Founded in 2017, The Ohio State University Innovation Studio is run by the OSU College of Nursing and Center for Healthcare Innovation and Wellness. In normal times, the Innovation Studio travels the country, encouraging students to create healthcare solutions, and helping them to use technology to develop their ideas into marketable new products.
How has the pandemic affected the innovation program? DailyNurse spoke to Tim Raderstorf, MSN, RN, the co-founder of the Innovation Studio and Chief Innovation Officer (as well as Clinical Instructor of Practice) at the OSU School of Nursing. Dr. Raderstorf has conducted neurosurgical research on Tethered Spinal Cord Syndrome, but his passion is healthcare innovation.
Before the pandemic, when he wasn’t teaching, Raderstorf traveled the country with OSU’s mobile Innovation Studio. He is also an expert on the role of innovation in nurse leadership and is now an award-winning textbook author. Evidence-Based Leadership, Innovation, and Entrepreneurship in Nursing and Healthcare, the textbook Raderstorf co-wrote with OSU School of Nursing Dean Bernadette Melnyk was an American Journal of Nursing (AJN) Book of the Year, winning first place honors in its category. (In Part Two, he discusses the book and explains why he found the judge’s comments particularly gratifying)…. click to continue reading.
This is the second part of a special two-part article on the importance of nurse preceptorship and mentoring. Click here to read Part One.
Ethical Standards, Just Culture, and the Faculty/Mentor/Preceptor – Student Relationship
Ethics and standards in nursing are principles associated with values, human conduct, and consideration for others. Nursing ethics, in particular, are ethical principles that guide practice. The principles related to nursing ethics and bioethics overall are beneficence, nonmaleficence, autonomy, justice, and fidelity. Each of these principles contributes to the foundation of nursing education and practice principles, and standards of practice devised by organizations, such as the American Nurses Association (ANA), the International Council of Nurses (ICN), and the American Association of University Professors (AAUP).
According to the ANA Code of Ethics 6.3, the nurse has a responsibility to contribute to an environment that encourages transparency, support, effective interpersonal communication, and respect.11 The National League for Nursing (NLN) indicated that another component of the guiding principles for nursing education is integrity. To exhibit integrity, it requires one to treat others respectfully while communicating courteously and positively.11 Additionally, the NLN identified diversity as an important guiding principle. The NLN position on diversity maintained that the faculty/mentor/preceptor member supports open communication, fosters uniqueness, utilizes innovative teaching strategies regardless of race, gender, religion, age, financial status, physical abilities, or other belief systems.11 The NLN indicated that to create an environment that supports diversity, inclusion, and just culture. All persons should provide open and respectful exchanges.11 This is not limited to the faculty/mentor/preceptor member.
Some of the ways that faculty/mentor/preceptor can achieve creating a just culture is to encourage the students to engage in self-reflection, promote professional practice standards within the curriculum, and be effective role models for collegial.1 Intimidation and disruptive behaviors foster medical error and create poor patient satisfaction, increase the cost of care, and cause knowledgeable clinicians to leave the workforce in search of new professions, thus increasing turnover and shortage rates. Therefore, the faculty/mentor/preceptor can engage and empower the student by creating a culture that is free from intimidation and punitive sanctions.11
Ten best practices to be used to incorporate standards into nursing practice and nursing education, which are: 1) support the nursing code of ethics; 2) offer ongoing education; 3) create an environment where nurses can vocalize concerns; 4) employ interdisciplinary and interprofessional learning; 5) enlist nurse ethicists to speak to nurses; 6) provide unit-based ethics mentors (for practice); 7) hold a family conference (in the practice setting); 8) sponsor an ethics journal or club; 9) reach out to other professional associations for resources; and, 10) offer employee or student counseling services.12 The ANA Code of Ethics, for instance, is a framework for nursing practice.11 Therefore, nurses should be familiar with this code and utilize it as a personal framework for practice.11, 12
The Impact of Negative Role Models
Negative role-modeling, horizontal violence, and aggression on the part of faculty or nurses in the clinical setting each serve to promote barriers in effective precepting and mentoring for the student or trainee. A study performed identified that barriers related to negative role modeling, such as passive-aggressive and threatening behavior and negative faculty and clinical staff attitudes, impede learning and threaten student progression and retention in nursing programs.13 Low retention rates of nursing students directly impact the matriculation of more nurses into the nursing profession, where a shortage already. Students who cannot identify with the nursing profession or fail to become socialized within the profession would eventually leave.13
Negative role models infringe upon the students’ ability to learn and contribute to a negative psychosocial learning environment.13 As the need for new nurses grows concerning an encroaching nursing shortage, effective management of the clinical setting related to students’ ability to think and effectively learn critically is vital. Negative role modeling and horizontal violence occur in both the clinical and classroom settings and have a deleterious impact on the nursing student’s ability to learn and critically think.
