Leadership Competencies and Attributes in Advanced Nursing Practice; an integrated review

Transcription

1 Leadership Competencies and Attributes in Advanced Nursing Practice; an integrated review Maud Heinen 1, Anita Huis 1, Hester Vermeulen 1, Catharina van Oostveen 2, Jeroen Peters 3, Radboud University Medical Center 1, Nijmegen, Spaarnegasthuis 2, Haarlem, University of applied Science 3 The Netherlands

2 Disclosure presenter

3 Leadership?

4 Management versus leadership

5 Management versus leadership* Management Administrating Planning To maintain Focus on system and structure Controlling Coordinating Communicating Rational Importance of expertise Leadership Innovating Vision Developing Focus on people Inspiring Guiding Role model Emotional Importance of trust *Ladkin 2015, Leadership Ch1

6 Nurse Leadership Elliot et al. 2017

7 Leadership fundamental in Care Fundamentals of Care Framework (FoCF); Feo, R., Conroy, T., Jangland. E., Muntlin Athlin, Å., Brovall, M., Parr, J., Blomberg, K., & Kitson, A. (2017); Kitson 2018.

8 Objective & Methods (1) Objective: To gain insight in leadership competencies and attributes expected of the Master level educated nurse (APN/CNL) from an international perspective Design: Integrated Review Design Ø Databases; CINAHL, Embase and Medline Search strategy; leadership, nursing, nurses role, professional role,.. Ø Websites of international professional nursing organizations

9 Objective & Methods (2) Inclusion; Countries; Europe, North America, Australia January 2005 December 2016, studies of varied designs, describing competencies Exclusion; editorials, management, leadership styles, governance Independently assessed; studies and frameworks, competencies, synthesis

10 Leadership domains Clinical Professional Health Policy Health System Hamric et al. 2014

11 Results Literature search Hits: 3099 o duplicates: 1045 Screened tiab:2045 o excluded:1891 Full text:161 o not available 21 o excluded 130 Included: 10

12 Included studies Author Year Title Design Country APN / CNL Ailey et al Educating nursing students in clinical leadership Case study in 22 master students USA CNL Bahouth et al Centralized resources for nurse practitioners: common early experiences among leaders of 6 large health systems Survey & focus group discussions USA APN Bearnholdt et 2011 The Clinical Nurse Leader - new nursing role with global implications Descriptive; CNL role education USA CNL al. Carryer et al The core role of the nurse practitioner: Practice, professionalism and clinical leadership Interpretive synthesis multiple data sources New Zealand / Australia APN Gardner et al Nurse practitioner competency standards: findings from collaborative Australian and New Zealand research Interpretive synthesis multiple data sources Gerard et al Course strategies for clinical nurse leader development Qualitative / education development Leggat et al Developing clinical leaders: the impact of an action learning mentoring Pre-post intervention program for advanced practice nurses longitudinal Australia / New Zealand Maag et al A Conceptual Framework for a Clinical Nurse Leader Program Descriptive USA CNL USA Australia APN CNL APN Nieminen et al Advanced practice nurses' scope of practice: a qualitative study of advanced clinical competencies Kalb et al A competency-based approach to public health nursing performance appraisal Qualitative Finland APN Review & piloting assessment tool USA APN

13 Included Frameworks Author Year Title Short description Country APN / CNL ICN 2015 International Council of Nurses Leadership For Change (LFC) program Leadership competencies & roles are focused on 3 strategic aims and include 11 defined outcomes Europe CNL ANMC 2014 Nurse practitioner standards for practice The leadership domain is couched within the clinically focused standards. NONPF 2014 A delineation of suggested content specific to the NP Leadership is 1 of 9 domains, the leadership domain core competencies, itself includes 7 competencies Australia United States APN APN AACN 2013 Master s Essentials and Clinical Nurse Leader Competencies The Master s Essentials & Clinical Nurse Leader Competencies are imbedded in 9 domains. Core leadership competencies are mainly described in the essential Organizational and Systems Leadership. United States CNL CNA 2010 Canadian nurse practitioner core competency framework Leadership competencies within the category Professional Role, Responsibility and Accountability Canada APN AACN 2006 The Essentials of Doctoral Education for Advanced Nursing Practice, Leadership competencies and roles are imbedded in eight domains United States APN

14 Results Ten studies and six frameworks 97 leadership competencies Synthesized to 29 core competencies o within the clinical, professional, health systems and health policy leadership domains (Hamric et al. 2014).

15 Synthesis in leadership domains Clinical (n=8) Clinical, Systems & Policy (n=2) Health Policy (n=2) Professional (n=6) Clinical & Systems (n=2) Health Systems (n=8) Professional & Systems (n=1)

16 Results: Synthesis to 29 competencies A. Clinical leadership I. Assumes as a clinical expert, a leadership role in establishing and II. monitoring standards of practice to improve client care Collaborates with healthcare professionals, to plan, implement and evaluate an improvement opportunity B. Professional leadership I. Participates in professional organizations and activities that influence advanced practice nursing II. Assumes responsibility for own professional development by pursuing education, participating in professional committees and work groups

17 Results: Synthesis to 29 competencies C. Health systems leadership I. Contributes to development, implementation, and monitoring of II. organizational performance standards Assumes a leadership role of an inter professional healthcare team with a focus on the delivery of patient-centered care and the evaluation of quality and cost-effectiveness across the healthcare continuum D. Health policy leadership I. Guides, initiates and provides leadership in policy-related activities to influence practice, health services and public policy II. Articulates the value of nursing to key stakeholders and policy-makers

18 Synthesis combined competencies (5/29) E. Clinical, Health Systems and Health Policy I. Provides leadership in the evaluation and resolution of ethical and legal issues within healthcare systems relating to the use of information, information technology, communication networks, and patient care technology.

19 Knowledge, skills and attributes o The APN/CNL has knowledge of Legal and ethical dimensions of practice, policy directives and best practice guidelines that influence their own practice o The APN/CN show skills to Apply evidence-based practice, research/ standards of practice o The APN/CN is...(attributes) collaborative in issues that bridge nursing and medicine

20 Discussion ü 97 APN /CNL leadership competencies identified àsynthesized to 29 in four domains, only two in the health-policy domain ü Lack of quality studies on leadership competency (development) ü Clinical and professional domains most used, but not in a coherent way ü Thorough, independent assessment of competencies & domains ü Knowledge, skills and attributes relate to different competencies; attributes appear difficult to define

21 Conclusion This study identified 29 core leadership competencies for APNs and CNLs. Next steps: identifying gaps in the leadership domains more health-policy competencies needed? linking Knowledge Skills and Attributes to each of the core competencies Ø Developing and evaluating Evidence Based Leadership programs for APN/CNL to take their role