New Graduate Nurses Educational and Professional Plan
College
Nursing Leadership
November 29, 2016
Introduction
As a former new graduate nurse and now having one year of work experience I realized how quickly a novice nurse must turn into an effective nurse leader. Being the charge nurse at a nursing home and now training new graduate nurses you are put in many situations where the unit manager may not be available and you must be the go-to person in critical situations. At the end of the day, you are the one the patients, other health care professionals, and staff turn to as they depend on your knowledge and care. Therefore, you must gain confidence in your skill set as this will help provide the highest quality of care to patients. Becoming an effective leader comes with time and experience, yet I believe that many new nurses have the qualities instilled in them at the beginning of their career. After working for a year I have learned just how important it is to educate novice nurses on areas in the nursing practice that are not fully taught in nursing school.
The educational and professional development plan for new graduate nurses will be part of a larger 14 week new graduate nursing orientation program at hospitals and nursing homes. The program will be three weeks in length and lasting four-six hours a day. The first five days will be classroom style education and the last ten days will consist of simulated learning experience and direct patient care. At the end of each classroom style education, there will be different case studies and questions relating to the topic covered for the day. There are many topics that new graduate nurses can benefit from, but the five that I feel that will help novice nurses transition to strong nurse leaders will be learning about the nurse of the future competencies, ethical framework, gaining cultural competence/workforce diversity, building effective teams, and critical thinking, delegation, and missed care. These major areas are necessary to learn as novice nurses because one can only learn so much in nursing school and most knowledge is gained through experience. Therefore, since nurses are at the forefront of care being able to use these factors in your nursing practice will only lead to improvements in care and help one become a strong nurse leader.
Nurse of the Future Competencies
In 20ll, the Institute of Medicine published the Future of Nursing (2011) report which emphasized that graduate nurses will be the future leaders in practice, administration, education, and research. Therefore, is essential that new graduate nurses are provided with the knowledge and tools necessary to provide safe and effective patient-centered care (AACN, 2011).
All new graduate nurses must be taught the core set of nursing competencies created by the Nurse of the Future Competency Committee as these competencies set the foundation for nursing practice and education. This model consists of ten competencies that all nurses must hold and describes how they emanate from the central core of nursing knowledge. The ten competencies include patient centered care, professionalism, informatics and technology, evidence based practice, leadership, systems based practice, safety, communication, teamwork and collaboration, and quality improvement (Nurse of the Future, 2010). The educational plan will explain the definition of each competency, and the knowledge, attitudes and skills expected for all nurses of the future (Nurse of the Future, 2010). In addition, the developmental plan will include testing the new graduate nurses the skills needed to attain these competencies’. Integrating these competencies into practice will allow for a smooth transition for the new graduation nurse into practice. By educating new graduate nurses of the core competencies needed, they will be given the tools necessary to gain the confidence in their skill set, become competent and knowledgeable nurses & enhance patient satisfaction and outcomes. These are very important qualities necessary to be a strong nurse leader (Nurse of the Future, 2010).
Ethical Framework for Leadership
Whether you are a novice nurse or experienced nurse leader, every healthcare professional is held to the highest moral standards. When becoming a nurse we took an oath to be a patient advocate, therefore, we carry a significant ethical responsibility as we influence the lives of others (Hunt, 2016). All nurses will face some form of ethical issue whether it is dealing with a misalignment between the nurse’s recommendation of clinical care and the decision of the patient, committing a medication error, end of life care, or dealing with privacy amongst patients. The new graduate nurse must learn about the importance of holding the proper values and morals needed to provide the best care.
The educational and professional development plan will discuss some of the ethical dilemmas faced by health care professionals, in addition to the four key ethical principles all nurses must hold: respect for persons, beneficence, non-maleficence, and justice (Hunt, 2016). New graduate nurses must be aware of the many different situations and problems that may arise in their career and how to handle the situation properly. Gaining the ethical knowledge and morals needed to be a successful nurse will help the new graduate nurse attain ethical leadership. Ethical leadership is the influence of a moral person who moves others to do the right thing in the right way for the right reasons (Northhouse, 2015, p. 262). The new graduate nurses will learn how the character, actions, goals, honesty, power, and values of the leader will help acquire ethical leadership which is attainable at any point in the nursing career. Whether you are a novice or experienced nurse your behaviors, decisions and interactions impact those around you (Northhouse, 2015 p 262).
Cultural Competence/Workforce Diversity
As a nurse you must be knowledgeable and willing to learn about the different ethnic and cultural groups that make up our diverse patient population. Cultural Competence includes “recognizing the importance of integrating persons who are from a non-dominant group into the culture and considering their values in the process of organizational operations” (Huber, 2015). Providing culturally competent care is of utmost importance because it allows the nurse to develop a rapport with their patients which allows them to properly assess and implement nursing interventions that will meet the patient’s needs. It is important to teach new graduate nurses the importance in developing cultural competency as it is at the forefront of the nursing career. As nurses we are our patients’ advocates and must support and create interventions designed to meet our patients cultural needs even if it conflicts with current medical practices.