The Continuous Need
There is a driving need to develop the knowledge and skills necessary to meet the demands and interpersonal issues evident in today’s patient populations.14 Today’s faculty members, mentors, and preceptors will need to address the needs of a changing society, act as change agents for progress, and be skilled and knowledgeable of technological advances. Further, today’s students need creative learning environments that encourage ethical standards, promote effective interpersonal behaviors, and educate students in rendering multidisciplinary care. The future of health care delivery systems will rely on a multidisciplinary approach to rendering safe and effective care. With the management of care serving to emerge as a critical component in health care delivery, nurses must exhibit leadership and skill in interdisciplinary and collaborative practice to improve health care delivery and quality.
Thus, the faculty mentor and clinical preceptor must incorporate methods to increase interdisciplinary collaboration, education, practice, and exchanges. Furthermore, both are charged with preparing current and future nurses for growth in their respective roles as members of the interdisciplinary health care team. Nurses are being called upon to fill expanding roles and to master technological tools, information management systems while collaborating and coordinating care across teams of health professionals. Therefore, they must work diligently to prepare future nurses for the challenging clinical environment that awaits them.
11American Nurses Association (ANA). (2001). Code of ethics with interpretive statements. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf
12Wood, D. (2014). 10 best practices for addressing ethical issues and moral distress. Retrieved from http://www.amnhealthcare.com/latest-healthcare-news/10-best-practices-addressing-ethical-issues-moral-distress/
13Hawthorn, D., Machtmes, K., & Tillman, K. (2009). The lived experience of nurses working with student nurses in the clinical environment. The Qualitative Report, 14(2), 227-244. Retrieved from https://nsuworks.nova.edu/tqr/vol14/iss2/2
14Wilcock, P. M., Janes, G., & Chambers, A. (2009). Health care improvement and continuing interprofessional education: Continuing interprofessional development to improve patient outcomes. Journal of Continuing Education in the Health Professions, 29(2), 84-90. doi:10.1002/chp.20016
The image of nursing has changed since the days of its founder, Florence Nightingale; however, the devotion is the same. Nursing as a profession, coupled with the men and women who make up its numbers, function as the first line of defense for their patients. Therefore, stewardship, governance, and advocacy for the profession must be employed by nursing leaders for its protection and progression.
Importance of Stewardship
The nursing profession is a vital component in functioning society, and nurses fill the roles of an educator, facilitator of care, administrator, counselor, and advocate. Nursing leaders have a pivotal role in the process of progress and change for the profession. They are the representatives and the face of their departments. They must exercise stewardship at the point of service while working to advocate for respectful interactions with patients and promote a just culture (Murphy, 2009). Stewardship is a concept that includes the philosophy of practical analysis and practice of serving others in such a way as to provide leadership while observing the shared values of the staff for which they are in charge. The staff is the intrinsic force in a department; therefore, its steward’s goal is to serve, protect, and perpetuate its growth and function (Murphy, 2009).
The steward at the point of service must be aware of challenges and differences while cultivating these aspects into objective and impartial practices. Nurse leaders and staff members can promote their practice while creating change by the effective communication of ideas and observations made on patient care. Further, the transformation of current practice into a more efficient delivery of care can be facilitated by open collaboration with nursing leaders and physicians. A realization that we are all in this together would serve to impact nursing in such a positive way.
