As the COVID-19 pandemic continues to take an enormous toll on human health across the globe, its impact is felt significantly in other industries as well. Higher education has been upended with most institutions sending nursing students home to complete the rest of the year online.
If you’re a nursing student, the impact is being felt even more keenly. Clinicals have been canceled while hospitals and healthcare facilities grapple with an overwhelming number of severely ill patients. But many nursing students will still be able to continue on as best as possible by completing the academic courses they have.
If you’re a nursing student who’s now trying to finish the rest of the year by taking all your courses online, it all might feel nearly impossible. Remember you’re not alone. Your peers and even many of your professors are trying to manage this new normal.
Wondering how you’ll manage the rest of the year as an online student? Here are a few tips:
Commit to a Class Schedule
Even if your online classes don’t require a specific meeting time, block out your schedule as if they do. Scheduling time when you log in or do the work or meet with a study group will give your days and weeks structure. Write it in your schedule and plan your days around those fixed times.
Ask for Help
If you find the online format is challenging or you’re struggling without the face-to-face contact, reach out to your professors or to your school. Asking for help early will ensure that you aren’t falling behind. They might offer different perspectives to nursing students on how to work in this new format.
Stick to a Routine
You’ve probably heard this, but keeping to a regular daily routine will keep you focused. Get out of bed at the same time every day and set aside time for specific free-time activities—exercise, reading, watching TV, hobbies, or video chatting with friends and family. Try to go to bed at a regular time as well. Carving out blocks for your work and your leisure helps you set boundaries so you don’t find you’re spending too much time or not enough time on either.
Take Care of Yourself
These times are stressful, chaotic, scary, and unsettling. Accept that you aren’t going to continue on with life as you know it. Plan to make adjustments. Try to eat nutritious food and get sleep at regular intervals. If you tend to eat three meals a day, keep doing that. If you prefer to spread out your eating, eat smaller meals, but at similar times every day. Again, the routine can help you feel like you have a schedule and give you structure. If stress is interfering with your daily functioning, reach out for help either with a therapist (many are offering telehealth appointments) or a close confidant or member of your faith community.
Keep Focused on the Future
Remember why you started nursing school and keep that end goal in mind every day. Remembering your goal, and working toward it, will give you purpose and help ground you in the day-to-day business of living your life. This virus is changing the world as we know it, and it will not always be as troubling as it is now.
If you are a nursing student, I would like to welcome you to the fabulous field of nursing! There is nothing more rewarding than serving in this meaningful profession. I anticipate you plan to practice in this arena upon graduating and passing the state board exam. However, be cognizant that one of the most challenging transformations your nurse educator will be responsible for will be in assisting you to become a professional in the medical field.
I know that you think that your instructors are always nagging you about your appearance, but at the end of this process, you will understand how important this transition is in order to socialize you. You have certainly heard educators discussing first impressions and how important they are in establishing credibility and rapport with your patients and with the health care team. As health care professionals, our demeanor affects everyone around us while we are on duty. Since I am a nurse educator, I would like to disclose some of the dos and don’ts of your daily conduct that you should be aware of as a student entering the nursing profession.
Let us start with the basics: punctuality. Have you ever heard the statement that when you are on time, you are late and when you are early you are on time? This applies to both the classroom and clinical setting. It is disturbing and disruptive as latecomers arrive to the classroom once lecture or testing has begun. As you enter the room tardy, open and close the door, remove extraneous clothing (coats, scarves, etc.), retrieve necessary items from your book bag… Well, you get the idea. While you catch up with the rest of the class, your colleagues have preceded you in doing so. Consequently, the energy in the room shifts as you now settle in for a long day of studies. Have you considered how your lack of punctuality affects those around you? Maybe it is time you do so.
You may ask, “How about makeup? How much is too much?” My answer for this is that if you are putting false eyelashes on before attending class and clinical, you clearly have too much time on your hands. Why not spend those extra 10 minutes reviewing notes taken during lecture or take a quick peek at those index cards? Why not work on those intravenous drip calculations you have been struggling with? It only takes a few minutes out of your day to commit to tackling the less desirable tasks. Facial makeup now takes second place once you realize that the extra minutes you use to embellish your outward appearance would be better spent on nurturing critical thinking skills.
