E d u c a t i o n a l i n n o v a t i o n s

AbstrActthis article explains the develop-

ment of a value-added leadership fo-cus to a graduate nursing program. With the changes to and complex-ity within the health care system, advanced practice nurses need aca-demic preparation in advanced care management of populations and leadership competencies. strategic environmental scanning suggested that some revisions could better pre-pare future nurse leaders. through literature review and focus groups, facultys analysis provided evidence for development of a different kind of advanced practice nurse. this pro-cess led to a graduate program that prepares nurse leaders who are com-petent in the clinical settings and leadership roles of todays health care organizations. the 40-semester hour program allows flexibility for minimum career disruption and a choice of tracks to accommodate indi-viduals educational needs. Grounded

in practicum experiences and guided by health care theory, policy, and re-search, graduates possess the knowl-edge and competencies to assume the advanced leadership roles required in future health care systems.

although a school of nursing at a southeastern university had a successful primary care nurse practitioner program since 1996, a strategic environmental scan indi-cated the need for a non-nurse prac-titioner program designed to prepare nurses for other types of advanced practice roles. the university, located in one of the most rapidly developing areas of the nation, serves a large, di-verse student body drawn principally from the metropolitan area and a few surrounding rural areas. the nurse practitioner program has maintained a strong recruitment and retention fo-cus, with approximately 40 students admitted each fall. Graduates of the nurse practitioner program demon-strate pass rates of 98% to 100% on national certification examinations and employment placement rates of 100% as nurse practitioners. the programs alternate-weekend class schedule and geographically conve-nient practicum site assignments are cited as strengths by the programs graduates.

through review of the evaluations of the current graduate nursing pro-gram and an assessment of its gradu-ates and other nursing leaders in the community, faculty identified an increasing need in the local health care community for advanced practice nurses who could provide leadership

and care management for popula-tions in a variety of health care set-tings. these advanced practice nurses would possess the knowledge, skills, and competencies necessary to suc-cessfully navigate the ever-increasing complexity of todays health care en-vironment. the purpose of this article is to describe the processes used in developing a new focus for the gradu-ate nursing program that included curriculum design and pedagogy, pro-gram implementation, and evaluation strategies.

Literature reviewa call continues to be issued for

preparation of nurses with advanced clinical and conceptual competen-cies in care management, ethical and value-based decision making, and leadership. in Health Cares Hu-man Crisis: The American Nursing Shortage, Kimball and oneil (2002) reported that the current model of nursing practice requires change to address the structural nursing short-age that exists in this country. the authors called for a re-envisioning of the nursing profession, with creation of new nursing practice models. they also suggested that nursing educa-tion and health care environments be reinvented to address the needs and values of the next generation of nurses. various authors continue to propose a new model of nursing lead-ership to handle the challenges and complexities of the ever-changing health care system (Barker, sullivan, & Emery, 2006; Boyatzis & McKee, 2005; Kerfoot, 2006; McGuire & Ken-nerly, 2006; nickitas, Keida, nokes, &

The Development of the Next Generation of Nurse Leaders Kathie A. Aduddell, EdD, RN; and Genie E. Dorman, PhD, APRN, FNP-BC

Received: May 7, 2008Accepted: February 4, 2009Posted: November 25, 2009Dr. Aduddell is Associate Professor, Well-

Star School of Nursing, and Director, Center for Community Health Care, WellStar Col-lege of Health and Human Services, and Dr. Dorman is Professor of Nursing, WellStar School of Nursing, Kennesaw State Univer-sity, Kennesaw, Georgia.

Address correspondence to Dr. Kathie A. Aduddell, EdD, RN, Associate Professor, Kennesaw State University, 1000 Chastain Rd. #1601, Kennesaw, GA 30144; e-mail: kaduddel@kennesaw.edu.

doi:10.3928/01484834-20090916-08

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neville, 2004; Porter-oGrady & Mal-loch, 2003; senge, scharmer, Jawor-ski, & Flowers, 2004).

nurse leaders need to thrive and embrace change as they effectively and efficiently guide their organiza-tions through turbulent and chaotic times (Porter-oGrady & Malloch, 2003). a new era of resonant lead-ers is emergingleaders who inspire organizations, are mindful, and in-still hope (Boyatzis & McKee, 2005). this new era of leadership requires presence, a skill process of suspend-ing, redirecting, letting go, letting come, crystallizing, prototyping, and institutionalizing in order to create transformation (senge et al., 2004). competencies must be framed around complexity science and leaders must have proficiency and comfort with the ever-evolving technology and inter-personal and intrapersonal abilities, such as coaching employees, manag-ing a team of colleagues, educating coworkers, managing conflict, and caring for self (Porter-oGrady & Mal-loch, 2007).

