The events of 2020 highlighted the inequities in health and the injustices faced by Black and Indigenous People of Color (BIPOC) in Minnesota. Many across the state have been awakened to the realities of racism and injustice. On a national level, we witnessed the devastation of COVID-19 and its disproportionate effects on Black and African-American communities.
On a local level, we witnessed the public murder of George Floyd in our city of Minneapolis. At the University of Minnesota School of Nursing, our faculty, students, and staff engaged and reflected with open eyes, ears and hearts the subsequent call to action. There is an unjust dual system that has been carefully woven into the very fabric of our society, including academia and yes, nursing. We acknowledge that white privilege and white supremacy has been institutionalized in academic settings. White supremacy is an insidious, toxic, and expansive system that must be renounced, including within our own schools of nursing.
Many schools of nursing in the United States have renewed their commitment to the courageous work of dismantling systemic racism in their schools and curriculum. The University of Minnesota School of Nursing is, likewise on a courageous transformational journey toward becoming more inclusive, equitable and diverse. As a place dedicated to educating nurses and transforming the healthcare system, our school has committed to unapologetic and unequivocal advocacy to address injustice and create sustainable change.
We, as the School’s Inclusivity, Diversity and Equity Director and Co-Director, recognized that leading a school toward anti-racism requires a combination of reflection, commitment and action. Paulo Frieree, Brazilian educator and philosopher, best known for his text Pedagogy of the Oppressed, said “Reflection and action must never be undertaken independently”. Reactive changes rarely provide the depth of understanding necessary to deal with deep issues of racism in healthcare, nor are they sustainable. We started by analyzing our school’s policies for student recruitment and admission,our systems of faculty hiring and promotion, and our fundraising and communication strategies.
In our experience, faculty needed time to reflect, learn about historical and systematic inequities, and the space to unpack the complex baggage of white supremacy and privilege that persists in our nation. As a school community, we created opportunities for safe and honest sharing and learning through listening sessions and discussion groups. Faculty were provided with resources to unlearn unconscious bias and deepen understanding about institutional racism in healthcare. Similar opportunities were offered to students across programs, from classroom learning, deep day activities, to monthly affinity group forums. Reflection is necessary, yet reflection without action is essentially the same as inaction. Without action, reflection can become a passive, self-absorbed pastime and is not helpful in creating substantial and sustained systemic change. Reflective and intentional planning, coupled with committed action is needed to bring about the changes in nursing education and dismantle places in our school where inequities persist. We are empowering faculty to recognize and interrupt microaggressions in the classroom. We are providing them with resources to make curriculum changes so social justice and antiracism content can be purposefully woven throughout nursing education.
The courageous and transformational journey is not a sprint, rather it’s a marathon that requires long-term commitment. At the center of this change is community because the commitment is ours to share. There is room for each person in the school community to work for equity and inclusion – from book clubs to policy writing; from recruitment and support of students to search, selection, and faculty development; from teaching antiracism curriculum to highlighting antiracism research. Reflection, coupled with commitment and action will lead to transformational change in nursing education and healthcare systems.
Since 1981 this unique peer-reviewed journal has provided a forum for discussion of the values, goals, and aspirations of professional and student nurses.
DN: The judge commented that “What I loved about this book is that the authors made complex leadership and business topics accessible and interesting by sharing leaders’ personal stories… Provides actionable and practical strategies students can use to further their own development… Readable and clear, it is sure to be a favorite among students.”
TR: “I love hearing that, by the way. I’m so grateful for the comment about the book. Because you know, when I went into academia, I committed to never writing a book, because I don’t learn particularly well through reading books. It’s just how my brain is wired.
And two, I’ve never, I have never heard anyone say ‘I love a textbook’ before. One thing that I think is missing from all academia is storytelling. So we said, if we’re going to write this book, we’re going to lean heavily on not just our stories, but the stories of people who’ve succeeded and failed at putting these evidence-based innovation leadership and entrepreneurship tactics in the place. And so it’s great to hear that shine through from the reviewer because that’s exactly what we were trying to do: create a type of textbook that students would enjoy, and they can actually be engaging with the content and be able to put that into practice.”
