vague, such as, “I want to learn tips on better management techniques.” Others were more specific, such as “I want to learn how to get the staff to take ownership,” “I want to create a positive environment on my unit,” and “I want to learn more about conflict management and time management.” These statements were very helpful to us, because we wanted to discuss the specific issues that were of the most concern to this particular group of managers. Although the curriculum has specific content, all of the content is compiled in a notebook that is distributed on day 1. The managers also receive a comprehensive management textbook for future reference. We have found that we use the traditional lecture format sparingly, because with skillful facilitation, the attendees guide the emphasis of the discussion. Although we specifically ask, “What do you want to learn?” in the first hour of the first day, we assess the group throughout the week. The primary faculty consult with each other and the group at the end of each day. We ask for feedback on what went well, what needed changing, and how the group would like to proceed the next day. The feedback includes how they want to structure the day (lunch breaks, etc.), but we also seek input on the content. For example, if a group feels comfortable with delegation and wants to spend more time on conflict management, we adjust the next day’s content accordingly. We are comfortable being flexible, because all of the content is available to them in their notebook.
MANAGERS’ BIGGEST INTERESTS After the experience of nine programs, we found that one of the biggest interests of the managers is how to manage and motivate by generations. The majority of the managers believe that the younger generation is not motivated to work in a manner that the managers find acceptable. Some describe younger ones as not committed June 2005
or even lazy. However, after presenting the content on managing different generations in the workplace, the managers began to see how each generation differs when balancing their work and personal lives. The discussion progresses toward how to manage the different generations and away from labeling some workers “driven” and others “slack.” Interpersonal conflicts among staff was another area of great concern to the managers. For example, most managers struggled over how to get employees to take responsibility for solving their own conflicts instead of laying all of their interpersonal issues at the feet of “Mom” (i.e., the clinical manager). Each course engendered much discussion of employees being adults, not children, and the need for these employees to take responsibility for their own actions. For example: Two employees have a disagreement. One goes to the manager expecting her to speak to the other employee to resolve the difference. If the manager accepts that responsibility, she has set a precedent that she is willing to take on the resolution of such disagreements. Interestingly, many managers believe that that is their role. The faculty tried to help the managers see that the employees, as adults, have responsibility in solving their own disagreements. If the employees make an attempt to resolve the problem and are unsuccessful, it might then be appropriate for the manager to intervene. One of the most distressing themes in each Institute was the manager’s description of the struggle to balance their personal and professional lives. Their angst was palpable, and the faculty worked hard to help managers develop a broader perspective on life and work. We had brainstorming exercises for time management tips and stress management techniques.
CLINICAL INSTITUTE II—MANAGEMENT PROJECT PRESENTATIONS At the beginning of Clinical Institute II, we asked the managers to reflect on the past 3 months and to tell us if they tried any new management techniques. One comment was, “I am much more relaxed in my role. We had a Joint Commission visit, and my staff couldn’t believe how calm I was during the visit.” Another said, “I am less stressed. I am having the shift leaders take more responsibility.” Another said, “This is the first conference I’ve attended when I felt I could take the material back to my work setting and apply it.” Not everyone was able to put a positive spin on returning to work. One manager said, “I was on a high, but I just got sucked back into life.” Once we had debriefed the participants, the management projects were presented. We were consistently pleased at the high quality of the projects. Most of them required much thought, research, networking, and strategic planning. Most of the managers indicated that their project was something they had wanted to do for a long time but never seemed to find the time. This requirement was the push they needed to begin work. Selected topics for the management projects can be found in Table 2. Nurse Leader 39
Table 2. Selected Management Project Topics Develop a unit-based patient education handbook Improve turnaround for short-term analysis and testing troponin I and partial thromboplastin time Identify reasons for high turnover of certified nursing assistants Develop a central scheduling project for imaging services Improve the safety and outcome for patients receiving moderate sedation in the emergency department Clarify the expectations of the charge nurse role Improve documentation (create a form and have it approved) Institute unit-based shared governance Implement an ambulatory surgery inventory management program Improve advanced care directive completion (co-coordinators: nurse manager & nonnurse manager) Improve patient transfer process between the emergency department and the units
Managers often said they were nervous about making a formal presentation of their projects, so we worked to make the experience as painless as possible. We emphasized that the content was the most important part of the presentation and that we didn’t care about fancy audiovisuals. We wanted the managers to use whatever media they found comfortable. If the managers were more comfortable sitting during the presentation, they sat. The only requirement was that each presenter provide a handout. This not only made it easier for the audience to follow the presentation, but it created an archive for future reference. Initially, we were concerned that the managers might find some of the presentations boring or irrelevant to their area, especially those presentations outside their immediate scope of practice. This concern was unfounded. For example, one lab manager presented a project on blood product wastage to 14 managers in the course, all but 4 of whom were nurses. The goal was to decrease waste. The manager defined a wasted blood product, stated the percentage of waste, compared this to the rate in other hospitals, talked about factors that affect the cost of blood products, gave the reasons for wastage, and presented his plan for reducing it. He gave specific examples of reasons for wastage such as miscommunication, physical breakage, improper handling or storage, and so on. The other managers were quite surprised at the potential role nursing had in reducing this wastage. The projects seemed to create alliances across nursing departments and between nursing and nonnursing departments.
