Post on 21-Jun-2020
Running head: SYNTHESIS PAPER 1
Clinical Practicum Synthesis Paper
Stephanie Adamczyk
Ferris State University
SYNTHESIS PAPER 2
Abstract
A clinical practicum was designed and completed in order to gain more knowledge and
experience related to the nurse administrator role. The practicum contained experiences that
furthered the knowledge related to nurse administrators' responsibilities in planning, resource
utilization, collaboration, and evaluation. These experiences included working on the Baby-
Friendly initiative and completing a practicum project. The practicum project was completed
using Kotter's Change Theory. Upon the completion of the practicum an evaluation was
completed to determine the effectiveness of the practicum.
Keywords: nurse administrator, Kotter’s Change Theory, Baby-Friendly, planning,
resource utilization, collaboration, and evaluation.
SYNTHESIS PAPER 3
Clinical Practicum Synthesis Paper
The nursing profession is lacking in the number of leaders needed to well represent nurses
(White Cumming, 2011). As a result, nurses step into leadership roles without proper education
and training, leaving these leaders unable to adequately lead nursing teams (White Cumming,
2011). Sherman and Pross (2010) discuss that current nurse administrators must advocate for
increased training and education related to leadership skills. It is through the final practicum of
my Master's in Nursing Program that I advocated for more experience and education related to
nursing leadership. This practicum allowed me the opportunity to gain more experience related
to important leadership skills such as, planning, resource utilization, collaboration, and
evaluation (American Nurses Association (ANA), 2009). The purpose of this paper will be to
discuss the project completed during the practicum, the leadership skills gained through meeting
practicum goals and objectives, the identification of issues that arose during the practicum and
the management of these issues, and to evaluate my performance during the practicum.
Practicum Project and Kotter's Change Theory
The project portion of this practicum was done by utilizing Kotter's Change Theory.
Kotter developed an eight step change model to help nursing leaders implement change and
avoid resistance to change from staff (Stoller, 2010). The first step of this change model is to
identify an area in need of improvement and communicate to staff members about the need for
change (Kingston, 2013). Once the issue has been identified nurse administrators should identify
key stakeholders and create a team that will help to develop a plan for change. This team will
create objectives and a vision that will be communicated to staff to ensure their understanding of
the upcoming change. The change should be implemented in steps to allow staff members to
adjust to the new process. Nurse administrators should also celebrate short-term wins with staff
SYNTHESIS PAPER 4
members to empower them to keep making necessary changes. Finally, nurse administrators
complete the implementation and evaluate staff performance to determine if the change has been
effective (Kingston, 2013). The following will review how the practicum project was completed
using Kotter's Change Theory.
The project portion of this practicum was completed within the Women's Health and
Infant Services department at Spectrum Health. This department is home to four nursing units,
which provide services to women with special risk pregnancies, women and infants during the
postpartum period, and women's health patients. In addition, Spectrum Health is the largest baby
delivery center in Michigan. With the aid of the Neonatal Intensive Care Unit, this department
helps care for nearly 7,400 babies a year (C. Pries, personal communication, January 13, 2014).
The Women's Health and Infant services department purchased new hearing screen machines in
July 2013 and has experienced an increase in hearing screen failures or referrals since then. As a
result, the department’s leadership team was considering changing their practice related to infant
hearing screens. Initially the hearing screen process called for the department's nursing assistants
to conduct the hearing screen at least 12 hours after birth and before the infant was discharged
from the hospital. If the patient referred their initial screen they would be screened again prior to
discharge. This process was time consuming for the nursing assistants and causing a decrease in
staff satisfaction. Therefore, department leadership was considering outsourcing the hearing
screen process to Pediatrix. Pediatrix provides services to maternal-fetal, newborn, and pediatric
patients nationwide. In addition Pediatrix is one of the leading providers of infant hearing
screens (Pediatrix Medical Group, 2014).
Improving the infant hearing screen referral rate was identified as the need for change for
the practicum project. Ms. Christina Pries, practicum preceptor and I were identified as the
SYNTHESIS PAPER 5
leaders of this project. The audiology department, department leadership, and department staff
were included in the list of key stakeholders. The plan for this project began through shadow
experiences. I shadowed in the audiology department to identify best practices related to the
infant hearing screen process. I also shadowed nursing assistants in the Women's Health and
Infant services department. Shadow experiences are an informal way for nurse administrators to
evaluate the performance of their staff and determine if there is a need for change or if current
processes are working well (Yee, Needleman, Pearson, & Parkerton, 2011). This allows for
interaction with the staff and for instant feedback that can be used when creating a plan for
change (Yee et al., 2011). These experiences allowed me to identify barriers to completing
hearing screens and to begin formulating a plan for change.
