- Email: [email protected]
Staff Development—Developing Individual Potential
STAFF DEVELOPMENT-DEVELOPING INDIVIDUAL POTENTIAL Dorothy Ellison, R.N. Two aspects of staff development cause major from the effects of the elimination of operatconcern in nursing services today-numbers ing room experience from the undergraduate and quality of nurses. We need a certain teaching program. The supply of professionnumber of nurses who have special abilities als needed to fill the responsible teaching and to do special jobs if our nursing service is to leadership positions is not being replenished. There no longer are adequate numbers of function. How are we to get the numbers of personnel needed in the operating room nurs- nurses who have even a basic understanding department? How are we to get the qual- ing of aseptic techniques which govern the ity of personnel needed in the operating room surgical environment and reduce the grave nursing department? In the matter of num- risk of surgical infection. ber we are all too familiar with the old reToday’s newly graduated ‘nurse lacks a frain of the “nursing shortage.” We have knowledge of most basic surgical techniques felt its effects for many years. and procedures, those tools which can equip We have seen the introduction of all man- her to anticipate and provide for the needs of ner of lay helpers into the health field. These the surgical patient; which can equip her to are, for the most part, the untrained, the comprehend surgery as a mode of therapy partly trained and the poorly trained-the and to provide competent assistance to the aides, the technicians and the nursing as- surgeon in the accomplishment of that thersistants. apy. She is not equipped to guide or teach Mere numbers have not been the answer. any level of worker in even the simplest task. The demands for numbers grow as the de- She has little conception of how to fit this mands for health services grow-with in- vital segment of the patient’s hospitalization creasing population, with expanding services, into the continuum of surgical nursing care. and with programs added to meet special We do not get adequate numbers of tohealth needs. day’s graduates into operating room nursing In the matter of quality, we are all too because it is difficult to induce a nurse to enfamiliar with the effects of using personnel ter a field of practice with which she is almost with less than basic nursing preparation. totally unfamiliar. She feels inadequate. She When the need is for a nurse, a nurse-sub- knows she is not prepared to function even at stitute will not do. Though jobs have been a beginner’s level in a field so highly specialfragmented and analyzed and duties delegat- ized as the operating room. The job of preed to other categories of workers, the operat- paring nurses for these first level functions ing room nursing scene still suffers mainly has come to the fore in recent years as a growing problem in developing an adequate Dorothy Ellison, R.N., is assistant professor of surgioperating room staff. cal nursing at Cornell University-New York Hospital In order to help this new graduate to shoulSchool of Nursing. She is also department head, operating room nursing service at the New York der her professional responsibilities and to Hospital. Miss Ellison received her Master’s degree meet her obligations to patients and to the from Teacher’s College, Columbia University, and agency which pays her salary, operating room frequently contributes to the Journal.
March 1968
77
nursing services must make up the deficien- to that formerly offered to undergraduate cies and plan to provide not only orientation nursing students. and a program of continuing education, but All workers in operating room nursing, be also a program of on-the-job training. they technicians or professionals, must masThis is remedial education and remedial ter aseptic techniques, surgical methods, and education in nursing reflects the failure of the use of surgical equipment and facilities. the educational system just as remedial read- These are the tools of the trade which enable ing programs reflect the failure of the ele- them to render care to patients at the time of operation. mentary school system. It is our philosophy 'that each worker be Though orientation programs are properly given both opportunity and inducement to the responsibility of any employing agencyas acknowledged by the AHA, and through advance as far as his capacity and ambition inservice education or continuing education, permit. No avenues should be artificially blocked and no dead ends encountered in the as acknowledged by ANA and NLN-on-thejob training has not generally been an ac- pursuit of a productive career in the health knowledged part of preparation for profes- field. sional practice. Indeed, it is more commonly Staff development activities begin with the thought of as a system for training in techni- induction and orientation of the new staff cal occupations. Operating room nursing member. The basic education and job prep services have been forced to pick up the ball aration of each individual are evaluated. Skill dropped by the educators, and undertake to training in job functions is provided at the teach a quite significant body of preservice levels needed for nursing aides, technicians required knowledge and skill-a practice and nurses. Where further formal education which the profession has, in the past, de- is a prerequisite for job change or advanceplored. ment, workers are aided to acquire it by We have seen this pattern develop within counselling and by tuition assistance. We our own nursing service. A few years ago, we have former nursing aides entering licensed were congratulating