Do you ever have downtime? By this I mean the time you have during breaks and lunch. How do you spend this time? Watching kitten videos, catching up with the celebrities, or perhaps finishing a movie or television show? I tire of overhearing the latest on the pop stars—the Kardashians, etc. You must know that your instructors are observing you and that we are very much aware of what occupies your time. No, we are not telepathic. We know by the incomplete homework you turn in (or not) and by the multitude of excuses you have for late assignment submissions. We know by the test scores that you feel are acceptable, even when we, as instructors, know you can perform academically better. I implore you to spend all the time that you have honing your skills for nursing. There is plenty of curriculum to embrace, so do so every moment you have. I promise you will not be disappointed.
It is not cool to have your shoelaces or velcro straps untied. This look appears anything less than professional. It is hard to take anyone seriously who has not taken the time to attend to such details before entering the clinical arena. Another detail worth addressing is gum chewing. Along with the former offenses, it is difficult to accept that the person who is chewing gum is focused on anything other than smacking idly while passively listening or speaking to their audience. In my profession, potential candidates for employment were simply dismissed during an interview because of gum chewing. Do not let this be your fate while seeking employment.
Confine all cracks, cleavage, tummies, and tattoos for activities aside from nursing. Let me be clear: cover all external crevices at all times while in uniform. Having these body images in view is unprofessional and if you want to be taken seriously, save this look for socializing (e.g., dating, clubbing, or spending weekends with friends). Your patient nor your instructor desires to be distracted.
While we are noting external appearances, there is a reason for us to request that you not wear jewelry larger than stud earrings and a wedding band. The focus on you should not be about your taste in jewelry. Jewelry is a vehicle for the transmission of germs, and while I am addressing the chain of infection, allow me to broach the topic of nails. Remember your lecture on infection control: hand washing in between patients, before and after meals, after smoking and toileting? You discovered how microbes harbor under long nails and in cuticles. The studies have been done, and the results are in. Nails are to be no longer than one-quarter of an inch. You cannot effectively palpate or percuss body contours and abnormalities with long nails.
Uniforms: the glorious look of a uniform, but only if it is clean and ironed. No wrinkles are allowed on uniforms or lab coats. Your first impression from your mentors and patients should exude professionalism as noted in unsullied and tidy apparel. Your patients want to know that they are safe with you—that you will protect them, not infect them. Not only does appearance count but so do scents. I will take the fresh aroma of antiseptic soap from thoroughly washed hands any day over the stench of cigarettes. While you are observing your patients, let it be known that they are observing you, too. Leave them with an impression you can be proud of. Think about your appearance this way: when you are practicing in the clinical setting, you are interviewing for potential employment.
When you are in class or clinical, you are in a work zone. No cell phones allowed! Please stop checking them. Instead, check the cell phones at the door and place them on silent, in your pocket, or in your car. I am looking forward to the day when administrators will mandate that cell phones be left with the instructor or outside of class and clinical altogether. I am aware of the potential family emergencies, children, health-related issues, etc. There must be arrangements for emergency calls. If a protocol does exist and despite this, we find our students clinging to these electronic devices making it difficult for instructors to maintain our students’ attention. For example, during clinical orientation (I am ashamed to say) students and educators are now being in-serviced regarding prohibiting cell phone use. Cell phones are not to be used in the facilities while practicing. It should be common sense that when you are at work, you should not have time for texting, checking emails, or Instagram. You should be working, which means meeting the needs of your patients.
In meeting patient needs, how do you communicate with them? Do you use “honey,” “sweetie pie,” or other affectionate terms with your patients? This is unacceptable as it is highly probable that your patients are older than you and as such, deserve your utmost respect. Along with respect for your patients, I would also like to add appropriate communication to use with your instructor: never use obscenities. You will develop a plethora of new words in this profession, none of which is profanity. Good communication skills entail proper dialogue with your instructor, among colleagues, patients, and health care providers. Using the last name with the prefixes Miss, Mrs., or Mr. is acceptable unless your patient has given you permission to call him or her otherwise. And how will you know how you should address your patients? If the patient does not inform you that they would like to be called by another name, simply ask them after having addressed them formally. You will always gain the respect of your patients by being respectful.
Did you know that your posture and gait say so much about you? Walk like you have purpose. Strut up that hallway and answer those call lights as if it were necessary, because it is. Exhibit energy and enthusiasm as opposed to being lethargic. You may be tired, but keep it moving! Your patients want to know that you have the vigor required to take care of them. For this emotionally and physically exhausting profession, I would advise you to follow the Beatitudes: be well rested, be fit, and be well nourished. Nursing is a taxing profession. Take care of yourselves so that you can take care of others.