DN: How does the Innovation Studio connect with your book’s study of nursing leadership, innovation, and entrepreneurship?
TR: “I actually teach in our masters of healthcare innovation program and is fully founded on innovation leadership, which adopts what we like to refer to as the entrepreneurial mindset. So if you are in charge of leading people, and that may be in a small capacity to large capacity formally or informally, but you’re always doing a few things.
One new favorite term that I have is building a culture of ambition. And I mean ambition in a way that you’re striving for excellence. So what we teach our team—and what’s in the book—is teaching people to find out what stories resonate most effectively with their co-workers and teammates in the population they engage in, and have that be the driving force that your team unifies around to make significant and substantial change. So by building this culture of ambition, you’re taking on ownership for your actions, you’re taking on ownership for the things that surround you, and the system that you work in.
And that doesn’t mean that you are saying that your system is perfect. But it’s saying that we are in the system, and we’re going to do the best that we can with it. That’s what we’re trying to get people to recognize. And when you come into that with an entrepreneurial mindset, you think about what resources are available to you, what are your key performance indicators, and how you can maximize those, and you let the things that are noise filter out.
So you focus on what’s important, you develop a ‘yes, and’ culture, you empower people to bring their ideas forward, incentivize them, provide them the permission to be innovative, and validate them when they engage in those behaviors. And you build a structure of innovation that lasts beyond your tenure within the organization.
Those are all things that are built into the textbook. And those are all things that we try to get the people engaged in the innovation studio to buy into because we know that if that happens, eventually we’ll find the success that we’re looking for.”
DN: 2020 was a big year for nurse leaders. They’ve been finding innovative ways to cope with shortages, fight burnout, and manage other pain points, and have made a huge impact.
TR: “And you know what, I’m very hopeful. I’m not one of those leaders right now, but I am very hopeful that through the exercises that you just mentioned, people are taking notes and debriefing and finding out what works well.
Because I do think that the exceptional leadership that’s occurring throughout health systems now needs to be the norm. Those things about celebrating our wins, focusing on what’s important today. ‘What’s important now’ — you know, that’s an acronym for ‘win’. How do we win today? What are we going to focus on?
A big component of leadership is making sure that your team is all aligned on the same goals. And, you know, creating the value that you commit to create so that that’s where innovation and leadership all come together.”
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).
DailyNurse: How have things changed for the Studio during the pandemic?
Tim Raderstorf: “We used to do to makerspaces that would travel. And, you know, it acted as this hub of interaction and engagement and excitement. But when COVID hit, people didn’t want those things [the makerspaces] in their lobbies… and we didn’t want 15 people hanging out in the same location. So, we shut down the traveling innovation studio, which was our original one, and [now we] just run our permanent location, which is right in central campus.”
DN: What did you do when the pandemic hit?
TR: “For the first six months of COVID, because we didn’t open our doors until the students came on campus in September, we ran a virtual makerspace. So Josh Wooten, our shop manager, particularly at the beginning, used our laser cutter and CNC router to make PPE, with our College of Engineering and a variety of public-private partnerships, to get our clinicians the safety equipment they needed to be able to save our communities. We wanted to keep Josh as safe as we possibly could, so we set up a makerspace in his house. He had five 3D printers in his home, and he was printing PPE around the clock with mostly faceshield frames, so that we could hook transparencies or plastic to them. It’d be running day and night, doing work for us while we slept.”
DN: Were the students able to participate at all last year?
TR: “Well, in May , we launched a COVID [Campus Safety] challenge, encouraging everyone to submit their ideas to us virtually. And when students came back to campus, we ran a second virtual challenge asking for ideas that would impact their safety on campus. Things like how to improve mask adherence, social distancing, and the mental health of our student population. We also had pitch days in October and December.