During the shadow experience it became very clear that there is significant variation in
how the hearing screens are done. Therefore, it was determined that a standardization of the
process should be done. Standardization of work helps to ensure that healthcare professionals are
utilizing best practices and providing continuity of care (Bohmer, 2010). By standardizing work
healthcare organizations can improve patient outcomes and decrease costs (Bohmer, 2010). This
standardization would help to ensure that nursing assistants are using the best practices when
completing the infant hearing screen.
Once the standardization was complete approval from key stakeholders was needed. I
attended a leadership meeting to present the standardization to this team first. Collectively we
reviewed the standardization and made changes as needed. Once leadership approved the
standardization I shared the proposed process with the staff at a Shared Leadership meeting. This
allowed me to present the information prior to the actual implementation.
SYNTHESIS PAPER 6
Once the proposed change was introduced to staff members, in-services were scheduled.
The staff in-services included multiple learning techniques to allow for learners to process and
apply the information presented during the in-service (Bluestone et al., 2013). I felt that I should
first discuss why the changes were occurring and then present the standardization. I planned to
go through each step of the standardization and then have the learner repeat the standardization. I
would then provide feedback about their performance. Feedback during in-services is a useful
technique to help clarify the new information and ensure that the learner has a clear
understanding of the information (Bluestone et al., 2013). I also planned to end the in-services
with a quiz to ensure the learners correctly understood the information after it was presented and
we discussed it.
Once in-services were complete I performed audits to determine if the standardization
was becoming part of the department’s culture. When implementing change it is important to
ensure the process has become part of the department's culture. However, ensuring the change
has become part of the department or organization's culture takes time (Kingston, 2013). When
new processes are implemented there will be a need for behavior changes among staff members.
Nurse administrators must observe staff members for the new behaviors. Audits are a beneficial
tool that allows nurse administrators to track and assess the progress of newly implemented
behaviors (Yee et al., 2011). When the majority of staff members are consistently performing
the new behaviors, the new process is considered to be part of the department or organization’s
culture (Carter, Sullivan, Goldsmith, Ulrich, & Smallwood, 2013). While the most of the nursing
assistants demonstrated the new behaviors not all of them did. Therefore, more audits will need
to be completed to ensure the nursing assistants are consistently demonstrating the use of the
standardization process.
SYNTHESIS PAPER 7
Review of Practicum Goals and Objectives
Prior to beginning this practicum a proposal outlining the practicum's goals and
objectives and plan to fulfill them was created. The following will briefly review the practicum's
goals and objectives and identify how they were fulfilled throughout the practicum.
Scope and Standards of Practice 4: Planning
According to the ANA (2009) nurse administrators must be able to develop unique plans
for each situation they are presented with. Nurse administrators must be able to identify a need
for change and create urgency within their organization to make the change. A nurse leader must
be able to identify the key stakeholders and utilize them to create an action plan. Nurse
administrators must be able to work with team members to develop plans to ensure the plan will
work for all stakeholders. While working with a multidisciplinary team, the nurse administrator
must incorporate current trends and research into plans to ensure changes in practice will be
based on the most current information. Once a plan is developed the nurse leader must work with
the multidisciplinary team to implement the plan. Continued attention to the implemented change
is needed to ensure the success of the change and to address unexpected issues.
It is through the practicum project that I gained experience related to planning. With the
aid of my preceptor I was able to identify the infant hearing screen referral rate as a need for
change. I identified the key stakeholders and utilized them throughout the planning process.
Through the shadow experiences I was able to collect information related to best practices and
incorporate that information into the plan. Once a plan was developed, key stakeholders
reviewed the plan prior to implementing the change. Once the plan was implemented I aided in
the evaluation process to determine if the plan was effective. This experience allowed me to
become more confident in my planning and implementing skills. I now have a better
SYNTHESIS PAPER 8
understanding of all the steps necessary to successfully implement change in a healthcare
organization.
Scope and Standards of Practice 12: Collaboration
Nurse administrators are responsible for the day-to-day operations, quality of care
delivered, and goal attainment for their area of practice (ANA, 2009). By collaborating with all
levels of nursing staff, interdisciplinary teams, executive leaders and other key stakeholders,
nurse administrators are able to create, implement, and evaluate plans that help them to fulfill
these responsibilities (ANA, 2009). When nurse administrators feel comfortable working with
nursing staff, interdisciplinary teams, and executive leaders they are more satisfied in their work,
remain in their leadership position, and play a more vital role in the decision making process
(Abraham, 2011). Therefore, it was important that this practicum included opportunities
that allowed me to gain experience related to collaboration.
