Clinical Practicum Ii Proposal1
CLINICAL PRACTICUM II PROPOSAL1
Clinical Practicum II Proposal
Kelli Benson
Ferris State University
Clinical Practicum II Proposal
Through the Master of Science in Nursing (MSN) program at Ferris State University, a clinical practicum to develop professional growth in the specialty area of nursing administrationhas been developed. This practicum will provide opportunities for the student to be immersed in the role of nurse manager and to help further develop the skills needed to perform in this leadership role in the future. The purpose of this paper is to discuss the learning plan for this practicum and to show how the self-assessment, American Nurses Association (ANA, 2009) standards of practice, nursing theory, and leadership theory have contributed to the development of the learning plan.
Self-Assessment
In order to develop goals for this clinical practicum, a self-assessment was utilized to identify gaps in learning utilizing two different tools from The American Organization of Nurse Executives and the Learning Nurse Resources Network. These tools were helpful because, while they addressed some different topics, they also had some overlapping areas. This has allowed identification of specific areas of nursing administration that would benefit from attention during the practicum experience. For instance, both tools identified strengths in human resources aspects of nursing administration such as interviewing, hiring, and conducting performance reviews (American Organization of Nurse Executives, 2011; Learning Nurse Resource Network, n.d). Areas of weakness have also been identified using these tools and the most evident topics to focus on include participation in organizational strategic planning, understanding and ensuring compliance with standards of regulatory agencies, and financial management (AONE, 2011; Learning Nurse Resource Network, n.d.).
Utilizing the scope and standards of practice set forth by the ANA (2009) for nursing administrators, criteria for meeting these standards have been reviewed. This evaluation has allowed assessment of current ability to meet set criteria as movement toward a career in nursing administration continues. Standards that have been identified as needing additional activities to meet criteria include education, professional practice evaluation, resource utilization, and leadership (American Nurses Association [ANA], 2009). Each of these standards has criteria that I think will be beneficial to my learning experience during this practicum. While there are criteria in each of these standards that have been met, these are the standards that have been chosen, along with results of the self-assessment, to guide the clinical practicum experience and to improve abilities to continue in this specialty.
Learning Plan
A clinical practice learning plan (see appendix A) has been developed to guide this experience and will be utilized to maintain focus during the practicum and to ensure experience to topics identified as practice weaknesses during the self-assessment. As mentioned previously, several standards of practice from the ANA (2009) were chosen to assist in providing outcomes for this experience. Activities to meet these outcomes were then developed and, allowing for adjustments made with input from the preceptor, will be carried out during the practicum experience.
Standard 8: Education-“The nurse administrator attains knowledge and competency that reflects current practice” (ANA, 2009, p. 36). This standard allows for the student to seek out opportunities during the practicum to improved knowledge related to the role of nursing administrator. Outcome criteria to be utilized for this standard are “Participates in ongoing educational activities related to appropriate knowledge bases and professional issues” and “Seeks experiences and independent learning activities that reflect current practice in order to develop, maintain, and improve skills and competence in the nurse administrator role” (ANA, 2009, p. 36). Work toward this standard will be accomplished during the practicum experience by identifying educational opportunities within the organization during the practicum experience. It is impossible to predict all of the possible experiences that will be available and the student will be open to taking advantage of any opportunities that are possible with help and guidance from the practicum preceptor. One opportunity identified for the practicum is to accompany the Director of the Children’s Hospital to an Executive Council meeting. This will be an exciting experience as all of the directors from hospitals within the system attend this meeting and all other nursing councils report to this council. This will be a great way to gain knowledge about nursing administration responsibilities on a higher level. Another identified practicum experience is to attend the Nursing Leadership Academy, which consists of several meetings in which presenters from nursing leadership offer information about topics such as budget, productivity, reimbursement, regulatory compliance, risk management, leadership roles, and human resources responsibilities. This will be an interesting experience, as many of these topics are directly related to the areas of weakness identified in the self-assessment.