DISCUSSION In each Institute we were pleased to see that the managers coalesced as a group and readily sought out other 40 Nurse Leader
managers from different agencies who had responsibility for the same or similar areas. These conversations developed into a network of associations that the managers used after the Institute was over. Managers exchanged emails, phone consultations, and even made site visits to tap these newfound resources. The overwhelming theme was that middle managers have a strong desire to do a better job at managing their human and material resources. Given that the Institute was originally designed to groom new clinical managers, we were consistently surprised at the high evaluations we received from managers with extensive experience. This suggests that managers, no matter their practice area or length of tenure in an organization or at a position, find rejuvenation and benefit in attending a course that has been designed to address their specific roles. The success of the program can be attributed to several factors. The faculty are credible to the participants, given their professional expertise, administrative backgrounds, and general approach to the course. We are cognizant of the fact that these are busy people who are in high demand 24 hours a day. As their faculty, we respect their positions and thus want to make their time in the Institute valuable. The nature of the interactions between the faculty and participants immediately sets a tone of conviviality, the idea being that this intense learning experience must be enjoyable if it is to be beneficial. A second reason for success is the strong desire of the participants to learn and apply anything that will enhance patient care in their areas of responsibility. This may include reducing costs; improving morale and teamwork; redesigning workloads; negotiating relationships with other departments; improving communications with employees, patients, and physicians; designing new programs; and so on. We have been humbled by their tenacity and energy in grasping new ideas and working to figure out how they can use them in their own environments. They are tired at the end of the week but seem tireless when it comes to improving the work environment for their employees. It seems that the CE Certificate in Clinical Leadership has met a need that was known to exist but had not been specifically addressed by the education or practice communities. Results indicate that participants from a variety of agencies and specialties have been energized through their experiences with other clinical managers in a format that stresses immersion and respectful collegiality. Our intent is to continue to meet this need by using the clinical managers as our guides. Barbara Jo Foley, RN, PhD, FAAN, is clinical professor and division chair and Elizabeth K. Woodard, RN, PhD, is a clinical assistant professor at the University of North Carolina-Chapel Hill School of Nursing in Chapel Hill, N.C. She can be reached at bfo [email protected]. 1541-4612/2005/ $ - see front matter Copyright 2005 by Elsevier Inc. doi:10.1016/j.mnl.2005.02.004
June 2005
As nurse administrators and other hospital and health administrators have studied ways to ease the nursing shortage, retention of current nursing staff has become critical. The literature has shown that the nurse manager is a key component in this retention process, yet nurse managers are often thrust into the role without formal leadership or management preparation. It was in this context that the continuing education (CE) program at the University of North Carolina at Chapel Hill School of Nursing began discussion of offering a nurse manager CE certificate program for new 36 Nurse Leader
nurse managers. CE certificate programs are mini-curricula programs that provide education in a particular study interest and are conducted over a span of 3 to 6 months. All content areas within certificate programs June 2005
relate to each other and are deemed critical knowledge for a particular skill, position, or practice area. Academic credit is not awarded with such a program, but a certificate is provided to each participant who successfully completes the program.