I was able to gain experience related to collaboration through the completion of the
practicum project. This project required me to work with a variety of organizational staff in order
to complete the project. These individuals included clinical staff, staff from the audiology
department, technical support from the hearing screen machines, equipment managers, and the
leadership team. Through my interaction with these people I gained confidence in my ability to
communicate effectively with a multidisciplinary team. This experience will be a great benefit in
future leadership roles. I will have a greater knowledge of communicating with individuals from
different departments that I may not be familiar with.
Scope and Standards of Practice 14: Resource Utilization
According to the ANA (2009) nurse administrators should find innovative solutions to
utilize resources. Resources should be utilized in a way that maximizes safety, efficiency,
SYNTHESIS PAPER 9
financial responsibility, and quality. The manner in which resources are utilized should also be
evaluated to ensure that current processes are the most efficient and effective way to provide
patient care.
It is important for nurse administrators to have a clear understanding of resource
utilization. This knowledge is necessary to effectively lead in healthcare organizations. Through
the completion of the practicum project I was able to gain experience and knowledge related to
resource utilization. The hearing screen project allowed me to evaluate a current process that was
not utilizing resources to the fullest. By creating a plan and implementing it I was able make
improvements in how resources were being utilized.
I also gained experience related to resource utilization by working on the Baby-Friendly
initiative. Baby-Friendly is a designation that is granted to healthcare organizations that promote
and support breastfeeding and mother-baby skin to skin interactions (Schoenfelder et al., 2013).
In order to receive this designation healthcare organizations must create and implement a
breastfeeding and skin to skin policy. This policy should include the promotion of education
related to the benefits of breastfeeding, facilitate breastfeeding within one hour of birth, stress the
importance of keeping newborns in the room with mothers after birth, and promote skin to skin
interactions during the hospital stay. Healthcare organizations should also provide discharge
information related to support with breastfeeding once discharged from the hospital and educate
families that they should not use formula or pacifiers while breastfeeding . Healthcare
organizations are also responsible for providing staff with education so that they can effectively
provide patients with the care and education laid out in the policy (Schoenfelder et al., 2013).
In order, to receive the Baby-Friendly designation, Spectrum Health has implemented a
breastfeeding policy and several new initiatives to support breastfeeding. As part of the
SYNTHESIS PAPER 10
implementation of Baby Friendly patient audits need to be completed. Audits are an effective
tool for ensuring that staff members are making the required changes and have the tools
necessary to complete the change (Semenic, Childerhose, Lauziere, & Groleau, 2012). Audits
also allow for leadership to provide feedback about staff performance (Semenic et al., 2012). By
completing patient audits I was able to help ensure that resources were being utilized effectively
and that the quality of care was meeting the standards of the Baby-Friendly initiative.
Scope and Standards of Practice 6: Evaluation
Nurse administrators must be able to implement change and monitor it to ensure its
success in the healthcare environment. Evaluation should be a done throughout the
implementation process to determine what is working and what needs to improve (Kingston,
2013). By doing this it allows the project stakeholders to address issues as they arise and create
action plans quickly to resolve barriers to implementing the change (Schaffer, Sandau, &
Diedrick, 2012).
By completing the hearing screen project I was able to implement a change and then
evaluate the new process to determine if the change had a positive influence on the infant hearing
screen referall rate. I completed the evlaution phase by shadowing nursing assistants to
determine if they were able to carry out the new hearing screen process. This also allowed me to
provide feedback to help nursing assistants improve the process. I also monitored the hearing
screen referall rate. The referall rate was 5.5% prior to starting the implementation phase and
decreased to 4.2% after implementation was complete. The evlauation phase will need to
continue to ensure the new process has become part of the departments' culture and to ensure that
the new process continues to decrease the referall rate.
SYNTHESIS PAPER 11
Management of Practicum Challenges and Ethical Implications
Leach and McFarland (2014) define leadership development as professional development
that improves the effectiveness of leadership skills. Leaders often learn the most valuable skills
through experiences. Challenging experiences allow leaders to handle a situation and then reflect
on how it went. This reflection will allow the leader to determine how they would handle it in the
future, allowing them to become more effective leaders. Issues arose throughout this practicum
that required me to revise me expectations and create a new plan. However, these issues acted as
a valauble learning tool and allowed me to gain further knowledge related to leadership. The
following will review issuses from the practicum experience, the ethical implications, and the
management of these issues.
