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Developing Executive Nurse Leaders: Exemplar for Using Information Technology to Bolster Professional Role Development of BSN-DNP Students

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Abstract

Background: Universities are offering a Bachelor of Science in Nursing (BSN) to Doctor of Nursing Practice (DNP) track to meet the demands of complex health systems by preparing nurses to lead change. Curriculums developed for the adult learner may benefit from adding supplemental resources to prepare nurses with limited leadership experience for their future roles. Objective: Support the development of executive leadership skills of BSN-DNP students. Methods: Faculty at a Western Pennsylvania university used the existing learning management system (LMS) to create a nursing leadership site. Practice competencies described by professional organizations were used as the framework for identifying best practice resources. Results: A supplemental site serving as a repository of information for students was successfully developed. Students were encouraged to access the site to augment their learning on professional competencies. Conclusions: Developing an online support site via the university LMS was a creative solution for providing supplemental professional development content to best prepare future nurse executive leaders. Implications for Nursing: Faculty teaching in streamlined academic programs can provide additional content based on professional standards to students using innovative and interactive methods. Promoting further development of executive leadership skills may bolster program strength and influence future nurse leaders.

The rapidly changing healthcare environment warrants that nursing leadership is present, prepared, and poised to face the challenges of the future. Changes in provider models, payment structures, primary prevention, chronic disease management, and rates of morbidity and mortality in high-risk populations dictate that health care will continue to be an area that requires strong leaders to be at the helm. As the largest group of healthcare professionals in the country at over 2.8 million strong (United States Department of Labor, 2017), nurses need to have a solid presence in the decisions impacting the future of health care.

Universities are tasked with aiding in the development of future nurse executives, yet streamlined, focused curriculums may not be all inclusive or have all the essential elements to fully prepare students with a comprehensive nurse executive skill set. This challenge is compounded by the increasing number of Doctor of Nursing Practice (DNP) programs available for students to choose from (American Association of Colleges of Nursing, 2018). Universities are often challenged to “right size” the number of credits and program length in the competitive academic market in order to attract and retain students, thus eliminating any nonessential programming. The following article shares a case exemplar using information technology to supplement curricular content and support the development of nursing executive leadership skill sets of students enrolled in a Bachelor of Science in Nursing (BSN)-DNP Executive Leadership track.

Background

The Institute of Medicine’s (IOM) formative report released in 2010 discussed the imperative need for nursing to provide significant leadership in the transformation of healthcare delivery. Of the four action items outlined in the IOM report, at the forefront was the need for nurses to achieve higher levels of education and training through a seamless academic progression. While variable, the traditional path to leadership has involved seeking advanced education while professionally transitioning from a clinical role through various management roles to gain a deep understanding of operations (Hardesty, Englebright, Huffman, & Davis, 2018). The shortage of professional nurses and historical lengthy educational programs has impacted healthcare organizations as evidenced by their struggle to fill nursing leadership positions (Hardesty et al., 2018).

Currently, there are over 200,000 pre-licensure nursing students in the United States according to the American Association of Colleges of Nursing (AACN, 2017, 2018). Fortunately, the rates of nurses receiving advanced degrees are steadily growing (AACN, 2017, 2018). The DNP degree, developed from AACN’s (2006) Essentials for Doctoral Education for Advanced Nursing Practice is well situated to prepare nurses for leadership roles. Considered both a practice doctorate and terminal degree, the DNP degree’s curriculum prepares nurses to function in a variety of roles while using the best evidence available for clinical decision-making, policy development, and outcome management (AACN, 2006). More specifically, Essential II: Organizational and Systems Leadership for Quality Improvement and Systems Thinking defines the knowledge and skills needed by the DNP graduate to lead change that impacts patients, providers, and payers in a way that promotes health outcomes, supports policy development, strengthens health systems, and sustains change.

To streamline educational requirements and bolster the number of DNP prepared nurses in the workforce, many academic institutions are following the recommendations of AACN (2016) and embracing a new vision for academic nursing and preparation for future nurse leaders. Most recent findings indicate that a large proportion of DNP programs across the United States are offering a bridge option, BSN-DNP track, for either advanced practice nurse (APN) preparation or non-APN preparation (Auerbach et al., 2014; Udlis & Mancuso, 2012). The development of new educational options reflects academic institutions’ responses to the call for innovation and creative solutions for advancing the quality of health care by providing efficient pathways for preparing nurse leaders (Porter-O’Grady, 2011).