Table 1. Clinical Leadership Certificate Program Requirements Clinical Leadership Institute I—5 Days (Classroom)
DEVELOPMENT OF THE CERTIFICATE PROGRAM After much discussion with nursing administration faculty and review of similar courses being offered nationally, a work group identified the content and the teaching format for the program (Table 1). In short, the CE Certificate in Clinical Leadership is designed to prepare clinical personnel to assume and grow in the role of clinical manager. The requirements are to complete two Institutes in Clinical Leadership and a management project. The certificate program has been endorsed by the North Carolina Nurses Association and the North Carolina Hospital Association. Based on their recommendations, the program is offered to all clinical middle managers; including those in lab, x-ray, pharmacy, and so on, not just nurse managers. The work group noted that these clinical managers work very closely with nurse managers, and they also needed leadership/management education. Clinical Leadership Institute I is a 5-day sequential, immersive workshop designed around the basic principles of clinical management. Attendees are expected to participate in class discussion and interactive learning exercises. After this intensive week, the managers return to their employing agencies and begin a management project. The purpose of this project is to facilitate the application of selected principles and concepts presented in the Clinical Leadership Institute I. During Institute I, the managers identify a topic for the project with assistance from the institute faculty. Ideally, the project will be completed before beginning Institute II, which occurs 3 months later. If the manager is not able to complete the project by the start of Institute II, he or she is asked to give a status report on the project and describe a plan for completion and evaluation. The project is supervised by us, the Institute faculty, who review the initial proposal and provide evaluative feedback throughout the implementation and evaluation of the project. We expect the project to offer the manager an opportunity to address, with expert support and feedback, a specific need in his or her work environment. The project is supported through the manager’s review of current literature, development of a proposal, implementation of the project, and evaluation of its effectiveness. Members of the Institute faculty are available for consultation and guidance, usually via e-mail, during the 3-month interim. The managers are encouraged to acknowledge that some projects do not deliver the desired outcome—a reality in the constantly changing health care environment. Still, we expect managers to present the project so that they and others may learn from the experience and discuss how the project might be handled differently in the future. In our June 2005
Day 1 Contemporary Styles of Leadership Understanding Organizational Culture Negotiating the Contemporary Health Care Organization Leadership Styles for a Diverse Workforce Professional Communication: The Way Work Gets Done Day 2 The Power of Valuing People: Human Resource Management Ethical Issues in Clinical Leadership Establishing and Maintaining Trust Managing and Motivating People: A Generational Approach Developing Effective Teams Retention and Recruitment: The Key Role of the Clinical Leader Day 3 Fighting the Battle of the Budget U.S. Health Care Environment: The Economic Perspective Methods of Health Care Reimbursement Budget 101: Basic Cost Concepts Budgets as Institutional Plans Operating Budgets at the Patient Unit Level Capital Budgets Slicing the Pie: How To Make Program Decisions with Limited Resources Day 4 Quality: Creating a Climate of Clinical Excellence Current Issues in Health Care Quality Evidence-Based Practice as an Incentive for Change Demystifying Quality Improvement Tools The Change Process and Quality Improvement Creating a Quality-Focused Work Culture The Change Process and Quality Improvement Day 5 Strategies for Managerial Challenges Delegation Managing Conflict Managing from the Middle Making Effective Presentations Management Project—3 Months (Independent Study) Clinical Leadership Institute II—2-Days (Classroom) Presentation and discussion of the management projects
experience, the “failed” projects are powerful teaching tools for everyone attending. The last requirement is attendance and participation in Clinical Leadership Institute II. This 2-day workshop is designed to reinforce the principles learned in Institute I after the managers have had an opportunity to apply them in their practice setting. It is during Institute II that the manNurse Leader 37
It is during Institute II that the managers present their projects and receive feedback and guidance from their peers and Institute faculty.
agers present their projects and receive feedback and guidance from their peers and Institute faculty. The managers present what went well as well as what did not go as expected. Faculty and peers then respond to specific issues on which the managers feel they would like assistance. These issues might include such things as conflict with another department, an employee trying to set the manager up for failure, or a supervisor who disrupts the work environment.
EDUCATIONAL TECHNIQUES The School of Nursing planning group discussed what educational techniques might provide the best experience for these clinical managers. We decided that two faculty members would be considered the primary faculty and would remain with the group throughout the two Institutes. The faculty, by virtue of their own immersion, would have the contextual perspective necessary to facilitate comprehension of diverse content and presenters. As it happened, the teaching interest of both of the authors (who made up the primary faculty) was in the human resource area. Therefore, we taught the content on days 1, 2, and 5. Our teaching style is experiential, so we presented the content using our own administrative experiences as well the managers’ experiences. Using this style with humor in a relaxed atmosphere set a warm, friendly tone for the Institute and helped the managers trust the faculty and each other. To facilitate this trust and open dialogue, each course began with a pledge of confidentiality. Thus, the managers could readily share their sometimes painful experiences, and the faculty and other managers could target their comments to these specific issues. The environment for teaching 38 Nurse Leader
was carefully crafted by the primary faculty such that the managers were able to learn as much, if not more, from each other as they did from the faculty. Days 3 and 4 of the Institute were dedicated to the two key issues of budget and quality management. Budget content was presented more traditionally, because there was a wealth of technical content to present. As in every situation, the managers were encouraged to bring budget concerns for group and faculty discussion. The quality day was very interactive, with many group activities. Day 5 covered strategies for handling managerial challenges. Structuring Institute I this way provided a variety of teaching styles over the week.