Leadership—it’s the Holy Grail that’s stressed in business and health care administration. But how can you get there? And how do you know if nursing leadership is even right for you?
“Not everyone has the skills, desire, or disposition to be an administrative leader,” says Laura S. Scott, PCC, CPC, ELI-MP, CPDFA, president and founder of 180 Coaching, an executive coaching and leadership training provider based in Tampa, Florida. “I recommend that my clients go to a trusted supervisor and ask, ‘Where do you see me going as a professional and leader?’ and then just listen. You might be surprised at what you hear. If you have a role in mind, ask that trusted supervisor if they think you would be a good fit for that role and ask, ‘Why or why not?’”
Use caution when thinking about getting into leadership. “Don’t rush into what isn’t easily seen as an opportunity,” says Alisha Cornell, DNP, MSN, RN, a clinical consultant with Relias, a health care talent and performance solutions company. To decide whether a leadership role is right for them and what they want get out of it, Cornell says that self-exploration is necessary. “How did the nurses identify that they even wanted to be nurses? My recommendations are to stick to the original design. Whatever got you to nursing school and whatever helped to push you out of there, that’s your personalized equation.”
If you’re not sure if you want to be a leader, Romeatrius Nicole Moss, DNP, RN, APHN-BC, founder and CEO of Black Nurses Rock, says, “First, it is determined by the specialty you enjoy, followed by what you can contribute. Leadership starts now, as a staff nurse.” She suggests you ask yourself these questions:
Do people often come to you for help, advice?
Do you offer suggestions at meetings?
Are you the go-to person for issues on the unit before elevation to leadership?
Are you available, outgoing, approachable?
“If you are the unit leader, charge nurse, etc., these positions are set up to move you to the [higher] levels when opportunities arise,” explains Moss. “So be ready.”
If you know that you aspire to a leadership position, then move ahead. If you don’t or you try a leadership role and don’t like it, that’s okay. “If you don’t like nursing leadership, you can always go back to patient care,” says Thomas Uzuegbunem, BSN, RN, an RN administrative supervisor as well as the editor of the nursing leadership blog, NurseMoneyTalk.com. “Some nurses can get enough leadership fulfillment by being on a board. Others find that it’s not enough, and they want to move into nursing leadership as a career.”
Make sure that after self-reflection, you are the one making the decision to move into a leadership position. “Nurses who are seen as good caregivers are often promoted. While patient care is extremely important, being able to care for a patient does not mean that a nurse can care for a team of peers,” explains Bill Prasad, LPC, LCDC, CTC, a licensed professional counselor who has also worked as a hospital director and a leadership coach. “A nurse must understand that moving to a leadership role means you are moving from a focus on health care to a focus on organizational health.”
If that doesn’t fit in your life goals, there’s no shame in not pursuing leadership or moving into management. Yanick D. Joseph, RN, MPA, MSN, EdD, an assistant professor of nursing at Montclair State University in New Jersey sums it up: “Not everyone is destined to lead or to be an administrator,” she says.
Skills and Characteristics Needed for Nursing Leadership
“Leaders are born, but there are no born leaders,” says Prasad. “Becoming an effective leader takes training and education. Without this, you don’t know what you don’t know.”
Communication, flexibility, and organizational skills are the most important skills that Moss believes nurses wanting to move to leadership need to have. “Leaders should have the skills that allow them to be calm in stressful situations such as in crisis, emergencies, schedule management, and more,” she says. Nurses also need the “ability to work with different personalities and change leadership styles based on the staff member. Nurses should understand this even while working with their teams: you cannot use the same leadership style on everyone. Some people do better with taskers and checklists, while others need a little supervision to flourish.”
Moss says that leaders must be relatable and personable. “Allow your staff to see you get your hands dirty. Be the expert on the unit/department and show the team your skills and that you can handle the unit if need be. Start IVs, jump in on a code, participate while letting your team lead.”
One other characteristic Moss believes is imperative for nurses who want to lead is to be calm when challenged or with disagreements. “It is important to understand differences of opinion and to negotiate the best options. It’s even more important when dealing with difficult staff, family, etc. to not get emotional and to always be open-minded.” She admits that this was tough for her when she began to lead. “I had to understand the different personalities, politics, and overall strategic plan, and how they all come into play with decision making. Once you get this, your life will become less stressful,” she explains.