ourselves upon our pro- practical nurse and technician programs. gressive posture in being able to plan and Skill training is supplemented for technical budget for a staff member to act as an ad- and professional workers by regular inservice ministrative assistant in charge of staff de- education sessions which are designed to envelopment. Today the problems of numbers hance the quality performance and keep the and quality of personnel have grown to such staff abreast of advances in their specialty. an extent that the staff development group Most recently, we have undertaken a semhas had to be expanded from one to five per- inar series for the development of the operatsons within a single department. This staff is ing room clinical specialist. We are hopeful currently conducting training programs for of defining the role and function of the leadoperating room technicians, on-the-job train- ership nurse in the operating room specialty. ing for graduate nurses and advanced train- This course includes formal lectures, demoning for leadership nurses-our clinical spe- strations, films and group discussions in a cialists. work-study program which is presented in a The orientation phase in which the new structured sequence over twelve months. The staff member is introduced to the work setting content includes theory and practice in depth and our way of managing basic routines has in the surgical specialties, surgical techhad to grow into a systematic course in oper- niques, surgical technology and the princiating room nursing with content very similar ples of asepsis and infection control. The
78
AORN Journal
main focus is on leadership and management methods. This includes teaching-learning theory, communications, group dynamics, personnel evaluation, team planning and analysis of patient care problems. In establishing these programs we have tried to give careful consideration to both short range and long range needs. We have tried to look at staff development both from the viewpoint of the service agency and its obligations to meet the health needs of the public and from the viewpoint of the individual health worker and his need for job satisfaction.
years in part-time study programs for the Bachelor’s and Master’s degrees. In fact nearly all the supervisors in my department have obtained their Master’s degree in just this way. Every one of these efforts has been extremely costly both for the persons involved and for the profession. Valuable and valid work experience, skill and j ob-derived knowledge have not been recognized. Repetitious study programs remove nurses from the field of service for hours, days and years because our programs have been shortsighted, unrelated and uncoordinated. One nursing departmen or one medical center has but limited powers to implement a philosophy of developing individual potential. The entire society must also ensure that the educational and economic systems which it creates encourage and enable freedom of upward movement.
We are concerned that the worker be fitted to the job level, and we are also concerned that the worker be provided with the opportunity for growth on the job, for advancement, and for improvement of his performance level. This is the present system we are working with. It is a patchwork of expedients In a nursing service we can foster a cliput together in an effort to cope with the mate and create a structure dedicated to current muddle in the health manpower situastaff development. We can attempt to break tion. down the barriers to individual motivation WHAT OF THE FUTURE? and take action toward self-fulfillment. That If we believe that higher qualified person- is our part as an organization. If our sonel means higher quality patient care, our ciety at large is permeated by a similar phiconcern will be to produce higher qualified losophy, then the individual will be truly free workers into the framework of a better sys- to develop. His advancement becomes more tem. If quality of care is dependent on qual- directly his own responsibility and will be ity of personnel then all health workers must limited only by his capacity, drives and talbe used to the highest level of their capacity. ents. We have all observed’nurse’s aides who We have to liberate him from regimentahave profited from on-the-job training, mo- tion, remove the blocks and barriers built into tivated by desire to improve their status and old systems and methods. Our educational earning capacity, armed with native intelli- system must be more flexible, more creative, gence and ability, who have gone on to suc- more responsive to individual circumstances, cessfully complete an LPN program. and life patterns. We have to implement the We have seen licensed practical nurses and Christian ethic which affirms the dignity and operating room technicians similarly moti- worth of each individual. vated toward higher status as job experience We have to promote the American ideal of encourages them to compete and go on to an an open ended society with freedom and associate arts nursing program. equality of opportunity. What is needed now We know of the great numbers of diploma is a fundamental change in the system of graduates in nursing who have worked long education and preparation for the health oc-
March 1968
79