IMPLEMENTATION OF THE CERTIFICATE PROGRAM We have offered this certificate program nine times over the past 2 years to a total of 142 managers. Four of the nine Institutes were contract programs, meaning that the faculty took the program on the road and offered the course for the clinical managers in a specific agency. We offered the other five Institutes in a central location (open programs) with managers coming from a variety of agencies and other states.
Contract programs We conducted the pilot Institute at a 316-bed acute care facility in a relatively rural community. Of the 24 managers attending, 20 were nurses, one managed the laboratory, one managed transport services, and two were from radiology services. Although we publicized the course as one for new managers, the managerial experience in this group June 2005
ranged from less than 1 year to over 30 years. Subsequently, we offered two contract courses in a 900-bed tertiary care hospital with 19 nurse managers in each Institute, for a total of 38. Once again, there was a wide range of managerial experience. The additional contract course was for a health care system in a rural tourist community. For the first time our attendees included team leaders and charge nurses as well as managers.
Open programs These courses attracted managers from various agencies, ranged in size from 14 to 25, and included both nurses and other clinical managers. The experience range in these courses was also wide, as was the diversity of participants. To date, we have had social workers, quality managers, and dieticians attend, as well as the other ancillary departments previously mentioned.
CLINICAL INSTITUTE I At the beginning of Institute I, we asked the managers to tell us what they hoped to learn in this course. Many answers were quite vague, such as, “I want to learn tips on better management techniques.” Others were more specific, such as “I want to learn how to get the staff to take ownership,” “I want to create a positive environment on my unit,” and “I want to learn more about conflict management and time management.” These statements were very helpful to us, because we wanted to discuss the specific issues that were of the most concern to this particular group of managers. Although the curriculum has specific content, all of the content is compiled in a notebook that is distributed on day 1. The managers also receive a comprehensive management textbook for future reference. We have found that we use the traditional lecture format sparingly, because with skillful facilitation, the attendees guide the emphasis of the discussion. Although we specifically ask, “What do you want to learn?” in the first hour of the first day, we assess the group throughout the week. The primary faculty consult with each other and the group at the end of each day. We ask for feedback on what went well, what needed changing, and how the group would like to proceed the next day. The feedback includes how they want to structure the day (lunch breaks, etc.), but we also seek input on the content. For example, if a group feels comfortable with delegation and wants to spend more time on conflict management, we adjust the next day’s content accordingly. We are comfortable being flexible, because all of the content is available to them in their notebook.
MANAGERS’ BIGGEST INTERESTS After the experience of nine programs, we found that one of the biggest interests of the managers is how to manage and motivate by generations. The majority of the managers believe that the younger generation is not motivated to work in a manner that the managers find acceptable. Some describe younger ones as not committed June 2005
or even lazy. However, after presenting the content on managing different generations in the workplace, the managers began to see how each generation differs when balancing their work and personal lives. The discussion progresses toward how to manage the different generations and away from labeling some workers “driven” and others “slack.” Interpersonal conflicts among staff was another area of great concern to the managers. For example, most managers struggled over how to get employees to take responsibility for solving their own conflicts instead of laying all of their interpersonal issues at the feet of “Mom” (i.e., the clinical manager). Each course engendered much discussion of employees being adults, not children, and the need for these employees to take responsibility for their own actions. For example: Two employees have a disagreement. One goes to the manager expecting her to speak to the other employee to resolve the difference. If the manager accepts that responsibility, she has set a precedent that she is willing to take on the resolution of such disagreements. Interestingly, many managers believe that that is their role. The faculty tried to help the managers see that the employees, as adults, have responsibility in solving their own disagreements. If the employees make an attempt to resolve the problem and are unsuccessful, it might then be appropriate for the manager to intervene. One of the most distressing themes in each Institute was the manager’s description of the struggle to balance their personal and professional lives. Their angst was palpable, and the faculty worked hard to help managers develop a broader perspective on life and work. We had brainstorming exercises for time management tips and stress management techniques.