In order to teach new graduate nurses how to develop and provide culturally competent care, Campinha-Bacote’s framework for cultural competence in health care delivery will be used. This model includes five constructs: cultural awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desire (Campinha-Bacote, 2002). Cultural awareness is the self-examination of owns own cultural background and to recognize one’s biases and assumptions about individuals from different backgrounds. This prevents the nurse from engaging in cultural imposition, which is the tendency to impose one’s beliefs onto another culture. Cultural knowledge is to obtain an educational foundation about diverse cultural groups. This includes learning about disease incidence amongst ethnic groups, such as hypertension in the African American culture. This is a skill needed by new graduate nurses that will allow for efficient medical diagnosis and proper treatment options. Cultural skill is the ability to collect relevant cultural data as well as performing a culturally based physical assessment. As a new graduate nurse this skill is important because the nurse should be able to know the different variances in body structure and laboratory values in each ethnic group. Cultural encounter and cultural desire complement each other as they encourage health care professionals to engage with patients from culturally diverse backgrounds and also motivates health care providers to want to provide care. These skills are extremely important for all nurses as it allows nurses to become more knowledgeable about different medical practices and can modify ones existing beliefs about another culture (Campinha-Bacote, 2002).
As a new graduate nurse becoming culturally competent will also help you to become a strong nurse leader because it will allow you to appreciate and promote diversity in the workforce. As a nurse leader you have the power to develop a team that comes from all different walks of life. Diversity in the workforce enhances performance, improves retention, provides a more supportive work environment and allows for one to create problem solving solutions that reflect today’s needs.
Building Effective Teams
Effective teamwork allows nurses to provide the highest quality of care especially when one may be overwhelmed with a highly acute patient workload. Teaching new graduate nurses the importance of developing relationships with the staff around you and other healthcare providers by assisting and collaborating during patient care instills a foundation that will lessen the risk of adverse events. According to the World Health Organization, effective teamwork in healthcare delivery can have an immediate and positive impact on patient safety. Teamwork is of utmost importance because there has been an increase in providing complex care, increasing co-morbidities, increasing chronic disease, global workforce shortages, and issues with safe working hours (WHO).
While educating new graduate nurses, there are many factors that need to be taught, an emphasis will be placed on learning about the different types of teamwork in health care, how the patient plays a role in the teamwork, how to be aware of the impact of change on teams and how to become mindful of how one’s values affect interactions with others (WHO). Developing a good rapport with unlicensed assistive personals will be emphasized as they are the nurses second set of eyes and are heavily depended on. These individuals spend more time with patients especially in nursing homes as they primarily assist with activities of daily living. Therefore, developing a positive attitude that you work as a team will help prevent any mishaps in missed care. Studies show that one of the biggest causes of missed care to patients is ineffective relationships between the nurse and UAP, therefore developing and maintaining a trusting and respectful relationship will lead to successful teamwork and in the end effective patient care (Bittner & Gravlin, 2009)
Learning and embodying the qualities that allow for effective teamwork on the unit will help the novice nurse grow to an effective nurse leader. A nurse leader sets the tone for the environment on the unit and those leaders that provide support, who are willing to ask for help, and show respect to other staff not only benefits the care provided to patients but also the satisfaction of the staff on the floor. When staff is satisfied the care provided will be positive, efficient, and effective. Staff learns from the nurse leader and if they see someone that is willing to help and assist others they are more willing to follow the same path (Northouse, 2015, pg 69). Educating new graduate nurses on the importance of how effective teamwork leads to effective care will allow them to grow to become a successful nurse leader as they are at the forefront of care provided.
Critical Thinking, Delegation, and Missed Care
Teaching new graduate nurses how to critically think and delegate helps provide quality care to patients at a time where nurses are faced with high acute patients, shortage in staff, and the expectancy to provide high quality care with shortened hospital stay. Nurses need to be able to synthesize large amounts of information and critically think through complex situations, while being able to delegate some aspects to unlicensed assistive personnel (UAP) (Bitter & Gravlin, 2009). In nursing school students are taught the process of delegation and the scope of practice of unlicensed personnel, but in the real world during times of stress it is easy to make a mistake. It is important to teach new graduate nurses how to effectively delegate to unlicensed assistive personnel as long as it is within their scope of practice. Studies show that newly licensed nurses have a sense of role uncertainty regarding delegation because they are fearful in making errors in their nursing career therefore, it prevents them from delegating any care to a UAP. This causes an increased burden on the new nurse and leads to an increased risk of committing an error (Bitner & Gravlin, 2009).