Scott agrees that good communication skills are crucial. “Effective communication and opening the channels for two-way feedback is very important. Also important is knowing what keeps these staff and providers on board and engaged so that you can give them what they need to stay motivated and fulfilled,” says Scott.
When communicating with others, Cornell says to keep this in mind: “Nurses are well-versed in the scientific methods of providing care from an academic perspective, but relating to ourselves, learning to listen for the conversation instead of solving a problem, and not reacting spontaneously are all critical skills of a strong leader.”
Nurses also need to be patient and have courage. “These characteristics are important because the normal job responsibilities of the nurse require quick thinking and paying attention to details. However, being a great leader requires the brain to slow down and digest the information in order to resolve a problem or at least know where to look to resolve it,” says Cornell.
Nurse leaders, Uzuegbunem says, must have an ability to accept diversity and understand technology. “Nurse leaders must be able to embrace diversity and adapt to those cultural differences of the nurses they lead as well as the patients the nurses take care of,” says Uzuegbunem. “Technology is having more of an influence in health care. From electronic medical records to the equipment nurses use. [Leaders] need to be able to adapt to these technological changes.”
While our sources have different opinions on how much education leaders need, one thing is certain: if you want to hold a leadership position, you must keep learning all the time.
“Nurses need to obtain additional education, certifications, and always continue to have a thirst for knowledge,” says Cornell. “A nurse leader should have, at minimum, a master’s degree in a focused area of nursing.” While she says other advanced degrees are helpful, one focused specifically on nursing “drives the objectives of nurse leadership and the shared experiences of nurse leaders. At the advanced leadership level—which includes directors and CNOs, they should have a doctorate. The terminal degree is a collaborative journey of nursing experience and leadership needed to facilitate a structured systems approach to patient care and organization of nursing teams.”
“A nurse aspiring a position in leadership should attain the highest level above what the unit or department requires,” suggests Moss. “Managing nurses who have higher credentials could lead to resentment or turnover as the staff nurse doesn’t see progression at the top. A unit should be led by the expert, in my opinion, the go-to person. This person should obtain the needed certification, education, and training to support this.”
Scott reminds nurses to check to see if the facility you work for provides funding for earning advanced education. “Many hospital groups will offer tuition reimbursement to qualified candidates, so you don’t have to go into deep debt to get this education,” she says.
Uzuegbunem believes that there’s no set educational path to leadership. “Depending on who you talk to, you’ll get different answers. Some will say that nurses should have at least a BSN before being able to get into leadership. I don’t. I also don’t think a certification is needed. All that’s required is a desire to lead others and a willingness to serve those you lead,” he argues.
Money, Money, Money
Besides the other skills, characteristics, and education that prospective leaders need, there’s another that many don’t consider—financial knowledge. Jane C. Kaye, MBA, president of HealthCare Finance Advisors, states that nurses in supervisory positions in all types of health care facilities need to have some financial skills. “The financial health of health care organizations depends on how well nurse leaders manage staff and supply costs. For example, salaries are the single largest expense line in any health care facility, and nurses represent the largest share of salaries. Similarly, nurses lead large departments such as surgical services, where supply costs are very high. If salary and supply costs are not managed, the sheer size of these spending areas can jeopardize the financial health of the health care entity,” explains Kaye.
According to Kaye, the types of financial skills nurse leaders need include: management of full-time equivalent staff, management of supplies, expense variance analysis techniques, knowledge of budgets, an understanding of operating statistics, and an understanding charge capture techniques so that all services performed are included on the patients’ bills.
For nurses who don’t have good math and finance skills, Kaye suggests that they find a trusted colleague in finance to help them understand financial concepts. “They should never be afraid to ask questions,” she says.
Attending webinars, seminars, and workshops on finance may also help.
A good way to prepare for a nursing leadership role, says Scott, is by taking on leadership roles outside of work. For those who want to become more confident speakers and grow in leadership presence, she recommends looking into Toastmasters, a national organization with chapters across the U.S. that help members learn to give great speeches.
Cornell says that networking is a must but can begin way before nurses are even considering leadership roles. “Knowing colleagues in the industry is always a plus, and it helps to learn what other nurses are doing. Volunteering for committees and sitting on boards are all great experiences, and nurse leaders should participate in these activities,” says Cornell. She cautions that doing this should be fine. If it’s not what the nurse is aligned with liking or doing then s/he will lose interest fast.
