Clinicalnursing leadership in France · •Leadership infirmier •Leadership and infirmier...
Transcript of Clinicalnursing leadership in France · •Leadership infirmier •Leadership and infirmier...
Clinical nursing leadership in France:
a concept to develop urgentlyChristophe DEBOUT. RN, PhD, CRNA
Nurse anesthetist programme director, IFITS, France
Nurse scientist, Health Chair, ScPo Paris/IDM UMR 1145
Disclosure presenter
Outline
• Context• Aims•Methods • Findings• Discussion• Recommendations
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Context
• Positive clinical outcomes and productivity are more and more monitored in health care throughout the world (Simonet, 2014)
• Change and innovation are key words in contemporary healthcare environment (Ostrovsky & Barnett, 2014)
• In this context, leadership in nursing is identified as a central concept in international nursing literature (IOM, 2010)
• Positive patients outcomes can be obtained through nursing leadership development (Wong & Cummings, 2007)
• In many countries, clinical leadership is a role expected from every nurses (Daly & Al, 2014)
• It is as well identified as a major role for APNs in Hamric’s competency framework (Hamric, 2013)
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National context
• Curiously, leadership concept seems absent of the lexicon of French nurses• In January 2016, the APN professional
title was officially introduced in the French legislation• APN role implementation policy were
only published in July 2018• The term « clinical leadership » now
appears in the national APN competency framework
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Aims
1. Identify how nursing leadership is approached in the French nursing literature, legislation and policy
2. Compare this national perspective on nursing leadership with the international literature on this topic
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Methods (1/2)
A review of the French literature was performed in June 2018:• Keywords and equations selected:
• Leadership infirmier• Leadership and infirmier• Leadership clinique• Leadership and Clinique and infirmier• Leader et infirmier• Infirmier et leader clinique• Chef de file et infirmier
• French data base Banque de Données en Santé Publique (BDSP®) was searched
• National French competency frameworks and national curriculums in nursing were also explored
• Inclusion criteria selected• French context• Nursing profession• Publication written in French
• Exclusion criteria selected• French speaking countries other than
France• Healthcare professions other than nursing• Concept of management
• Quantitative and qualitative analysis of references was performed
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Methods (2/2)
A comparison was made with international literature• Keywords selected in French
were translated in English using the MeSH bilingue Inserm® tool
• These keywords were used to search in Pubmed® data base
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French data baseBDSP®
Pubmed®
Keywordsand equationsused
LeadershipLeadership infirmierLeadership and infirmierLeadership cliniqueLeadership and cliniqueand infirmierLeader et infirmierInfirmier et leader cliniqueChef de file et infirmier
Leadership“Nursing leadership”Leadership and nursing“Clinical leadership” Clinical leadership and nursingLeader and nurse« Clinical nurse leader »Nurse leader
References identifiedthrough BDSP®
n=172
References identifiedthrough other sources
n= 7
Total referencesretrieved
n= 179
References screened by title and abstract
n=179References excluded
n=164
References reviewed for inclusion
n=15
References excludedn=6
References includedn=9
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Findings (1/4)(inspired PRISMA guideline, 2009)
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• French data base: BDSP®• Keywords and equations
used: • Leadership infirmier• Leadership and infirmier• Leadership clinique• Leadership and clinique and
infirmier• Leader et infirmier• Infirmier et leader clinique• Chef de file et infirmier
Findings (2/4)
National vs international literatureBDSP® 30/6/18• Leadership : 1 180 references• Leadership infirmier : 84 references• Leadership and infirmier: 84 references• Leadership clinique 29 references• Leadership and Clinique and infirmier: 9 references• Leader et infirmier: 46 references• Infirmier et leader clinique: 3 references• Chef de file et infirmier : 1 references
Pubmed® 30/6/18• Leadership: 37 351 references• “Nursing leadership”: 14 951 references• Leadership and nursing: 10 436 references• “Clinical leadership:” 10 639 references• Clinical leadership and nursing: 3 641 references• Leader and nurse: 1 753 references• « Clinical nurse leader »: 501 references• Nurse leader: 1 434 references
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Findings (3/4)
Leadership term is absent of competency frameworks of• Registred Nurses (2009)
• Nurse specialists
• Child care nurses (1983, modified in 1990)
• Operating room nurses (2001 modified in 2015)
• Nurse anesthetist (2012)
• Nurse managers (1995)
• It is included, associated with he concept of management, in the Nurse executives programme (2003
modified in 2017)
• The APN's competency framework, published in July 2018, includes the term « clinical leadership » (competence 5)
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Findings (4/4)
• The term “leadership” does not have an equivalent in French language
• The English term “leader” is frequently used, it is sometimes translated by “chef de file” by French speaking Canadians
• Very few literature is available in French about leadership in nursing in the French context
• Some articles are available in French but are written by French speaking Canadians/Swiss authors
• No exhaustive reference book about nursing leadership is available in French