The new graduate nurses in the educational program will be educated on Kalisch’s conceptual model of missed nursing care. This framework uses Donabedian’s structure-process-outcome framework to explain how structural factors such as low staffing numbers, competency level of nursing staff, material resources, and teamwork can contribute to missed nursing care (Kalisch & Lee, 2010). This framework will allow new graduate nurses to visualize the specific factors that lead to missed nursing care and methods that will help one to either prevent or resolve the issue.
Nurse leaders have an important role in preventing missed care as the most consistent predictors of missed care are staffing levels, work environment, and teamwork (Missed Nursing Care, 2016). Ensuring staffing levels are met and creating a positive work environment that consists of teamwork and support all starts with the nurse leader. The nurse leader, whether it is the charge nurse or unit manager must be able to learn how to critically think and delegate, especially when there are complex situations. This skill will be emphasized to the new graduate nurses as it takes time and experience to gain these skills. Progression of skills in this area of practice is extremely imperative in providing quality care.
Summary
While practicing as a novice nurse you are unsure of the qualities and skillset you must hold to become a competent nurse. In nursing school you can only be taught a small percent of what one will face in their nursing career. Therefore, it is imperative to develop an educational plan for new graduate nurses that will provide an insight into the different competency areas and qualities in nursing practice that one should attain. This will allow the novice nurse to gain the confidence needed to provide quality care and become a strong nurse leader.
First, by developing the ten Nurse of the Future Core Competencies as a novice nurse you are building the foundation and gaining the basics of nursing knowledge, which will allow you to provide competent and quality patient care (Nurse of the Future, 2010). Furthermore, learning about the importance of becoming an ethical leader and how your actions will impact those around you, will educate the novice nurse on the morals needed and how to deal with and prevent unethical situations. Also, becoming a culturally competent nurse is imperative as we live in a time where the patient population consists of many different cultural groups. Gaining the knowledge, motivation, and desire to provide care to these individuals will lead to developing a rapport with your patients which will allow you to provide comprehensive healthcare that complements the patient’s desires (Campinha-Bacote, 2002). In addition, nursing is a career that depends on the teamwork from the patients and other healthcare professionals. Instilling the foundation of teamwork to novice nurses is important in order to provide effective and compassionate care to patients. Health care is a field that can be extremely volatile, therefore healthcare professionals rely on the assistance, advice, and support of those around them, which helps prevent adverse events from occurring. Lastly, novice nurses often fear committing an error, therefore they do not effectively delegate. It is imperative to teach them about the scope of practice amongst all individuals on the unit and educating them about how to critically think and delegate as this will help prevent missed nursing care (Bittner & Gravlin, 2009).
Becoming a strong nurse leader can occur at any point in one’s nursing career, many novice nurses are put into situations where they must take charge and help guide those around them, whether it is a patient, a family member or another staff member. By educating them on these key factors, novice nurses will have the tools necessary to become confident, competent, & caring providers, all of which are key qualities to becoming a strong nurse leader.
References
Being an effective team player. World Health Organization. Retrieved November 22,2016. http://www.who.int/patientsafety/education/curriculum/who_mc_topic-4.pdf
Bittner, N. P., & Gravlin, G. (2009). Critical thinking, delegation, and missed care in nursing practice. The Journal Of Nursing Administration, 39(3), 142-146. doi:10.1097/NNA.0b013e31819894b7
Campinha-Bacote, J. (2002). The Process of Cultural Competence in the Delivery of Healthcare Services: a model of care. Journal Of Transcultural Nursing, 13(3), 181-184.
Graduate Level QSEN Competencies. (12, September 24). Retrieved November 22, 2016, from http://www.aacn.nche.edu/faculty/qsen/competencies.pdf
Huber, D. L. (2014). Leadership and Nursing Care Management (5th ed,). Maryland Heights, Missouri: Saunders Elsevier.
Hunt, V. (2016). Ethical considerations in nursing leadership, power point slides, Regis College.
Kalisch, B. J., & Lee, K. H. (2010). Article: The impact of teamwork on missed nursing care. Nursing Outlook, 58233-241. doi:10.1016/j.outlook.2010.06.004
Nurse of the Future Core Competencies. (2010, August). Massachusetts Department of Higher Education. Retrieved November 27, from http://www.mass.edu/nahi/documents/NursingCoreCompetencies.pdf
Missed Nursing Care. (2016, July). Retrieved November 22, 2016, from https://psnet.ahrq.gov/primers/primer/29/missed-nursing-care
Northouse, N. G. (2015). Introduction to Leadership Concepts and Practice (3rd ed.). Los Angeles, California: Sage Publications.