Recommendations for developing executive leaders is well discussed in the literature (Kendall-Gallagher & Breslin, 2013; MacMillan-Finlayson, 2010; Malloch & Melnyk, 2013; Malloch, 2017) and offered by professional organizations (American College of Healthcare Executives, 2017; American Organization of Nurse Executives [AONE], 2015). Commonly discussed competencies include effective communication, relationship building, knowledge of healthcare environment, professionalism, change and strategic management, and commitment to lifelong learning (AONE, 2015). However, a paucity of literature exists regarding how to support the development of such competencies in non-APN BSN-DNP students. BSN-DNP students may be at a disadvantage when compared to traditional DNP students, potentially due to limited professional work experience and the completing of non-APN Master of Science in Nursing (MSN) and general DNP courses simultaneously. Therefore, the inference can be made that supplemental content needs to be incorporated to promote the development of executive leadership skills within this population of students.

While this may seem like an easy task, curricular plans and program outcomes are driven by accreditation requirements. Programs intentionally aim to develop streamlined programs to attract the most students. This leaves the opportunity to include any coursework with additional role development content not required to meet program outcomes. As such, faculty can be challenged with finding innovative methods for providing supplemental content while maintaining interest in the students and reaping benefits to the nursing profession.

Approach

A medium-sized university in Western Pennsylvania offering a Commission on Collegiate Nursing Education accredited online non-APN DNP program, considered curricular enhancements to meet the charge for re-envisioning preparation for future nurse leaders (AACN, 2016) and the need to place nurse leaders at the decision-making table (Institute of Medicine, 2010). After thoughtful analysis of the university’s accredited online MSN leadership degree, a decision was made to offer nurses interested in being at the forefront of healthcare change a non-APN BSN-DNP track for the executive nurse leader. Upon completing this track, the students would graduate with an MSN leadership degree as well as a general DNP degree. The track was not intended to prepare APNs in a clinical role (e.g., nurse practitioner, nurse anesthetist, nurse midwife, clinical nurse specialist). The DNP curriculum was focused in evidence-based practice and intended to be appropriate for any master’s prepared specialization. In the case of this case exemplar, the preparation was that of an executive nurse leader. With this decision came a thorough review of the curriculum for both the MSN and DNP programs. Although both degrees meet the Essentials put forth by AACN for masters and doctoral education, it was decided that to best prepare nurse executives for their critical role, the curriculum should be augmented with supplemental professional development content.

Task Force

To begin the process of augmenting the curriculum to best prepare the BSN-DNP students for their future professional roles as a nurse executive, a task force was formed. Since the new track impacted different areas of programming, the key was choosing group members who would add their expertise to the planning and development of the BSN-DNP Executive Track Student Support Site. The nursing program director, also the DNP program coordinator, invited three other faculty members to join the initiative. The MSN program coordinator was essential to provide input on the MSN leadership track course content. Since the BSN-DNP student needs to plan a practice experience that prepares them for executive leadership roles, the graduate practice experience coordinator was included. The last member of the task group was a faculty member who researched and developed the BSN-DNP executive track. While the task force did not include a practicing nurse executive, both the program director and the faculty member responsible for track development had extensive executive leadership experience prior to their roles in academia in both the hospital and corporate healthcare environments. The MSN program coordinator was considered the leading expert in the department on education and pedagogy. The practice experience coordinator had a strong information technology background both in and out of academia and had experience with fostering engagement. The task group was charged with selecting the mode of delivery, identifying appropriate content to augment the established curriculum and the development of the support site.

Mode of Delivery

The task force first needed to select the mode of delivery for the support site. Since all the nursing programs are online, the decision to create a virtual support site on the current university learning management system (LMS) was made from the onset. The LMS is secure and accessible only through university-generated usernames and individually created passwords. Specific sites on the LMS are limited to identified creators and users. The BSN-DNP students would be familiar with the functionality of the LMS, given that all coursework is facilitated through this platform.

Support Site Content

Next, the task force met to compare the established BSN-DNP curriculum with the recommendations for developing executive leaders discussed in the literature (Kendall-Gallagher & Breslin, 2013; Malloch & Melnyk, 2013; Malloch, 2017) and offered by professional organizations (ACHE, 2017; AONE, 2015). The faculty members identified that while the MSN Leadership Track had five courses specific to leadership development, the DNP curriculum was generic allowing for a diversity of nursing specialties, student interests, training, and practice experience sites. Additionally, understanding the BSN-DNP student may have limited work experience led the faculty members to conclude that supplemental educational material on the executive leadership skills as suggested by the AONE would be beneficial. Topics were divided among group members to locate appropriate resources to be included on the support site. A follow-up meeting was held in which all group members shared the resources they identified. Each resource was reviewed by the task force for clarity and relevance before being included on the support site resource list.