according to Kerfoot (2006), in our 21st century world:

the successful leader and man-ager have two very important chal-lenges: to scan the horizon and not be thrown into crisis by not seeing predictable surprises, and to rec-ognize the longer, more pervasive trends that are in the distant future (pg. 47). Kerfoot suggested competencies in

developing an annual plan that incor-porates four parts:

l Review any changes in the or-ganizations plan.

l determine changes required from an annual autopsy.

l Review goals already outlined in the long-range plans for the com-ing year.

l alter the plan based on evi-dence so as to avoid predictable sur-prises.

the leaders of the 21st century must envision new and different re-alities and futures. of critical impor-tance is the emotional competence required as one functions in a leader-ship role that focuses on facilitating the transition to a new way of living

and working in the 21st century (Porter-oGrady & Malloch, 2003, p. 21).

various reports and articles call for specific requirements in the develop-ment of graduate programs for nurse leaders (Bleich et al., 2003; Hanson & Hamric, 2003). trends on the type of leader required are well documented in various publications (american col-lege of Healthcare Executives, 2005). in preparing nurse leaders, cardin and Mcneese-smith (2005) stated that the goals of an effective nurs-ing administration graduate program must be to produce graduates who can lead others, and who will make a positive difference to patients, staff, and organizations (p. 154). the emer-gence of new advanced practice spe-cialties need to be deliberately shaped to posses core competencies that are standardized and meet national certi-fication and regulation requirements. unfortunately, senge et al. (2004) in-dicated that we often see the world through our own mental models and have a difficult time suspending these models to envision new and different realities and futures. as we plan for new realities, academic and service partnerships are essential to prepare leaders who are innovative, adapt to the changing workplace, and integrate the new set of competencies to assure nursing efficiency, patient safety, and quality of care.

in summary, the review of litera-ture provided evidence of the need for new competencies. in light of this review, faculty conceptualized an ad-vanced practice role that incorporates components of the various advanced practice specialties, as well as estab-lishes a possible career-track path-way for more individuals obtaining a doctorate in nursing. the new com-petencies inherent in the role include the following:

l care management and leader-ship.

l information and health care technology systems.

l Research process and evidence-based practice.

l Human resource use.l conflict resolution and negotia-

tion.

l advanced assessment and dis-ease management principles.

l teaching-learning strategies and curricular patterns.

l Health policy and health sys-tems thinking.

Initial Program Developmentthis university provides strong

undergraduate and graduate educa-tion programs that prepare students for advancement in their chosen pro-fessions. this preparation includes critical thinking, effective communi-cation and interpersonal skills, lead-ership development, social responsi-bility, and lifelong learning. Faculty inculcated these concepts through the process of program development. the Master of science in nursing, ad-vanced care Management and lead-ership program needed to be built around these concepts to contribute to the universitys mission, as well as to the enhancement of health care institutions in the community. the initial stage of program development consisted of the three phases.

the first phase involved focus sur-veys with surrounding health care institutions through advisory boards and meetings with nurse leaders. the findings of these surveys and meet-ings indicated that nurses did not have an adequate understanding of the policy, power, financial, and care management issues inherent in to-days health care environment.

a second phase involved inter-views with interested faculty who had expertise in specific curricular areas. the faculty were invited to partici-pate in exploring the possibility of a new focus in the graduate programs at the university and the design of a new curriculum. a component of this development also included ana-lyzing and incorporating nationally recognized nursing education stan-dards within the curricula. From the beginning, the program developers subscribed to such standards as the american association of the colleges of nursings (aacn) The Essentials of Masters Education for Advanced Practice Nursing (1996) and to the national association of clinical nurse

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specialists (nacns) Statement on Clinical Nurse Specialist Practice and Education (1996).

the final phase of the program development involved a consultation and collaboration process with other university graduate programs. Be-cause the literature review indicated the need for curricular instruction in team building, conflict management, human resource focus, and manage-ment skills, input was sought from faculty in the universitys Executive Masters in Business administration Program and the Masters of science in conflict Management Program. input from these focus groups led to the development of collaborative partnerships between the programs, as described in the curriculum design below. a second part of this phase also included consultation with a nation-ally recognized expert on leadership in nursing, which led to further re-finement of the curriculum design.

curriculum Designthe next stage of program devel-

opment consisted of the curriculum design, which included the develop-ment of specific courses and course sequencing to achieve the overall pro-gram goal of preparing experienced professional nurses for leadership roles in advanced care management in various health care settings. the curricular design focused on three major areas that provided a frame-work for course development based on standards, competencies, and student needs. these three areas included:

l core advanced practice nursing knowledge (assessment, professional role, pathophysiology, pharmacology, nursing and health care theory, re-search).

l Ethical leadership and health policy, with global application in health care systems.

l Principles of evidence-based practice and leadership in advanced care management.