cupations. This system should encompass and articulate the various levels of preparation and responsibility for the auxiliary, the technical, the professional and the specialist worker over the whole spectrum of health manpower. The biological, medical and social sciences are the foundation studies for any career within this realm-be it lab or medical technician, operating room technician, nurse, doctor, pharmacist, dentist, veterinarian or biochemist. The new system should enable the individual seeking a career in the health occupations to progress in an orderly fashion without loss of time or repetitious endeavors from one level to another. The requirements for each level must be spelled out, the units of knowledge and skill must build on each other systematically without overlap or redundancy. Required modules of study need to be geared to successive levels of job function and responsibility. There must be free entrance and re-entrance into the educational and job preparatory structure at all levels. There must be free exit from successive levels to a variety of health occupations. CLINICAL INTERNESHIP Academic study would b.j complemented by clinical interneships in appropriate service agencies offering various medical, paramedical and nursing specialties. Health service agencies whether hospital, clinic, school, medical center or nursing home, would be accredited to supply laboratories for clinical practice and have reciprocal agreements with their corresponding academic and degree granting institutions. In the nursing profession, candidates on completion of the academic study requirement would select one or more areas of clinical interest of job specialization. Certificates would document modules or units completed. Certification credits earned by examination of clinical proficiency and academic credits
ao
earned through standard achievement tests would be applied toward academic degrees and specialist ratings. Work-study combinations on advancing levels could permit uninhibited vertical or horizontal movement in the health professions. Doors would open on a broader, more alluring vista for those choosing their careers and more would come into the health field. Such a change in the system of preparation offers the only realistic hope for the future of getting the numbers and quality of workers in the right positions. However exhaustively thought-out or carefully devised a new system might be, the secret of developing human potential depends in the end upon p e o p l e u p o n individuals. LEADERS ARE NEEDED For this reason, it is of the utmost importance that those in the leadership rolesteachers, clinical specialists, supervisors or head nurses-whatever the title or manner of their working-these persons must be adept in leadership techniques. They must understand the theory of the teaching-learning situation, the problems of the adult or mature learner and the anxieties of those in new and demanding situations. They must be able to effectively stimulate, motivate, nurture and foster the basic human desire to perform at a high level, the need to derive satisfaction from job performance and to survive in the work situation. They must understand the nature of human emotional barriers to effective learning and productive activity which are derived from the interactions between individual and individual-between the individual and the situation-as well as those that come from the individual’s own background, previous learnings, experiences and habits. Leadership nurses must be able to mobilize all human resources effectively and focus them on the job to be done. They must be ever mindful of the ultimate goal and be convinced that the development of effective staff and the enhance-
AORN Journal
ment of each individual’s potential will be through task analysis and job descriptions. The development of effective leaders and the best guarantee of a high quality of care for patients. If these nursing leaders are able responsible workers is hampered most often to handle staff effectively, they will have by the failure to delegate-to put the learner acquired the means of handling patient care on his own responsibility. Inability to delegate may be based upon the insecurities withproblems effectively. The effective leader must be self-directing. in the senior. When these are faced, and irShe must have a clearly defined philosophy rational fears of censure or personal failure about her own role and how it relates to those are overcome, the senior may feel safer in she is guiding. She needs to be sincerely con- setting the juniors free and thus promoting vinced of the potential for development in their growth. Individual development is in the last analyeach member of her team. Flexibility and sensitivity to individual differences will in- sis self-development. Only the individual can make effective changes in his behavior in crease her effectiveness, too. Job coaching by a qualified senior is one response to his own needs and drives. Every of the best methods of individual develop means that can be taken to develop selfment. In coaching sessions the senior and awareness, self-confidence and security should junior work out together a mutual under- be seized by those who are responsible for standing of the job to be done. The junior is the development of a staff. In the people’s professions in medicine, given the freedom and authority to accomnursing, teaching and the ministry, effectiveplish the job within established guidelines. The senior is more apt to delegate responsi- ness depends upon skill in human relations. bility and the authority or self-direction com- Human potential is truly amazing. To let it mensurate with it, when a basis of mutual develop more fully, we must stop putting up trust has been established. This can be done artificial psychological and social barriers. REFERENCES 1. Kissick, William, “How Imagination and Innovation Can Help Bridge Manpower Gaps,” Hosp., (JAHA), October 1, 1967, p. 76. 2. Brown, E. L., “Preparation for Nursing,” AJN, September, 1965, p. 70. 3. Alexander, F. M., “Some Observations on Nurse Education,” RN, May, 1965, p. 79.