“Becoming part of committees and boards allows you to gain the experience and confidence you need to speak out on your opinions, work with different personalities, and see your strengths and weaknesses,” says Moss. “It can really show you what type of leader you naturally are.”
To prepare for taking a leadership role, Joseph suggests the following: reading professional journals, attending seminars, networking, joining LinkedIn, researching the role you want, reaching out to professional organizations for best practices, speaking to a mentor or someone who has made the transition, being proactive and enthusiastic about learning the intricacies of the new role, and being visible.
No matter what, being true to yourself is most important. “Being a leader is challenging, arduous, demanding, trying, and hard,” says Joseph. “But the joy of doing what you are born to do and have a passion to accomplish is indescribable.”
Evidence-Based Leadership, Innovation and Entrepreneurship in Nursing and Healthcare
This application-based text is designed to cultivate nursing and healthcare leaders who embrace the demands and opportunities of today’s health care environment, which is rooted in innovation.
Nursing education is the foundational pillar that enables future nurses to become competent and knowledgeable in their respective practices. This education was normally provided to nursing students through various didactic theoretical lectures and practical clinical training but recently, the use of advanced simulation technology as an adjunct educational tool has slowly become a significant addition to student centric learning.
History of Simulation
The concept of simulation practice can be traced back to the fields of military, aviation, and nuclear power (with military having used simulation the longest), dating back to the 18th century. Simulation was initially created as a cost-effective strategy for training professionals because it was considered exorbitant to train in these areas in the real world. As the years progressed however, the healthcare profession realized the practicality and usefulness of incorporating advanced simulation technology into educational practice and as a result, spurred the growing movement of simulation in healthcare training settings and educational establishments around the world.
The Impact of Simulation on Nursing Students
The emergence of computer technology has led to the development of innovative tools for healthcare professionals such as simulation technology and patient simulators Simulation technologies have had a profound effect on the nursing profession because it allows nursing students to apply their recently learned skills and knowledge to solve real life scenarios in a safe and structured setting.
In a typical simulation session, two students are often asked to participate and mimic the roles of a registered nurse or a certified nurse assistant (CNA). The rest of the remaining students are then asked to go to a separate room and observe the scenario through a one-way mirror and a live video stream. At the start of the session, the facilitator usually gives report on the patient, which allows the students to familiarize themselves with the patient’s situation, history, charts, and medications in order to successfully manage and implement high quality nursing care for the patient. As the simulation progresses, the facilitator controls the patient’s prognosis and provides cues to the team to enhance the realism of the situation. Once the simulation is completed, the students are then asked to head back to the debriefing room to discuss their experiences.
During the debriefing session, the students learn through self-reflection, group interaction, and questions asked by the facilitator. The use of group discussion engages students in reflective learning and enables the group members to consider a situation from multiple perspectives and consider other alternatives in order to broaden their scope of practice and clinical understanding. By performing simulation scenarios on a regular basis, students are able to develop better critical thinking skills, decision-making abilities, and application of theoretical knowledge in real-life situations.
Facilitating Simulation into Nursing Practice
According to the Institute of Medicine (IOM), approximately 98,000 people die every year from medical errors in U.S. hospitals, and a significant number of those deaths are associated with medication errors. This means that adverse events affect nearly 1 of 10 patients in the hospital setting. Based on this staggering number, the IOM called for a systematic change in healthcare practices and identified simulation practice as a resource to address the needed reform. By fostering experiential learning, simulation ingrains good nursing habits early, while discouraging bad nursing habits from forming before it becomes second nature.
In addition to allowing individuals to hone their nursing skills, simulation has also proven to increase student confidence and self-efficacy once they transition into the clinical setting. Nursing efficacy is an important aspect in nursing practice because it gives the students the confidence required to provide excellent nursing care to their patients. By incorporating what they have learned in simulation, more students are self-reliant in their capabilities, which are invaluable in ensuring that patient safety is implemented in the hospital setting.
Implications for Future Nursing Practice and Further Study
The shortage of availability of clinical sites is quickly becoming the norm for many nursing schools due to changing healthcare reform and the struggling economic crisis. One solution to combat the shortage of clinical sites however is to utilize simulation practice to replicate essential aspects of clinical situations for beginning nursing students. The National Council of State Boards of Nursing is currently conducting a landmark, longitudinal study to examine the knowledge and clinical competency outcomes of students when simulation technology is used in the place of actual clinical experiences. Although calls for additional research in these areas need to be performed, simulation is still quickly gaining momentum as the gold standard for effective learning practice in nursing education.