In fact, at that December pitch day, one of the nurses on the unit [came by on her] 15-minute break to pitch her idea to us. And she was wearing PPE, and—unknown to her—it was PPE that we had printed for her.”
DN: Has the pandemic been inspiring nurses to innovate?
TR: “I feel that during the pandemic, some of the acclaim and attention and interest has prompted more nurses to raise their voices in terms of public health and policy, but also to innovate and come up with solutions for the various pain points that you’ve encountered during the pandemic. And I think that’s going to build. I’m very bullish on that. I’m big on systems of innovation and building a structure of innovation, to have a proper culture of innovation that thrives.
Dr. Tim Raderstorf demonstrates an innovation exercise at the Academy of Nurse Leaders.
I’d argue there probably still isn’t much structure for nurses, physicians, pharmacists, whoever is at the frontlines to bring their ideas for [innovations] to most organizations. I do think clinicians have never been more willing and engaged in changing the system. The question is, can systems become engaged and willing and set their clinicians up for success so that they can appropriately drive the changes that need to occur? Particularly as we become cash strapped and healthcare is going through a massive transformation.
I think it there’s going to be a very challenging component to the future of healthcare once the pandemic is over. We have to decide what we refuse to go back to and what we will continue to make changes on.”
DN: Who comes to the pitch days? Students? Faculty?
TR: “We’ve had over 1000 people pitch to us over the last three years. It’s about 55 to 60% students and about 40 to 45% faculty and staff, which is a nice healthy mix, and it’s trending much more towards the students. We are seeing an increase in faculty and staff, but the students are increasing at a much faster rate.”
DN: Are nurses pitching ideas?
TR: “You know, one of my least favorite terms is ‘nursing innovation’. Because there’s no such thing as physician innovation, there’s no such thing as dentist innovation, there’s no such thing as pharmacist innovation. So why do we label ourselves other than just being innovators and really showcasing that we are indeed equals with our peers?
We knew that in order to raise the awareness of the amazing things that nurses do, and create and innovate and invent, that we need to do this alongside our peers, and, you know, almost be humble bragging, as we go along, and said, ‘hey, look, what we’ve created, why don’t you come over here and create something great with us too’.”
DN: When you describe the Studio as “interprofessional,” can you elaborate a bit?
TR: “We encourage people to engage with other individuals who have different backgrounds and professional expertise; [in fact] we require it. If you don’t have an interprofessional team, that is one of the things that disqualify you from being eligible for funding. So if two physicians come up with a great idea, we say, ‘awesome, who are you going to use this on’? And they usually say, ‘well, it’d be an operating room or height’. ‘So who preps your trays? Well, that person needs to be on your team, or you need to be getting insights from the people who are going to be interacting with this tool as well.’”
DN: Are the people who pitch to you mainly aspiring entrepreneurs looking to develop a product that they can sell?
TR: “It’s probably about half and half. A lot of people are interested in developing a new business, a new tool, something along those lines. But [we] also see a lot of people interested in policy change and awareness campaigns. Our most successful commercial effort was a method for preventing addicts from injecting drugs into their system through their IVs at the hospital. We really want to be able to help these people while they’re under our care and give them the resources they need to continue to be successful. So this nurse in the team wanted to find a way to stop people from being able to access the lines without us knowing about it and created a tape that would go over IV ports.
And, you know, it’s now on the market. Her idea has gone from something she drew on a napkin to a tool that is now being used worldwide to help patients.
[The entrepreneurial aspect helps spur change because] there’s nothing that’s free in our health system. That makes it really challenging to scale your ideas without going the commercialization route. If you can’t sell it, it’s really hard to have that mass impact. But really, the key goal of innovation studio is to build a culture of innovation at Ohio State. We really believe that the true impact is in getting our students, faculty, and staff together and creating an atmosphere where great things can happen.
That’s a long game, you have to you have to be patient, and you have to be willing to continue to water the seeds until they’re able to until they’re able to sprout.”