Outcome

To formally develop the site, task force members were responsible for adding their identified content to the LMS system. To streamline the flow of content, retrieved resources were grouped by the general headings of supplemental readings, professional organizations, professional role development, certification opportunities, sample DNP projects, academic program resources, and the general forum. Under each heading, the responsible member uploaded specific information, including links, Word documents, and explanations as necessary. To further delineate the focus of the resources, additional level headings were included as warranted. For example, under supplemental readings, the headings included books, professional journals, and newsletters from various organizations. Resources in this section encompassed topics related to professionalism and leadership skills and strategies directed toward change and management. The professional organizations’ category provided Web links that directly linked to various organizations’ Web pages for easy access and retrieval of information directed toward communication, relationship building, and considerations for nurse leaders. The professional development section further supported the growth of professionalism through listing annual conferences; leadership-focused academies, institutes, and workshops; specific webinars to advance leadership knowledge and skills; and other tips such as competencies and assessment tools. The certification section reinforced a commitment to lifelong learning through providing different options for career advancement beyond the DNP degree. Whereas the categories of sample DNP projects, academic program resources, and general forum offered program-specific information to facilitate academic success and program progression of the BSN-DNP students. To further personalize the support site, the nursing programs’ director added a welcome in the introduction section. The task force reviewed the final product before it was made available to enrolled students. The faculty members recognized that while it contained all the agreed-upon content during the review process, the site was to be considered a living resource that is quickly able to be adapted for new information. All BSN-DNP students were given access to the support site by their assigned faculty advisor. Students were encouraged to access the site to learn more about the program and augment their learning of professional competencies of nurse executive leaders.

Implications for Nursing

Faculty should recognize the environmental influences occurring in healthcare systems that impact the needs of the workforce beyond traditional nursing roles. To meet the needs of health care organizations, academic institutions should seek opportunities to plan and implement curricular enhancements to support the development of nursing leaders who are capable of efficiently and effectively navigating the evolving healthcare system. By supplementing curriculums with professional and practical information that aids in leadership role development, faculty can help students transition and meet the workforce expectations seamlessly (AONE, 2010).

Even with the rigor of doctoral coursework, students need additional training and resources to aid in their development of future nurse leaders (Hardesty et al., 2018). Faculty should strive to find innovative ways outside of the planned curriculum to foster the development of skills needed for future role demands. Finding easy to use and affordable solutions such as the university LMS to quickly roll out supplemental material is helpful in promoting new offerings and educating BSN-DNP students for challenging roles. While graduates leave programs optimistic about meeting future leadership role demands, they often feel unprepared when in the practice setting (Dyess, Sherman, Pratt, & Chiang-Hanisko, 2016). Introducing resources which reflect current practice standards, students can be prepared with useful strategies as they define and refine their professional expertise as executive leaders after they graduate. By arming graduates with practical and professional skills and knowledge, they can excel in their chosen career paths.

Future projects or studies related to the provision of this site could include an evaluation of student access of the site and their views on usefulness to their career development. Like any supplemental resource, the site’s effectiveness is dependent on the actual use by the students. Current functionality in most LMSs allows faculty and administrators to monitor student access of a site or function within a site. Garnering this information could aid in the understanding of how students view the usefulness of the resource. Additionally, a survey could be developed, providing an opportunity for students to evaluate the site and add suggestions for future resources.

Conclusion

Academic programs could use the approach described in this case exemplar as a framework for making their own curricular enhancements. Through first establishing a task force, faculty can review curricular content and identify appropriate supplemental resources to support the development of the necessary skill sets of an executive nurse leader. A repository of resources that are easily accessible and organized in sections for students can be curated after content is selected. In a virtual, online teaching environment, the LMS has been found to serve as a convenient, existing resource and easy to use platform in which students are familiar with the functionality of. Although curricular content provides the necessary building blocks for role development and leads to degree attainment, expanded content related to a subject further prepares the student for role adoption. By providing supplemental content to further augment what is already in the MSN leadership track and DNP curriculums, students can potentially be elevated to a higher level of preparation resulting in career success.

References

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