Improving Nursing Through Shared Governance
Shared governance is a term that was introduced over twenty years ago and was used to provide actionable strategies to provide nurses with power over their practice. Shared governance is a collaborative strategy used by organizations to encourage nursing staff to manage their practice with a high level of commitment to practice (Green & Jordan, 2004). Further, the process of shared governance works to stimulate workplace advocacy, which operates at the local, state, and national levels of government. Without nurse leaders, staff participation, and the use of collective knowledge of patient care implications related to poor staffing ratios, policies will not change. Simply put, shared governance provides nursing with a vehicle to promote their collective voice.
The Leader and Advocacy
Nurses and nursing leaders are already aware that health care reform is needed. They are the first to see a breakdown in the efficiency and efficacy of patient care; therefore, it is the nursing profession’s collective responsibility to promote change (Abood, 2007). Further, to be an effective advocate for change, one must possess the desire, will, time, and energy required to engage in reform at the legislative level. There are a growing number of uninsured patients, a rise in the costs associated with providing quality care, and a continual decrease in the healthcare workforce. These problems impose a great strain on the nurses currently in practice. The strain further imposes the numbers of those who choose to be involved in reform. The current workforce is under excessive stress, which directly corresponds to a lack of interest in representing themselves or sharing their collective voice. Work stress aside, Abood asserts that nurses find it difficult to leave the comfort of their practice to engage in the battle to be heard by their legislators (Abood, 2007). However, without representation from the nursing leadership in practice, policies cannot be changed. It is the combined knowledge and field experience held by the nursing profession that is needed to influence those who make policies for change to occur.
Nursing leadership will encounter greater challenges in the near future. The management of human capital, digital technology advancement, and cost control are three of the major challenges and opportunities that nursing leaders will face in the 21st Century (Lee, Daugherty, and Hamelin, 2017). Nursing leaders will play a critical role in transforming healthcare through active participation on the nursing units and in executive boardrooms. Critical issues, such as an aging population and the nursing shortage, continue to be prevalent in the United States and globally. Therefore, nursing leaders will need to address issues that affect retention and create new ways to promote the profession.
Nursing leaders need to expand upon the foundation created by nursing pioneers such as Florence Nightingale. The integration of shared governance into the workplace begins with the nursing leader. There also needs to be a collective effort to revise and reform policies at all levels of administration within an institution and our state and national governing bodies. There is a legacy to uphold. By joining state nursing associations and showing solidarity, the profession can serve the public in a much larger capacity. The nurse leader has many challenges ahead. In taking pride at the bedside, the nurse has the power to impact not just those that he or she serves, but to the families, administrators, and peers alike. Our presence can be our voice, as well.
Our first Nurse of the Week in 2021 is a nursing icon. On December 27—the day before her 100th birthday—AAN Living Legend Loretta C. Ford, EdD, RN, PNP, NP-C, CRNP, FAAN, FAANP was awarded the Surgeon General’s Medallion for exceptional achievement in the cause of public health and medicine.
Dr. Ford, who helped to create the first NP program at the University of Colorado in 1965, is regarded as a co-founder of the Nurse Practitioner (NP) profession. As a public health nurse in the 1940s and 1950s, she became concerned about Colorado’s underserved rural communities, and came to believe that with specialized training, nurses could help to fill the gap. Ultimately, Ford and pediatrician Henry Silver joined forces to found the University of Colorado pediatric NP program and the NP profession itself. Ford’s pathblazing role has led to numerous honors. She was the inaugural member of the Fellows of the AANP (FAANP), a special title reserved for providers that have made a lasting impact on the NP profession, and in 2003, she received a Lifetime Achievement Award from the journal Nurse Practitioner. In 2011, she was inducted into the National Women’s Hall of Fame, which acclaimed her for having “transformed the profession of nursing and made health care more accessible to the general public.”
Ford’s latest award, the Surgeon General’s Medallion, is the highest honor granted to a civilian by the Public Health Service and the U.S. Public Health Service Commissioned Corps. AANP President, Sophia L. Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP commented, “Dr. Ford has received this recognition for her vision and commitment to the health of our nation. Thanks to her trailblazing efforts, millions of patients have access to high-quality health care from NPs, the provider of their choice, and the profession has grown to more than 290,000 strong.”