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
Teaching, precepting, mentoring, guiding, or instructing are all used interchangeably when describing the role that one takes to teach another in any setting. Effective and passionate role models, who are willing to guide another to learn in the work or school environment, are pivotal to the success of an organization.
Mentoring or teaching in the academic nursing setting serves to promote the advancement of nurses in both clinical and academic work environments. Precepting in nursing, which most often occurs in the clinical setting, promotes the use of role modeling and shadowing to build specific skill-sets required for the specialized field of nursing. Guiding and instructing in the nursing academic and work settings consist of mentoring, precepting, role modeling, and input from staff in administrative positions.
Nurses Teaching Nurses
As an operating room nurse, I was blessed to have a wonderful nurse preceptor. She was extremely generous with the knowledge that she had gained over a very long nursing career. Her willingness to spell out each procedure using visual diagrams and thorough explanations helped me to excel. She taught me the surgical procedures, the instruments to be used, the technique to follow, the descriptions of the temperaments of the surgeons for whom I would work, and the way to deal with difficult personalities of the environment. She approached each surgical case with a tenacity of spirit and a drive to provide the very best possible care for each patient…every time. To this day, she embodies the truly compassionate art associated with nurses teaching nurses.
I have been blessed with learning the challenging and unique aspects of nursing from some incredible nurses. I have also learned valuable lessons from those who gave credence to the adage that nurses eat their young. Despite the challenges of navigating the stress associated with those lessons, I have continually modeled the positive behavior of strong nursing preceptors to contribute to the profession. Part of being a strong nursing preceptor or educator is having the ability to recognize the talent around us. When I was working as a clinical educator, I knew that there was a plethora of talent around me. There was a proverbial treasure trove of experience and untapped potential everywhere I went. It was my job to provide education and guidance while ensuring that competencies were met. However, I also felt that it was my responsibility to tap into the potential around me. I encouraged nurses to develop short presentations to share with the staff on topics that impacted their work environments and patient populations. The unofficial program was called simply, “Nurses Teaching Nurses.” Who better to speak to the department about significant issues and patient concerns, than the nurses who had to deal with it every day?
We have so very much to learn from one another. It is so important that we are open to sharing our experiences and to be willing to teach others. Not only does the simple act of sharing what we know serve to help the patients that we serve; it improves the work environment.
When Should We Seek Guidance?
Asking for help and guidance is an important component of learning. The relationship between the student and the faculty member or clinical preceptor should find its foundation in open communication and mutual respect. The faculty member, academic administration, clinical preceptors, and leaders are required to facilitate a learning environment that promotes a just culture, is conducive to learning, and aids students achieve desired didactic and clinical outcomes.1 Likewise, the nursing profession is required to abide by professional standards and a code of ethics. These standards and codes of ethics serve as a guiding force throughout the nursing career. In all of the interactions, nurses have while caring for patients and representing an institution.
What About Mentoring?
Students require strong mentoring to understand his or her potential role as a nurse. Further, faculty members, mentors, and preceptors also require mentoring to be effective leaders in the classroom and clinical areas. Providing active mentorship during the novice educator’s transitioning phase is a helpful strategy that is useful for enhancing effective transitioning for the new educator.2 Therefore, effective mentoring programs provide a strategy for improving retention in nursing.2 Further, equal importance is placed upon the facilitation of positive mentor/preceptor-to-student relationships while they transition into the role.
The National League for Nursing (NLN) created an excellence model to identify eight core elements necessary to attain and maintain excellence in the nursing profession. Additionally, the NLN stressed that the nurses need to understand the principles that are fundamental to their profession, use technology to manage and find information, and be leaders and agents for change.3
The American Association for the Colleges of Nursing (AACN) indicated that the United States faces a major nursing shortage and increased workforce opportunities in the next eight years.4 In 2011, the National Academy of Medicine (NAM) (formerly the Institute of Medicine (IOM)) recommended that all nurses have a Bachelor’s of Science in Nursing (BSN) by the year 2020.5 The NAM’s recommendations create an emergent need to increase the nursing faculty and staff nursing workforce. Nursing is one of the many vocations in which a growing need for improvement of workforce retention exists.