Budgetary Concerns
When planning for the project portion of this practicum I anticipated evaluating the
current hearing screen process and determining if the process could be improved or if the process
should be outsourced to Pediatrix. Determining if the process should be outsourced would have
provided me with more experience related to budgeting and finances. However, due to budgetary
concerns outsourcing the hearing screen process was no longer a financially viable option
because it would be a loss of revenue for the organization.
According to the ANA (2009) nursing leaders must be able to optimize fiscal resources to
ensure that patients are receiving safe, quality, and up-to-date care in their area of practice.
However, fiscal resource management is becoming more difficult as health care costs continue to
increase and reimbursements for services decrease (Gurtner, 2014). This is causing health care
organizations to make budgetary cuts which may negatively affect the quality of care that
patients are receiving (Gurtner, 2014). This causes an ethical dilemma for nursing administrators
SYNTHESIS PAPER 12
who are being forced to improve patient outcomes with fewer staff members and less financial
resources (ANA, 2009). Nurse administrators must work to create solutions that will improve
patient outcomes with the resources available to them (ANA, 2009). Therefore, it is important
for nurse administrators to have a strong understanding of their fiscal resources and how they are
distributed throughout their area of practice.
This experience allowed me to observe that even when a change may benefit the quality
of care being delivered to patients it might not be the best option for the organization. Therefore,
it is important for nurse administrators to have a strong understanding of their resources to
improve the quality of care within their means. While outsourcing was not an option, improving
the current process with current resources was. This allowed me to recognize that it is important
to effectively communicate with staff members when there is a need for change. When staff
members have an understanding of why the change needs to occur they are more willing to
implement the change and improve the quality of care they are delivering (Heuston & Wolf,
2011). This expereince will allow me to better create action plans and implement change in the
future.
Staff Feedback
While administering staff in-services, I received feedback that staff members felt they
were not learning anything new. According to Whitehead, Weiss, and Tappen (2010) when
implementing change nurse administrators must be prepared for resistance and to answer
difficult questions from their staff. Staff members will want to know when the change will occur
and why the change is happening. Staff members also want to know how the change will benefit
them or make more work for them. When answering these questions it is important to answer
clearly and concisely, to ensure that the necessary information is heard. It is also important for
SYNTHESIS PAPER 13
staff members to feel that their questions and concerns are valued by the leadership team. Staff
members who feel that their opinions matter tend to be more engaged in the performance
improvement process and helping to ensure that new action plans succeed (Shriberg & Shriberg,
2011).
According to ANA (2010) it is nurses’ ethical responsibility to question current and new
practices in healthcare. Nurses should ensure that their practice allows them to provide safe and
quality care to their patients. Nurses can aid in the improvement of current process by
formulating recommendations that will improve the process. Therefore, the feedback I received
was the nursing assistants’ ethical responsibility to question the new process and ensure that it
was the right thing to do for their patients.
After reflecting on the in-services and the information I was presenting I decided to
revise how I worded things and stress the importance of providing me with feedback and
questions. By doing this the remaining in-services were much more successful. I received several
questions about the hearing screen machines and the change in the process. I was not able to
answer all the questions on the spot but reinforced to the nursing assistants that I would seek out
answers and send the information to all nursing assistants. At the completion of the in-services I
addressed every question that I received and sent the information to all staff members. While I
was disappointed at first with the feedback I received it turned out to be beneficial to the
implementation process. If I had not revised the in-services I would not have received the
questions from the nursing assistants. These questions helped me to ensure that the nursing
assistants had the correct information to improve the hearing screen process. This was a valuable
lesson that even negative staff feedback can be used constructively.
SYNTHESIS PAPER 14
Practicum Evaluation
In addition, to evaluating the outcome of the hearing screen project I evaluated my
performance throughout the practicum. Reflecting on one's performance is an important practice
for nursing professionals because it allows for professionals to continue growing personally and
professionally. Reflection allows them to continuously learn, integrate what is learned on the job
with their personal beliefs, and encourage individuals to continue to grow and discover
themselves (Asselin & Fain, 2013). Reflecting on my performance allowed for me to determine
that my leadership skills and knowledge have grown through this practicum. I gained confidence
related to collaboration and planning and implementing change. I feel that I also gained
expereince with project management and making adjustments to the project to ensure its
completion and success. These skills will allow me to continue to grow as a leader and become
an effective nurse administrator (See Appendix A for completed self evaluation form).