During the last three months, I had the opportunity and privilege to participate in a work program that collaboratively raises standards for learning and teaching, leading students to the highest levels of engagement and success. This was an eye-opening experience, allowing me to evaluate my own teaching practices in higher education and giving me additional tools to be more adventurous as I continue on with my role in academia.
Here are my five takeaways from the experience:
1. Make sure your students are actively learning enough.
Current evidence in higher learning no longer supports the effectiveness of sole lectures in the classroom setting. Instead, increase use of Active Learning Strategies (ALS) in the classroom setting to offer improved student learning and outcomes. Examples of ALS include: Minute Paper, Think-Pair-Share, Small and Large Groups, Role Playing, Storytelling, etc. One of the biggest student complaints with ALS is the idea that students are teaching themselves. When properly implemented, ALS helps to initiate learners and faculties into effective ways to help learners engage in activities that encourage deep learning.
2. Traditional “lecturing” still has a place in the classroom.
Many educators are considered the “experts” and offer a wealth of knowledge when they step foot in their classrooms. Most of us are familiar with traditional lectures in the classroom setting, where we had a professor “lecture” for hours in front of the classroom. However, many can argue that these professors are not necessarily “Sages on the Stage” but rather “Bores at the Board” for the majority of the time. Do not forget that higher education encourages educators to be more “Guides on the Sides” and become facilitators of student learning as they guide them from the sideline. Whichever method you choose to do in the classroom, you must be humble enough to accept if certain practices require tweaking for improvement.
3. Preparing the adult brain for learning: Evidence has shown that deep learning requires the adult brain learner to be primed.
But how does one prepare the brain to be at the optimal state in which the learner is alert and focused on learning? Several techniques have been noted to help students learn best, including but not limited to: Breathing Exercises, Nutrition, Music, Aroma, and Visualization. All these techniques work in various ways, but more importantly can help in how the adult brain is able to process information. How are you helping prepare your students for learning?
4. Technology belongs in the classroom.
Imagine a classroom without technology… For most of us, this can be very strange, as we are surrounded by technology on a regular basis. And our students are ALWAYS using technology, whether they are using laptops or tablets to take notes or their own personal devices (mobile phones) to stay in touch with their social media world. We must embrace that technology is here to stay, and figure out better solutions in including them in the classroom setting.
5. As educators, we must also be willing to learn (from peers and our own students).
Just because we have completed our studies and are now educators does not preclude us from learning new things. We must never cease to inquire and acquire knowledge. If anything, being an educator challenges us to be the best that we can possibly be for the students that we serve.
What has been your experience with student learning, both good and bad? Please share your own experiences, as I want to better myself as an educator. To be able to meet the students from where they are at, and take them on their own educational journey!
According to the American Association of Colleges of Nursing, only 2.1% of deans and directors are 45 years of age or younger. Further, according to the Robert Wood Johnson Foundation, a large percentage of senior nursing faculty members and Academic Nurse Administrators (ANAs) will retire over the next decade, and half are likely to retire by 2020. While experienced ANAs are retiring or resigning, formal mentoring for incoming Novice Academic Nurse Administrators (NANAs) remains relatively absent. Few nurses or nursing faculty fully grasp the complex responsibilities of this position. Typically, ANAs preside over the perpetual cycle of nursing student admission, academic progression, student attrition, and graduations. The specific roles and legal responsibilities of ANAs are outlined by each state in their state nurse practice act. Most programs are offered in community colleges or universities.
Regardless of the location or type of nursing educational program, ANAs are responsible for the majority of decisions made regarding the legal operations of these programs. Ultimately, ANAs are critical to the delivery, operations, and sustainability of nursing education and ultimately to the perseverance of the nursing profession. Unfortunately, formal nursing educational programs seldom address the daunting operational challenges that ANAs—and particularly NANAs—face when attempting to meet the expectations of this role transition. Consequently, vacancies loom across the nation, creating an urgent need for retention through formal mentoring.