Standard 12: Ethics-“The nurse administrator integrates ethical provisions in all areas of practice” (ANA, 2009, p. 40). Attainment of this standard will allow the student to understand how the nursing administrator needs to be aware of ethics in the many different aspects of the role and the resources within healthcare organizations available to help maintain ethical practice. Outcome criteria to be utilized for this standard are “Maintains confidentiality within legal and regulatory parameters” and “Participates on multidisciplinary and interdisciplinary teams that address ethical risks, benefits, and outcomes” (ANA, 2009, p. 40). The first activity planned to meet this standard is to research hospital policies related to ethics and risk management. This will help the student to gain knowledge about practices within this facility. Another activity planned for the practicum is to meet with the Director of Clinical Risk Management and Accreditation to discuss regulatory parameters. This will be an important opportunity for the student to gain knowledge about these practices and to prepare for the responsibilities of the nursing administrator in meeting compliance with regulatory agencies. During this meeting, the student will identify possible opportunities to sit in on a root cause analysis. The student is hopeful this opportunity will be available; however, there is no guarantee since these are not planned several months in advance, but are done as needed based on situations that arise within the hospital.
Standard 14: Resource Utilization-“The nurse administrator considers factors related to safety, effectiveness, cost, and impact on practice in the planning and delivery of nursing and other services” (ANA, 2009, p. 42). This standard is one that is important for the student to understand and work toward, as maintaining fiscal responsibility and educating staff about this is an important aspect of the role. Outcome criteria to be utilized for this standard are “Develops innovative solutions that address effective resource utilization and maintenance of quality” and “Promotes activities that assist others, as appropriate, in becoming informed about costs, risks, and benefits of plans and solutions” (ANA, 2009, p. 42). The budgets for the hospital have already been developed for the hospital’s next fiscal year, so one activity planned for the practicum is to discuss the department budget with the practicum preceptor. The student also plans to meet with the Director of Children’s Hospital to identify the budget goals, discuss how the nurse manager participates in developing those goals, and discuss how the nurse manager can most effectively stay within a proposed budget while also providing safe patient care. An additional opportunity the student will participate in during the practicum experience involves renovation to the department where the preceptor is the nurse manager. The student plans to sit in on meetings related to the renovation and discuss how this affects the resource management, such as budget and staffing, in the department.
Standard 15: Leadership-“The nurse administrator provides leadership in the professional practice setting and the profession” (ANA, 2009, p. 43). Working toward attaining this standard of practice will allow the student to develop the leadership skills necessary to step into a nursing administration role and to effectively lead a nursing staff. Outcome criteria to be utilized for this standard are “Willingly accepts mistakes by self and others, thereby creating a culture in which risk-taking is not only safe, but expected” and “Displays the ability to define a clear vision, the associated goals, and a plan to implement and measure progress” (ANA, 2009, p. 43). Activities planned for the practicum to support this standard include frequent communication with the practicum preceptor related to leadership style. The student plans to interact with staff regularly through rounding using formal and informal communication. In addition, the student plans to seek feedback from both the preceptor and department staff related to the student’s leadership style in order to identify areas of strength and weakness and to best learn how to improve.
Literature Review
Search Method
In order to search for evidence-based research related to this learning plan, the Ferris State University Flite Library, Cumulative Index to Nursing and Allied Health Literature, and Pub Med databases were utilized. Search parameters included English language, published within the past five years, and peer-reviewed. Searches were conducted using keywords including: nursing administration, nurse manager, nursing,leadership, transformationalleadership, novice to expert, education, development, ethics, risk management,budget, lean, and resource utilization. Articles found during this search, along with relevant articles and professional sources gathered throughout the MSN program have been compiled into a resource list to guide the practicum experience (see Appendix D).
Theory
The use of theory to guide nursing practice allows nurses moving into leadership roles to understand the relationship between practice, research, and theory within nursing discipline (Yancey, 2015). For this practicum, the nursing theory being utilized is Benner’s From Novice to Expert. This nursing theory was chosen because it exemplifies how a nurse moves through different levels of experience. Since the role of nursing administrator is new to me, this theory helps to show how this role and the skills required for it take me back to the first levels of Benner’s theory.
A leadership theory has also been chosen to be used in this practicum, which is helpful since nursing administration is definitely in a leadership role. Transformational leadership allows leaders and followers to inspire each other through a “commitment to shared values” (Marshall, 2011, p. 3). This theory was chosen because it represents the type of leader that I aspire to be. As a new nursing administrator, it will be important to focus on the leadership skills that will empower staff to develop their own professional goals. Having followers who are committed to professional growth will help the leader and the entire organization to flourish. For this reason, I want to make sure the theory is at the core of all activities for this practicum experience.