Review of graduate curriculum re-quirements from aacn and nacns resulted in the development of the fol-lowing core courses: advanced Health assessment, Health Maintenance,

and Health Promotion; Pharmacol-ogy for advanced Practice nursing; Pathophysiology for advanced Prac-tice nursing; Professional advanced Practice Role development and Health care issue; Healthcare the-ory, and Research application and outcome Evaluations in advanced Practice nursing. these courses are taught jointly to students in the Pri-mary care nurse Practitioner Pro-gram and the Masters in advanced care Management and leadership Program to maximize the use of re-sources.

a review of the american nurses associations Code of Ethics for Nurs-es with Interpretive Statements (2001) and the Scope and Standards of Ad-vanced Practice for Registered Nurses (1996) resulted in the development of the following courses: Ethics of lead-ership for advanced Practice nurs-ing, and advanced care Management leadership Practicum. in addition, the literature review demonstrated the need to include a course on health policy and finance. these courses em-phasized ethical leadership, health systems, and health policy in client care situations and from a global per-spective.

Finally, work by tanner (1998; 1999) and Youngblut and Brooten (2001) provided a framework for es-tablishing a strong foundation of evidence-based practice principles. For this reason, the research, ad-vanced care management, and lead-ership courses were designed to focus on evidence-based practice and out-comes linked to patient safety and quality care. these courses included advanced care Management Models, Research applications and outcome Evaluations in advanced Practice nursing, analytical Business ap-plications and leadership skills for advanced Practice nursing, and ad-vanced care Management Project.

Evaluation strategiesthe school of nursing uses the uni-

versitys assurance of learning model that is based on outcome evaluation strategies. the program also adheres to the requirements of the commis-

sion on collegiate nursing Educa-tion and the american nurses cre-dentialing center (ancc, 2009) for graduate programs and certification eligibility. the curriculum design pro-vides for appropriate practicum expe-riences to allow students to apply for specific national certification. in ad-dition, the program has specific out-comes based on curriculum foci and graduate competencies and skills. an example of this process relates to the curriculum focus of budgetary and fis-cal knowledge. after completion of the program, students have acquired the knowledge and skills needed to over-see budgets and participate in the fi-nancial planning process. another ex-ample concerns the curriculum focus of health systems and health policy. upon graduation, students possess the knowledge and skills needed to analyze current health care delivery models and systems, as well as the dynamics of health policy develop-ment.

another aspect of the evaluation process is the opportunity for stu-dents, alumni, and the graduates em-ployers to provide ongoing feedback to the program. students are given the opportunity to evaluate the pro-gram while they are enrolled and at the time of graduation. as alumni, they are asked at 1-year, 3-year, and 5-year intervals to complete program evaluations. Employers of the gradu-ates are also asked to evaluate the program at 1-year, 3-year, and 5-year intervals. as faculty and adminis-trators reviewed the initial program evaluation data provided by students, specific changes were implemented (i.e., the addition of a second research course and the delineation of specific curricular tracks). documented ben-efits of the program from alumni and employers indicated that many of the graduates are obtaining promotions to leadership positions.

conclusion the Master of science in nurs-

ing in advanced care Management and leadership Program incorpo-rates several innovative strategies, as evidenced in literature and envi-

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ronmental scanning, to ensure the development of the next generation of nurse leaders while building on existing strengths and opportunities of an already existing graduate nurs-ing program. the program prepares graduates to be expert clinicians and outstanding leaders equipped to man-age and improve client care outcomes. students have the opportunity to fo-cus their studies in a particular area of interest via the practicum courses, which provide an overall value-added educational experience. they can cus-tomize their educational experiences to best meet their learning needs and overall professional goals.

other value-added experiences in-clude geographically diverse opportuni-ties for practicum experiences, clinical experts, and facilities, as well as the opportunity to participate in practi-cal experiences in the community. the delivery model of the program allows students to complete advanced prac-tice education with a minimum of ca-reer disruption. the 40-semester hour cohort program provides the flexibility of online and alternate-weekend class delivery and is built around core gradu-ate courses with the fluency of tracks to accommodate individuals educational needs. Grounded in clinical practice and guided by health care theory, policy, and research, graduates possess knowl-edge and competencies to assume the advanced leadership roles required in future health care systems.

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american nurses association. (2001). Code of ethics for nurses with interpretive statements. Washington, dc: author.

american nurses credentialing center. (2009). ANCC Nurse Certification Re-quirements. Washington, dc: ana. Retrieved 9/14/09 from http://www.nursecredentialing.org/certification.aspx

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cardin, s., & Mcneese-smith, d. (2005). a model for bridging the gap from theory to practice to reality. Nursing Adminis-trative Quarterly, 29(2), 154-161.

Hanson, c.M., & Hamric, a.B. (2003). Re-flections on the continuing evolution of advanced practice nursing. Nursing Outlook, 51(5), 203-209.

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