Internal Leadership Program Reaffirms Nurses’ Contributions to Healthcare Redesign

One of the recommendations in the Institute of Medicine (IOM) Report, The Future of Nursing: Leading Change, Advancing Health (2010), was the importance of nursing leadership involvement in the redesign and delivery of healthcare. Bedside nurses who are prepared, nurtured and mentored as clinical leaders have the potential to transform healthcare.

Today, many bedside nurses at Cleveland Clinic have an opportunity to participate in a highly interactive clinical leadership course called LEAD. Nurses are selected by their chief nursing officers and clinical directors based on their enthusiasm, curiosity and passion for nursing. Participants are challenged to assume active leadership roles with patients, families and clinical colleagues.

“Many nurses don’t view themselves as leaders unless they are in a management position, but all nurses are leaders as a result of their interactions,” says LEAD program designer Mary Beth Modic, DNP, RN, CDE. “Patients look to nurses to alleviate their suffering, educate them on managing their chronic diseases, and help in navigating the complex healthcare system.” Dr. Modic is a diabetes clinical nurse specialist and Director of Advanced Clinical Practice in the Center of Excellence in Healthcare Communication at Cleveland Clinic.

LEAD has four major objectives:

• Orient nurses to their leadership potential for effecting change at all levels of care
• Introduce ways nurses can include elements of leadership in day-to-day patient care
• Describe real and perceived barriers to nurse leadership from bedside to boardroom
• Capture nurses’ voices on leadership in clinical care through personal storytelling about experiences with patients and families

Course development

“The course was born out of my desire to use the knowledge I gleaned as a doctoral student at the Frances Payne Bolton (FPB) School of Nursing, Case Western Reserve University in Cleveland,” says Dr. Modic.

In spring 2013, she received approval from Executive Chief Nursing Officer K. Kelly Hancock, MSN, RN, NE-BC, to create the program for Cleveland Clinic nurses in collaboration with Joyce Fitzpatrick, PhD, MBA, RN, a professor of nursing and former dean at FPB. Dr. Fitzpatrick mentored Modic and fellow Cleveland Clinic colleague and classmate Jennifer Van Dyk, DNP, RN, Director of Nursing Education, in facilitating a dynamic clinical leadership program.

“As facilitators, we have very different teaching styles, which allows participants to experience a myriad of approaches to problem-solving, advocacy and discovering their authentic voices.”

Course content includes:

• Explorations of personal influence
• Clinical leadership practices
• Nursing’s image and the public perceptions of our contributions
• The IOM report’s relevance to each participant’s career trajectory
• The effect of relationship-centered care on clinical outcomes
• The economic and policy influences on care delivery
• The impact of empathy and the REDE to CommunicateSM Model on relationship building
• The use of appreciative inquiry on problem-solving
• Transformational leadership characteristics in everyday practice

LEAD introduces nurses to what the IOM report envisioned as the central role of nursing leadership —to provide patient-centered, evidence-based care that results in improved health for the U.S. population.*

Modic describes the course as “unique in its design because it is predicated on a high level of participant interaction and the creation of a safe and trusting environment for personal disclosure.”

She goes on to say that the course provides abundant opportunities for self-reflection, which is rare in courses in continuing education. It also gives participants a chance to practice their communication skills and encourages professional networking by collaborating in small group projects.

Launching the program

The course was initially offered as a pilot to diabetes management mentors, an elite group of 34 bedside nurses with advanced education in diabetes inpatient management who had been working together for several years. Many were enrolled in baccalaureate or graduate education programs.

“Dr. Van Dyk and I were concerned that their enthusiasm for the program was influenced by their strong group identity. So we went on to make the course available to assistant nurse managers throughout Cleveland Clinic,” says Dr. Modic.

Assistant nurse managers spend about 70 percent of their time at the bedside and 30 percent in managerial activities, such as payroll and staffing. They are clinical leaders who are in a position to model skills such as empathy, reflective listening and appreciative inquiry for other nurses, Dr. Van Dyk explains. The response from this group of nurses has also been positive.

“After the first session ended, I couldn’t wait for the next session,” says Susan Biega, BSN, RN, a family health center clinical coordinator. Thomas J. LaMarca, BSN, RN, assistant nurse manager in invasive cardiology, says, “After each class, I brought back concrete opportunities to facilitate others in leadership roles.” Laura Dripps, BSN, RN, a clinical nurse and diabetes management mentor on a medical cardiology unit says, “I am exceptionally grateful for the opportunity to attend the program and for the insight it offers me and so many others.”

Group projects

Groups identified projects of interest that would meet a recognized need on their unit or within their institute. Examples of projects include establishing an online journal club, offering professional education programs on the night shift, empowering patients to be more proactive in the discharge process, and examining teamwork on the labor and delivery and postpartum units at one Cleveland Clinic regional hospital.

Each group is at a different phase of implementation of their projects, and some projects have evolved into nursing research proposals. In addition, participants were surveyed at the beginning of the course, at its conclusion and again three months post course using the Leadership Practices Inventory®. In preliminary results, there was a statistically significant improvement in the participants’ perceptions of the importance of leadership behavior and the frequency of demonstrated leadership behaviors from the beginning to the end of the course, which was sustained at the three month post-course mark.

LEAD is now being offered to two new groups of bedside nurses — an assistant nurse manager cohort and a bedside nurse cohort. “These new cohorts of nurses are embracing the LEAD concepts. They are eager to learn how to operationalize new knowledge in their everyday work,” says Dr. Modic.

Hancock has been encouraged by the response, saying, “The LEAD program is a wonderful way to support our rising leaders. We are ensuring that we hear their voices, recognize their contributions and develop our nurses for the future.”

*Summarized from The Future of Nursing: Leading Change, Advancing Health, published in 2010 by The National Academies Press.