In the French nursing literature The concept of leadership and the concept of management are always intertwined
As a consequence Activities related to management and leadership are considered to be the exclusive domain of nurse managers/nurse executiveIn France, to lead you need to be a manager
Clinical leadership promotion seems then more improbable
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Discussion (1/3)
• The Globe culture and leadership study gives an idea of how the concept of leadership (at large) is viewed in France (2004)
13Source: http://globeproject.com/results/countries/FRA?menu=country
Discussion (2/3)
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Source: http://globeproject.com/results/countries/FRA?menu=country
Discussion (3/3)
There is an urgent need to promote the development clinical leadership considering the characteristics of nursing and practice environments in France (Daly & al, 2014)
Many strategies and programs have been published in this objectiveThe development by nurse managers of a concurrency feeling regarding leadership towards future APNs is a major risk in France (Fealy & al, 2011)
It could seriously impede APNs' role implementation and have a negative impact on clinical outcomes and organization performance (Sangster-Gormley, 2011)
Resources available in French are lacking to sustain competency development of APNs in this field
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Recommendations
Management • Nurse executives and nurse managers
need to be instrumental in the promotion of clinical nursing leadership• Synergy needs to be build between
managers and APNs in the future to promote positive outcomes for the patient and positive practice environment for the nursing team
Education• Facilitate clinical leadership development
offering nurse managers CE sessions about nursing leadership and clinical leadership• Use adequate references/models in
teaching/learning activities related to nursing leadership• Limit the negative impact on APN students
of the absence of role model • Prepare the clinical instructors/tutors to give
opportunities to APN students to develop clinical leadership in nursing
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Areas for further research
• Observe how APN will implement clinical leadership in the French context
• Observe the nurse managers’ reactions to APN clinical leadership implementation
• Observe nursing teams’ reactions to clinical leadership implementation by APNs
• Identify the teaching/learning strategies selected by faculty in charge of the leadership unit
• Identify the theoretical frameworks adopted by APNs to exert clinical leadership
• Evaluate the impact of clinical leadership on patient's clinical outcomes and on staff work related quality of life
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References• Arrêté du 18 juillet 2018 fixant la liste des pathologies chroniques stabilisées prévue à l'article R. 4301-2 du code de santé publique
https://www.legifrance.gouv.fr/affichTexte.do?cidTexte=JORFTEXT000037218197&dateTexte=&categorieLien=id
• Arrêté du 18 juillet 2018 fixant les listes permettant l'exercice infirmier en pratique avancée en application de l'article R. 4301-3 du code de santé publique https://www.legifrance.gouv.fr/affichTexte.do?cidTexte=JORFTEXT000037218201&dateTexte=&categorieLien=id
• Arrêté du 18 juillet 2018 relatif au régime des études en vue du diplôme d'Etat d'infirmier en pratique avancée https://www.legifrance.gouv.fr/affichTexte.do?cidTexte=JORFTEXT000037218463&dateTexte=&categorieLien=id
• Daly, J., Jackson, D., Mannix, J., Davidson, P. M., & Hutchinson, M. (2014). The importance of clinical leadership in the hospital setting. Journal of Healthcare Leadership, 6, 75-83.
• Décret n° 2018-629 du 18 juillet 2018 relatif à l'exercice infirmier en pratique avancée https://www.legifrance.gouv.fr/affichTexte.do?cidTexte=JORFTEXT000037218115&dateTexte&categorieLien=id
• Décret n° 2018-633 du 18 juillet 2018 relatif au diplôme d'Etat d'infirmier en pratique avancée https://www.legifrance.gouv.fr/affichTexte.do?cidTexte=JORFTEXT000037218444&dateTexte&categorieLien=id
• Fealy, G. M., McNamara, M. S., Casey, M., Geraghty, R., Butler, M., Halligan, P., … Johnson, M. (2011). Barriers to clinical leadership development: findings from a national survey. Journal of Clinical Nursing, 20(13-14), 2023-2032.
• Hamric, A. B., Hanson, C. M., Tracy, M. F., & O’Grady, E. T. (2013). Advanced Practice Nursing - E-Book: An Integrative Approach. Elsevier Health Sciences.
• House, R. J., Hanges, P. J., Javidan, M., Dorfman, P. W., & Gupta, V. (2004). Culture, leadership, and organizations: The GLOBE study of 62 societies. Sage publications.
• Institute of Medicine (US). Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing. (2011). The future of nursing: Leading change, advancing health. National Academies Press Washington, DC.
• LOI n° 2016-41 du 26 janvier 2016 de modernisation de notre système de santé https://www.legifrance.gouv.fr/affichTexte.do?cidTexte=JORFTEXT000031912641&categorieLien=cid
• O’neill, J. A. (2013). Advancing the nursing profession begins with leadership. Journal of Nursing Administration, 43(4), 179-181.
• Ostrovsky, A., & Barnett, M. (2014). Accelerating change: fostering innovation in healthcare delivery at academic medical centers (Vol. 2, p. 9-13). Présenté à Healthcare, Elsevier.
• Sangster-Gormley, E., Martin-Misener, R., Downe-Wamboldt, B., & DiCenso, A. (2011). Factors affecting nurse practitioner role implementation in Canadian practice settings: an integrative review. Journal of advancednursing, 67(6), 1178-1190.
• Simonet, D. (2014). Assessment of new public management in health care: the French case. Health research policy and systems, 12(1), 57.
• Wong, C. A., & Cummings, G. G. (2007). The relationship between nursing leadership and patient
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