4. Leone, L. P., ‘‘Is Nursing Ready,” A J N , May, 1965, P. 68. 5. Buchanan, Paul C., “The Professional Nurse Looks at Individual Motivation,” N5, Leadership in Nursing Monographs, Leadership Resources, Inc. 6. Knowles, M. S., “The Professional Nurse Looks at the Learning Climate,” N14, Le&,yship in Nursing Monographs, Leadership Resources, Inc.
What is it to be wise?
’Tis but to know how little can be known; To see all others’ faults, and feel your own. Pope: Essay on Man, Episode IV
March 1968
81
March 1968
77
nursing services must make up the deficien- to that formerly offered to undergraduate cies and plan to provide not only orientation nursing students. and a program of continuing education, but All workers in operating room nursing, be also a program of on-the-job training. they technicians or professionals, must masThis is remedial education and remedial ter aseptic techniques, surgical methods, and education in nursing reflects the failure of the use of surgical equipment and facilities. the educational system just as remedial read- These are the tools of the trade which enable ing programs reflect the failure of the ele- them to render care to patients at the time of operation. mentary school system. It is our philosophy 'that each worker be Though orientation programs are properly given both opportunity and inducement to the responsibility of any employing agencyas acknowledged by the AHA, and through advance as far as his capacity and ambition inservice education or continuing education, permit. No avenues should be artificially blocked and no dead ends encountered in the as acknowledged by ANA and NLN-on-thejob training has not generally been an ac- pursuit of a productive career in the health knowledged part of preparation for profes- field. sional practice. Indeed, it is more commonly Staff development activities begin with the thought of as a system for training in techni- induction and orientation of the new staff cal occupations. Operating room nursing member. The basic education and job prep services have been forced to pick up the ball aration of each individual are evaluated. Skill dropped by the educators, and undertake to training in job functions is provided at the teach a quite significant body of preservice levels needed for nursing aides, technicians required knowledge and skill-a practice and nurses. Where further formal education which the profession has, in the past, de- is a prerequisite for job change or advanceplored. ment, workers are aided to acquire it by We have seen this pattern develop within counselling and by tuition assistance. We our own nursing service. A few years ago, we have former nursing aides entering licensed were congratulating ourselves upon our pro- practical nurse and technician programs. gressive posture in being able to plan and Skill training is supplemented for technical budget for a staff member to act as an ad- and professional workers by regular inservice ministrative assistant in charge of staff de- education sessions which are designed to envelopment. Today the problems of numbers hance the quality performance and keep the and quality of personnel have grown to such staff abreast of advances in their specialty. an extent that the staff development group Most recently, we have undertaken a semhas had to be expanded from one to five per- inar series for the development of the operatsons within a single department. This staff is ing room clinical specialist. We are hopeful currently conducting training programs for of defining the role and function of the leadoperating room technicians, on-the-job train- ership nurse in the operating room specialty. ing for graduate nurses and advanced train- This course includes formal lectures, demoning for leadership nurses-our clinical spe- strations, films and group discussions in a cialists. work-study program which is presented in a The orientation phase in which the new structured sequence over twelve months. The staff member is introduced to the work setting content includes theory and practice in depth and our way of managing basic routines has in the surgical specialties, surgical techhad to grow into a systematic course in oper- niques, surgical technology and the princiating room nursing with content very similar ples of asepsis and infection control. The
78
AORN Journal
main focus is on leadership and management methods. This includes teaching-learning theory, communications, group dynamics, personnel evaluation, team planning and analysis of patient care problems. In establishing these programs we have tried to give careful consideration to both short range and long range needs. We have tried to look at staff development both from the viewpoint of the service agency and its obligations to meet the health needs of the public and from the viewpoint of the individual health worker and his need for job satisfaction.