In the wake of a nursing faculty shortage, there is a need to retain current faculty and recruit new faculty. Academic institutions and health care facilities are responsible for the retention of nursing faculty. An important component of maintaining work environments conducive to retention of the nursing faculty workforce is associated with the provision of adequate mentorship. The Health Resources and Services Administration (HRSA) indicated that the primary problems facing healthcare are: financial constraints, healthcare workforce shortages, the changing needs of an aging population, which have prompted a national dialogue on the need for new healthcare models to meet the healthcare demands of the 21st century, facilitation of working nurses’ abilities to participate in continuing education programs and increasing healthcare information technology demands. Medical schools, institutions, practitioners, and students will be required to create strategies for coping with the increased volume of new information and changing patient demographics.6
Improving the Student-Faculty/Mentor/Preceptor Member Relationship through Mentoring
Mentoring is a critical component to the success of a program and the nurse. Mentoring is a relationship between a seasoned and novice professional that aids in developing the novice individual to be a productive component of the team. The goals of mentoring are to assist the novice faculty member in overcoming obstacles encountered in daily work, improving individual productivity, and increase employee satisfaction.7 Mentoring is effective for the faculty member and contributes to the increased awareness on the part of the student via interaction, sharing of enthusiasm, and formulation of new insights that contribute to the advancement of teaching styles.
There are many issues to consider when mentoring or receiving mentorship. The nursing profession has a responsibility to remain vigilant regarding influences that change the direction of not only the profession but in nursing education. Further, nursing educators must work to adapt the changes in a curriculum to model the changes that occur in society, political climate, demographics, economics, workforce trends, and any external or internal issues that may influence change in the way nurses deliver care.8 For change to occur in a curriculum and to build meaningful learning experiences for students, nursing educators need to prepare the nursing student by continually analyzing those forces that impose change and encouraging interpersonal dialogue between students and in the student-faculty/mentor/preceptor relationship.8 Therefore, there is a need for academic administration to construct methods for assessment and to provide the tools to monitor changes as they relate to curriculum design and redesign. Imposing change without assessment and communication will create an ineffective learning environment.
Types of Mentoring Processes and Strategies
Other researchers contend that mentoring effectively enhances cultural diversity in the profession of nursing and academia. Four effective mentoring strategies to encourage academic success consist of communication, professional leadership, confidence-building activities, and students. Further, successful mentoring programs are dependent upon a strong organizational infrastructure.9 Shadowing is another method of mentoring. The literature indicated that shadowing is now a tool for medical residents. The assignment of medical residents to nursing staff, as each makes patient rounds, serves to educate the resident about the role of the nurse.10 Sternszus et al. ‘s 2012 study served to identify the importance of residents as role models, and the impact role modeling had on undergraduate medical students.10
7Kapustin, J.F. & Murphy, L.S. (2008). Faculty mentoring in nursing. Topics in Advanced Practice Nursing 8(4).
8Veltri, L. M., & Warner, J. R. (2012). Forces and issues influencing curriculum development. In In D.M. Billings & J.A. Halstead (Eds.), Teaching in nursing: A guide for faculty (4th Ed., pp. 92-104). St. Louis, MO: Elsevier Saunders.
9Wilson, V., Andrews, M., & Leners, D. (2006). Mentoring as a strategy for retaining racial and ethnically diverse students in nursing programs. Journal of Multicultural Nursing & Health (JMCNH), 12(3), 17-23.
10Sternszus, R., Cruess, S., Cruess, R., Young, M., & Steinert, Y. (2012). Residents as role models: Impact on undergraduate trainees. Academic Medicine, 87(9), p 1282–1287. doi: 10.1097/ACM.0b013e3182624c53
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.