CLINICAL INSTITUTE II—MANAGEMENT PROJECT PRESENTATIONS At the beginning of Clinical Institute II, we asked the managers to reflect on the past 3 months and to tell us if they tried any new management techniques. One comment was, “I am much more relaxed in my role. We had a Joint Commission visit, and my staff couldn’t believe how calm I was during the visit.” Another said, “I am less stressed. I am having the shift leaders take more responsibility.” Another said, “This is the first conference I’ve attended when I felt I could take the material back to my work setting and apply it.” Not everyone was able to put a positive spin on returning to work. One manager said, “I was on a high, but I just got sucked back into life.” Once we had debriefed the participants, the management projects were presented. We were consistently pleased at the high quality of the projects. Most of them required much thought, research, networking, and strategic planning. Most of the managers indicated that their project was something they had wanted to do for a long time but never seemed to find the time. This requirement was the push they needed to begin work. Selected topics for the management projects can be found in Table 2. Nurse Leader 39
Table 2. Selected Management Project Topics Develop a unit-based patient education handbook Improve turnaround for short-term analysis and testing troponin I and partial thromboplastin time Identify reasons for high turnover of certified nursing assistants Develop a central scheduling project for imaging services Improve the safety and outcome for patients receiving moderate sedation in the emergency department Clarify the expectations of the charge nurse role Improve documentation (create a form and have it approved) Institute unit-based shared governance Implement an ambulatory surgery inventory management program Improve advanced care directive completion (co-coordinators: nurse manager & nonnurse manager) Improve patient transfer process between the emergency department and the units
Managers often said they were nervous about making a formal presentation of their projects, so we worked to make the experience as painless as possible. We emphasized that the content was the most important part of the presentation and that we didn’t care about fancy audiovisuals. We wanted the managers to use whatever media they found comfortable. If the managers were more comfortable sitting during the presentation, they sat. The only requirement was that each presenter provide a handout. This not only made it easier for the audience to follow the presentation, but it created an archive for future reference. Initially, we were concerned that the managers might find some of the presentations boring or irrelevant to their area, especially those presentations outside their immediate scope of practice. This concern was unfounded. For example, one lab manager presented a project on blood product wastage to 14 managers in the course, all but 4 of whom were nurses. The goal was to decrease waste. The manager defined a wasted blood product, stated the percentage of waste, compared this to the rate in other hospitals, talked about factors that affect the cost of blood products, gave the reasons for wastage, and presented his plan for reducing it. He gave specific examples of reasons for wastage such as miscommunication, physical breakage, improper handling or storage, and so on. The other managers were quite surprised at the potential role nursing had in reducing this wastage. The projects seemed to create alliances across nursing departments and between nursing and nonnursing departments.
DISCUSSION In each Institute we were pleased to see that the managers coalesced as a group and readily sought out other 40 Nurse Leader
managers from different agencies who had responsibility for the same or similar areas. These conversations developed into a network of associations that the managers used after the Institute was over. Managers exchanged emails, phone consultations, and even made site visits to tap these newfound resources. The overwhelming theme was that middle managers have a strong desire to do a better job at managing their human and material resources. Given that the Institute was originally designed to groom new clinical managers, we were consistently surprised at the high evaluations we received from managers with extensive experience. This suggests that managers, no matter their practice area or length of tenure in an organization or at a position, find rejuvenation and benefit in attending a course that has been designed to address their specific roles. The success of the program can be attributed to several factors. The faculty are credible to the participants, given their professional expertise, administrative backgrounds, and general approach to the course. We are cognizant of the fact that these are busy people who are in high demand 24 hours a day. As their faculty, we respect their positions and thus want to make their time in the Institute valuable. The nature of the interactions between the faculty and participants immediately sets a tone of conviviality, the idea being that this intense learning experience must be enjoyable if it is to be beneficial. A second reason for success is the strong desire of the participants to learn and apply anything that will enhance patient care in their areas of responsibility. This may include reducing costs; improving morale and teamwork; redesigning workloads; negotiating relationships with other departments; improving communications with employees, patients, and physicians; designing new programs; and so on. We have been humbled by their tenacity and energy in grasping new ideas and working to figure out how they can use them in their own environments. They are tired at the end of the week but seem tireless when it comes to improving the work environment for their employees. It seems that the CE Certificate in Clinical Leadership has met a need that was known to exist but had not been specifically addressed by the education or practice communities. Results indicate that participants from a variety of agencies and specialties have been energized through their experiences with other clinical managers in a format that stresses immersion and respectful collegiality. Our intent is to continue to meet this need by using the clinical managers as our guides. Barbara Jo Foley, RN, PhD, FAAN, is clinical professor and division chair and Elizabeth K. Woodard, RN, PhD, is a clinical assistant professor at the University of North Carolina-Chapel Hill School of Nursing in Chapel Hill, N.C. She can be reached at bfo [email protected]. 1541-4612/2005/ $ - see front matter Copyright 2005 by Elsevier Inc. doi:10.1016/j.mnl.2005.02.004
June 2005