years in part-time study programs for the Bachelor’s and Master’s degrees. In fact nearly all the supervisors in my department have obtained their Master’s degree in just this way. Every one of these efforts has been extremely costly both for the persons involved and for the profession. Valuable and valid work experience, skill and j ob-derived knowledge have not been recognized. Repetitious study programs remove nurses from the field of service for hours, days and years because our programs have been shortsighted, unrelated and uncoordinated. One nursing departmen or one medical center has but limited powers to implement a philosophy of developing individual potential. The entire society must also ensure that the educational and economic systems which it creates encourage and enable freedom of upward movement.
We are concerned that the worker be fitted to the job level, and we are also concerned that the worker be provided with the opportunity for growth on the job, for advancement, and for improvement of his performance level. This is the present system we are working with. It is a patchwork of expedients In a nursing service we can foster a cliput together in an effort to cope with the mate and create a structure dedicated to current muddle in the health manpower situastaff development. We can attempt to break tion. down the barriers to individual motivation WHAT OF THE FUTURE? and take action toward self-fulfillment. That If we believe that higher qualified person- is our part as an organization. If our sonel means higher quality patient care, our ciety at large is permeated by a similar phiconcern will be to produce higher qualified losophy, then the individual will be truly free workers into the framework of a better sys- to develop. His advancement becomes more tem. If quality of care is dependent on qual- directly his own responsibility and will be ity of personnel then all health workers must limited only by his capacity, drives and talbe used to the highest level of their capacity. ents. We have all observed’nurse’s aides who We have to liberate him from regimentahave profited from on-the-job training, mo- tion, remove the blocks and barriers built into tivated by desire to improve their status and old systems and methods. Our educational earning capacity, armed with native intelli- system must be more flexible, more creative, gence and ability, who have gone on to suc- more responsive to individual circumstances, cessfully complete an LPN program. and life patterns. We have to implement the We have seen licensed practical nurses and Christian ethic which affirms the dignity and operating room technicians similarly moti- worth of each individual. vated toward higher status as job experience We have to promote the American ideal of encourages them to compete and go on to an an open ended society with freedom and associate arts nursing program. equality of opportunity. What is needed now We know of the great numbers of diploma is a fundamental change in the system of graduates in nursing who have worked long education and preparation for the health oc-
March 1968
79
cupations. This system should encompass and articulate the various levels of preparation and responsibility for the auxiliary, the technical, the professional and the specialist worker over the whole spectrum of health manpower. The biological, medical and social sciences are the foundation studies for any career within this realm-be it lab or medical technician, operating room technician, nurse, doctor, pharmacist, dentist, veterinarian or biochemist. The new system should enable the individual seeking a career in the health occupations to progress in an orderly fashion without loss of time or repetitious endeavors from one level to another. The requirements for each level must be spelled out, the units of knowledge and skill must build on each other systematically without overlap or redundancy. Required modules of study need to be geared to successive levels of job function and responsibility. There must be free entrance and re-entrance into the educational and job preparatory structure at all levels. There must be free exit from successive levels to a variety of health occupations. CLINICAL INTERNESHIP Academic study would b.j complemented by clinical interneships in appropriate service agencies offering various medical, paramedical and nursing specialties. Health service agencies whether hospital, clinic, school, medical center or nursing home, would be accredited to supply laboratories for clinical practice and have reciprocal agreements with their corresponding academic and degree granting institutions. In the nursing profession, candidates on completion of the academic study requirement would select one or more areas of clinical interest of job specialization. Certificates would document modules or units completed. Certification credits earned by examination of clinical proficiency and academic credits