David Hebert, JD, Chief Executive Officer of AANP, added, “As we celebrate Dr. Ford’s 100th birthday, I can’t think of a more fitting tribute to this titan of American health care. From co-creating the NP profession to advocating for patient access to NP care, she has played a profound role in strengthening health care access and choice for America’s patients.”
Online education has become a fact of life during the pandemic, and on-campus nursing schools have been looking to online institutions for guidance. What should on-campus nursing programs know about the challenges of remote instruction, and what lies ahead for online teaching? DailyNurse asked Dr. Camille Wendekier, Program Director and associate professor for the Online Masters of Science in Nursing at Saint Francis Universityand Dr. Tom Kannon, Program Director of the Online Psychiatric Nurse Practitioner Program at Regis College to share their perspectives on distance education in the COVID era.
What are the greatest challenges that nursing instructors face when teaching in a virtual environment? What measures can they take to overcome these challenges?
Dr. Tom Kannon, Regis College: When teaching in the online learning environment, you have to remember that, for the majority of the time, the students don’t have that tangible face-to-face interaction with the instructor. Most courses are asynchronous, and it can create a bit more anxiety for the student than a regular class as they cannot simply raise their hand to get clarification for something on the spot.
As an instructor, you have to be mindful that students are in and out of the course at all hours of the day and night, and will email with questions at all hours. It is best to try to keep to a schedule for replying, such as all emails will be responded to within 24 hrs. It is also necessary to still have scheduled virtual office hours that provided a more tangible connection to the instructor if help is needed. Another necessity is to have a contact list for technology support.
Above all else, clear communication is vital. Things happen, it’s inevitable, but communicating with the students that an issue is known and is being worked on, and providing updates, does a tremendous amount to quell uncertainty and anxiety. One major adaptation has been the need to provide greater flexibility in the clinical arena. Regis implemented use of various simulation experiences to meet some of the requirement, and implemented expanded use of telehealth for precepting to try to enhance the ability for students to achieve meaningful clinical hours towards meeting competencies.
Dr. Camille Wendekier, St. Francis University: The biggest challenge in a virtual environment is maintaining the personal student connection. Nursing faculty can offer small group and individual tutoring via video conference applications such as Google Meet or Zoom. The ability of the course instructor to mentor reasoning and knowledge construction can move students beyond using rote memory associated with passive learning activities such as reading or watching recorded lectures.
Video sessions also offer students an opportunity to introduce themselves on a personal level… Such activities help the course instructor and students better understand the uniqueness of each person in the class and the unique contributions each student can make to the learning experience. Knowing each other on a more personal level can help add excitement to learning, which could improve the metacognition associated with learning.
The other challenge is providing for testing security during stay-at-home orders. There are many companies that offer remote testing services, but several of these companies were unable to offer their services during the pandemic, so schools needed to investigate alternative options. It is important to adopt a secure testing application that has a good workflow for both the faculty and students. In addition to workflow, it is also important to consider the Internet requirements of each application in relation to Internet resources that students have at home… [so students] can take the test without losing connectivity.
In the wake of the accelerated changes brought on during the pandemic, what are the key developments in online education that you hope/expect to see over the next 5 years?
Dr. Tom Kannon, Regis College: I hope to see greater inclusion/implementation of telehealth/teleprecepting for students. The COVID pandemic has shown us how quickly providers can adapt to using telehealth and how successful it has been in maintaining provision of care to millions of people.
I expect that for an institution to stay successful and positively impact their students’ education, all courses will be interchangeable between live and online, with maybe more of a mix of synchronous and asynchronous courses. I also expect to see a growth in the creation of more robust clinical simulation experiences that colleges/universities can tap into to provide greater flexibility to their students.
Dr. Camille Wendekier, St Francis University: Key developments in online education over the next five years may include:
Requiring faculty to obtain Distance Education Certification—either offered by the University or by an outside entity.
Utilizing more Virtual Clinical Simulations as allowed by State Boards of Nursing and accrediting agencies. These simulations will improve over the years with the use of more avatars and more critical thinking virtual experiences.
Utilizing more Google Meets or Zoom sessions to provide for more personalized classes and office hours. These videoconference sessions allow the course instructor and students to interact in real-time and discuss the course information in relation to individual learning needs.