Significant Challenges for ANAs
Experienced and novice ANAs are responsible for their nursing program’s state approval through accreditation. This lengthy endeavor requires at least one year of advanced preparation. State accreditation for pre-licensure nursing programs includes a program self-study and program evaluation, generally under severe time constraints. Accreditation topics under review include a total program evaluation plan, sufficiency of resources, appropriate administration, nursing faculty, nursing content experts, curriculum assessment, adequate clinical facilities, demonstration of student engagement, and a self-study summary. Additional responsibilities include monitoring the program’s National Council of Licensure Examination for Registered Nursing (NCLEX-RN) pass rates, sustaining student enrollment, maintaining nursing faculty stability, retaining program accreditation, and remaining fiscally sound despite varying degrees of institutional rigidity. Seasoned ANAs recognize that the terminal goal for each nurse graduate is to successfully pass the NCLEX-RN exam and thus earn state registered nursing licensure.
For ANAs, policymaking occurs continuously. Issues are brought to administration and faculty for exploration of the necessity to make or change policies to ensure that educational and nursing practice standards are current, and to change policies when they are not. Changes are also generated by requirements of affiliating health care agencies, university, college, and statewide policy recommendations that require extensive institutional buy-in and support. Many ANAs exert great efforts to receive institutional and faculty support in the operations of their nursing programs. A 2014 study in Nursing Education Perspectives found that among 242 ANAs, factors associated with job dissatisfaction included a lack of institutional support, mentorship, recognition, and respect. Furthermore, over a decade ago, it was reported that aging, bullying, and stress correlated with increased vacancies among all ANAs. In a current online survey of nursing faculty from 12 of the 15 highest-ranked universities, 22.5% reported not having a mentor, most (61.2%) found mentors on their own, and only 16.3% had formally assigned mentors. Overall, studies have revealed that the most helpful role transition experiences came from mentoring (53.5%), while (30.2%) came from work experiences, strongly indicating the need for formal mentoring.
Formal Mentoring Praxis
In Integrated Theory & Knowledge Development in Nursing, authors Peggy Chinn and Maeona Kramer define praxis as the integration of knowing: empirical, ethical, aesthetic, personal, and emancipatory concepts. In formal mentoring, experienced ANA mentors will apply their integration of knowing through mentorship of NANAs with the following conceptual guidelines:
Empirical: Use of a practical and pragmatic approach to mentoring
Ethical: Addresses the legal issues affecting nursing education
Aesthetic: Sharing of creative artistic diagrams, charts, and visual aids
Personal: Storytelling of lessons learned as an experienced ANA
Emancipatory: Supporting the independence and growth of the mentee
Critical Social Theory (CST) and NANA Mentoring
Critical social theorists aim to aid in the process of progressive social change by identifying not only what is, but also identifying the existing (explicit and implicit) ideals of any given situation and analyzing the gap between what is and what might and ought to be. In Advances in Nursing Science, P.E. Stevens identified six tenets of CST. Three of the six tenets of CST have important underpinnings to the praxis of leadership mentoring for NANAs. The first tenet examines the academic institutions’ social, political, and economic influence on the development of a formal NANAs mentoring program. The second seeks to reduce invisible oppressive institutional rigidity found in an academic environment while the third seeks to provide formal mentoring that emancipates and liberates the NANAs leadership potential.
Strategy and Implementation
Following the attendance of a formal mentoring workshop, ANAs would be assigned to mentor NANAs for one year. The three tenets of CST would serve as guides for the ANAs mentoring endeavors. Informed by CST and the praxis (integration of knowing), ANAs will share knowledge beyond empirics to more aesthetic, ethical, personal, and emancipatory patterns. The ANA mentor and NANA mentee would agree upon a formal mentoring schedule of two-hour weekly meetings to address specific nursing program director related topics, such as:
Faculty to Director Role Transition
Compliance with the State Nurse Practice Act
Program Directors Manuals/Handbooks
Maintaining State Program Accreditation
Writing of Policies and Procedures
Seeking Institutional Support
Handbooks (Student & Faculty)
Ethical and Legal Issues
Hiring and Orientation of New Staff and faculty
Collegiality Among Stakeholders
New Student Orientations
New Student Admissions
Student Essential Behaviors
NANAs Scholarly Expectations
Director & Faculty Professional Development
This formal mentoring program design aims to report positive post survey responses in job satisfaction and retention among NANAs. It is intended to create scholarly academic dialogue to explore the implementation of this mentoring model for NANAs. Future research and discussion will focus on the qualitative experiences of the ANAs mentors’ roles and NANAs mentees as participants. The provision of the CST as a framework for the praxis of formal mentoring guides ANAs in their mentoring endeavors. The success of a praxis leadership mentoring model can facilitate enhanced role transition and increased retention among NANAs.