ao
earned through standard achievement tests would be applied toward academic degrees and specialist ratings. Work-study combinations on advancing levels could permit uninhibited vertical or horizontal movement in the health professions. Doors would open on a broader, more alluring vista for those choosing their careers and more would come into the health field. Such a change in the system of preparation offers the only realistic hope for the future of getting the numbers and quality of workers in the right positions. However exhaustively thought-out or carefully devised a new system might be, the secret of developing human potential depends in the end upon p e o p l e u p o n individuals. LEADERS ARE NEEDED For this reason, it is of the utmost importance that those in the leadership rolesteachers, clinical specialists, supervisors or head nurses-whatever the title or manner of their working-these persons must be adept in leadership techniques. They must understand the theory of the teaching-learning situation, the problems of the adult or mature learner and the anxieties of those in new and demanding situations. They must be able to effectively stimulate, motivate, nurture and foster the basic human desire to perform at a high level, the need to derive satisfaction from job performance and to survive in the work situation. They must understand the nature of human emotional barriers to effective learning and productive activity which are derived from the interactions between individual and individual-between the individual and the situation-as well as those that come from the individual’s own background, previous learnings, experiences and habits. Leadership nurses must be able to mobilize all human resources effectively and focus them on the job to be done. They must be ever mindful of the ultimate goal and be convinced that the development of effective staff and the enhance-
AORN Journal
ment of each individual’s potential will be through task analysis and job descriptions. The development of effective leaders and the best guarantee of a high quality of care for patients. If these nursing leaders are able responsible workers is hampered most often to handle staff effectively, they will have by the failure to delegate-to put the learner acquired the means of handling patient care on his own responsibility. Inability to delegate may be based upon the insecurities withproblems effectively. The effective leader must be self-directing. in the senior. When these are faced, and irShe must have a clearly defined philosophy rational fears of censure or personal failure about her own role and how it relates to those are overcome, the senior may feel safer in she is guiding. She needs to be sincerely con- setting the juniors free and thus promoting vinced of the potential for development in their growth. Individual development is in the last analyeach member of her team. Flexibility and sensitivity to individual differences will in- sis self-development. Only the individual can make effective changes in his behavior in crease her effectiveness, too. Job coaching by a qualified senior is one response to his own needs and drives. Every of the best methods of individual develop means that can be taken to develop selfment. In coaching sessions the senior and awareness, self-confidence and security should junior work out together a mutual under- be seized by those who are responsible for standing of the job to be done. The junior is the development of a staff. In the people’s professions in medicine, given the freedom and authority to accomnursing, teaching and the ministry, effectiveplish the job within established guidelines. The senior is more apt to delegate responsi- ness depends upon skill in human relations. bility and the authority or self-direction com- Human potential is truly amazing. To let it mensurate with it, when a basis of mutual develop more fully, we must stop putting up trust has been established. This can be done artificial psychological and social barriers. REFERENCES 1. Kissick, William, “How Imagination and Innovation Can Help Bridge Manpower Gaps,” Hosp., (JAHA), October 1, 1967, p. 76. 2. Brown, E. L., “Preparation for Nursing,” AJN, September, 1965, p. 70. 3. Alexander, F. M., “Some Observations on Nurse Education,” RN, May, 1965, p. 79.
4. Leone, L. P., ‘‘Is Nursing Ready,” A J N , May, 1965, P. 68. 5. Buchanan, Paul C., “The Professional Nurse Looks at Individual Motivation,” N5, Leadership in Nursing Monographs, Leadership Resources, Inc. 6. Knowles, M. S., “The Professional Nurse Looks at the Learning Climate,” N14, Le&,yship in Nursing Monographs, Leadership Resources, Inc.
What is it to be wise?
’Tis but to know how little can be known; To see all others’ faults, and feel your own. Pope: Essay on Man, Episode IV
March 1968
81