According to Whitehead et al. (2010) all professionals need feedback to determine their
effectiveness. Both positive and negative feedback is valuable. Positive feedback allows
professionals to have an understanding of skills that they perform well. Negative feedback
illustrates the areas in need of improvement. Therefore, I met with my preceptor and asked her to
complete an evaluation form. The feedback I received was positive and beneficial. Overall, she
felt I performed well and met my objectives for the practicum. She felt that I had the potential to
become a nurse administrator and would improve with more experience. This feedback helped to
assure me that I am on the right track. I will continue to seek new opportunities that will allow
me to continue to grow s a leader (See Appendix B for completed preceptor evaluation form).
SYNTHESIS PAPER 15
Conclusion
Nurse leaders are often given leadership roles without first having the necessary training
and skills to be an effective leader. Nurse leaders must advocate for education and experiences
that will allow them to develop the skills needed to effectively lead the nursing profession. By
completing this clinical practicum I advocated for myself and gained valauble experience and
knowledge related to the nurse administrator's role and responsibilities. By completing the
practicum project I gained knowledge related to planning by creating a plan, implementing the
change, and evaluating the success of the plan. By creating this plan I developed skills related to
collaboration. Implementing change requires nurse administrators to work with
multidisciplinary teams to ensure the success of change. This project encouraged me to work
with individuals from multiple departments, allowing me to gain confidence in my ability to
collaborate. By participating in the project practicum and the Baby-Friendly initiative I furthered
my knowledge of resource utilization. I was able to evaluate whether resources were being used
effectively and proposed changes based on my findings. Finally, I gained more knowledge
related to evaluation by evaluating the outcomes of the hearing screen project and by evaluating
my performance throughout the practicum. I gained much knowledge and experience through
this practicum and will be better prepared for future nurse administrator roles.
SYNTHESIS PAPER 16
References
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skills and professionalism. Nursing Administration Quarterly, 34(4), 306-312.
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SYNTHESIS PAPER 17
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SYNTHESIS PAPER 18
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SYNTHESIS PAPER 24
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skills and professionalism. Nursing Administration Quarterly, 34(4), 306-312.
doi:10.1097/NAQ.0b013e31822ecc6e
American Nurses Association (2009). Nursing administration: Scope and standards of practice.
Silver Spring, MD: American Nurses Association.
American Nurses Association (2010). Nursing: Scope and standards of practice. (2nd ed.).
Silver Spring, MD: American Nurses Association.
Asselin, M. E., & Fain, J. A. (2013). Effect of reflective practice education on self-reflection,
insight, and reflective thinking among experienced nurses. Journal for Nurses in
Professional Development, 29(3), 111-119. doi:10.1097/NND.0b013e318291c0cc
Bluestone, J., Johnson, P., Fullerton, J., Carr, C., Alderman, J., & BonTempo, J. (2013).
Effective in-service training design and delivery: Evidence from an integrative review.
Human Resources for Health, 11(51). Retrieved from
http://www.biomedcentral.com/content/pdf/1478-4491-11-51.pdf
Bohmer, R. (2010). Harvard Business Review. Fixing healthcare on the front lines, 88(4), 62-69.
Retrieved from http://ocvets4pets.com/archive23/Fixing_Health_Care_on_
the_Front_Lines_-_Harvard_Business_Review.pdf
Carter, L., Sullivan, R. L., Goldsmith, M., Ulrich, D., & Smallwood, N. (Eds.). (2013). The
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organization (2nd ed.). Wiley.
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SYNTHESIS PAPER 25
Gurtner, S. (2014). Making the right decisions about new technologies: A perspective on criteria
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doi:10.1097/HMR.0b013e3182993b91
Heuston, M. M., & Wolf, G. (2011). Transformational leadership skills of successful nurse
managers. JONA: Journal of Nursing Administration, 41(6), 248-251.
doi:10.1097/NNA.0b013e31821c4620
Kingston, M. B. (2013). The System Chief Nursing Officer: An Evolving Role. Nurse Leader,
11(3), 27-29. doi:10.1016/j.mnl.2013.03.004
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experienced nurse executive leaders. JONA: The Journal of Nursing Administration,
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SYNTHESIS PAPER 26
Schoenfelder, S. L., Wych, S., Willows, C. A., Harrington, J., Kaufer, K., & Becker, A. B.
(2013). Engaging Chicago hospitals in the baby-friendly hospital initiative. Maternal and
Child Health Journal, 17(9), 1712-1717. doi:10.1007/s10995-012-1144-2
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