From Novice to Expert. This nursing theory, made up of five different levels of nursing experience, was developed by Patricia Benner and is based on the Dreyfus Model of Skill Acquisition (Benner, 1982). A nurse with no experience for a given situation or role would be in the first level, or novice nurse. A nurse who can demonstrate performance that is seen as acceptable, but still requires support would be in the second level, or advanced beginner. Once the nurse is competent in the skills or role, he or she would be considered in the third level, or competent. A proficient nurse is the fourth level and can identify problems by seeing the whole situation before them. The final level is a nurse who is seen as the expert in the skills or role (Benner, 1982). This theory is useful for nurses to utilize throughout their practice because an expert nurse can easily become a novice once again when a new situation or role is encountered (Benner, 1982). As mentioned earlier, this use of the theory during changing roles was the main reason for choosing it to guide this practicum.
Transformational Leadership. J. M. Burns introduced transformational leadership in 1978 and B. M. Bass later continued the theory’s development (Marshall, 2011; Transformational Leadership, n.d.). According to Burns (1998), transforming leadership “occurs when one or more persons engage with others in such a way that leaders and followers raise one another to higher levels of motivation and morality” (p. 133). This suggests that these leaders inspire their followers to develop and utilize their own personal leadership skills. A transformational leader is one who is able to empower those who follow them to unify in a manner that is both constructive and positive (Bormann & Abrahamson, 2014). This leadership theory requires the leader to have characteristics such as elevating, inspiring, and uplifting (Burns, 1998). In addition, a transformational leader is able to set clear goals and inspire people to see beyond their own goals to the goals of the team (Marshall, 2011; Transformational Leadership, n.d.). This leadership theory is one that can allow nursing leaders to empower their staff to attain goals for the improvement of the entire staff.
Support for Learning Plan
Education. Ongoing education is important for every nurse and in moving to a graduate level of nursing preparation, there is additional practice education that will be required outside of the classroom. In order to have leadership competency ingrained into the nurse, there needs to be opportunities to participate in projects and teams during nursing school (Morrow, 2015). The practicum experience is an ideal place to gain some of this education through mentoring with a preceptor and through participating in available learning opportunities. Having a coach or a mentor, such as the preceptor in the practicum experience, can be an important experience for a new nurse administrator and can improve resilience, confidence, and coping mechanisms (Westcott, 2016). In addition to the benefits of mentoring, being able to interact with interdisciplinary teams during the education period and work on team projects allows nursing students to develop leadership skills that improve their transformational leadership abilities (Fitzpatrick, Modic, Van Dyk, & Hancock, 2016). This suggests the opportunities to interact with teams and other committees during the practicum experience will provide important education experiences.
Ethics. “Ethics is a branch of philosophy concerned with moral principles that guide decisions on how to live and how to behave”(American Academy of Nursing, 2013, p. 374). In nursing, ethics is a constant issue and is guided by the ANA which has published the Code of Ethics for Nurses with Interpretive Statements and sets the expectation of nurses to both adhere by and embrace this code in practice (American Academy of Nursing, 2013; ANA, 2015). These statements allow nurses to base their practice on honorable principles. For the nurse administrator, there are many aspects of ethics that need to be addressed and maintained. Principles of ethical behavior for this role include respect for person, beneficence, nonmaleficence, justice, veracity, and fidelity (Doucette, 2013). Since the nurse administrator is often working from a position of problem-solving, it is important to use an ethical framework to help build a consensus with those involved which makes the problem about doing the right thing for the patient and organization, rather than focusing on the people involved (Doucette, 2013). Since nursing is based on ethics, utilizing the same principles as a nursing administrator can help to build trust with employees.
The nurse administrator is often involved in risk management and is essential to developing and maintaining an effective risk management plan (DiMeo Grant & Ballard, 2011). The focus of risk management is preventing loss of resources, including monetary, property, and human (Barger, 2014). Utilizing ethical behaviors during this aspect of the role is imperative. The ANA (2015) states “Provision 3: The nurse promotes, advocates for, and protects the rights, health, and safety of the patient” (p. v). This suggests that the nurse administrator should consider the patient at all times and keep them in mind when they are developing risk management plans. Nurse leaders should familiarize themselves with organizations such as National Patient Safety Foundation, the Institute for Health Care Improvement, the Federal Agency for Health Care Research and Quality, and The Joint Commission in order to adequately consider clinical care and patient safety in relation to risk management plans (DiMeo Gran & Ballard, 2011). This is important because the ability to develop a well-informed, effective program allows for better and safer decisions to help protect resources and deliver quality healthcare to patients (Barger, 2014). These organizations are important resources for the nurse administrator, and basing risk management plans on guidelines from them will help in the development of an effective plan that protects the patient.