JULY / AUGUST 2006
FEATURES
Acibadem continues to develop nursing leadership
Since partnering with HMI in 2003, Acibadem Healthcare Group has made the development of its nursing staff, particularly in the area of leadership, a central component of a vigorous alliance focused on improving overall quality in its hospitals. In May, sixty charge nurses from throughout the Acibadem network participated in the third of a series of nursing leadership workshops.
“A key part of Acibadem’s strategic vision is the development of a premier nursing practice model to help ensure continuous improvements in clinical practice and continuing education for our staff,” said Saliha Koc, RN, director of nursing at Acibadem. “The achievement of these objectives depends on strong nursing leadership throughout our network.”
The term “charge nurses” refers to the mid-level nursing leaders whose counterparts in the U.S. are nurse managers. As HMI’s Elizabeth Brown, RN, MSN, MBA explains, these nurses play a critical role not only in health care quality but also in workforce retention—a chief concern for Acibadem as it grows its network.
“Nurse leaders are often the ‘chief retention officers’ in the hospital—an invaluable liaison between patients, physicians, and other nurses and clinicians,” said Brown, HMI’s director of clinical services. “They are in the position, more than anyone else in the hospital, to create and nurture a workplace culture that emphasizes teamwork, communication, and professionalism, and ultimately contributes to a sense of job satisfaction. All of this is closely linked to health care quality.”
During the first two programs, Acibadem focused on defining the competencies and corresponding behaviors demanded of charge nurses working in the Acibadem network, with close attention to building the capacity to lead change and developing their communication skills. This competency model was seen as the foundation for further work on developing the leadership and management skills of these nurses. An Acibadem Charge Nurse Task Force carried this work forward, and now the competency model serves as the baseline that guides Acibadem’s nursing leaders as they define roles and expectations, develop orientation and mentoring programs, and assess individual strengths and areas for growth.
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Patricia Folcarelli, RN, PhD and Joanne Ayoub, both of Beth Israel Deaconess Medical Center (BIDMC), have been involved with the nursing leadership initiative from the beginning. Their experiences at BIDMC, which has recently undergone a series of leadership development initiatives, have helped inform the work they are doing with Acibadem.
“As Joanne keeps reminding us all, leadership development is an ongoing process for individuals, teams, and organizations. Therefore throughout this work we have used a Challenge-Assess-Support Model that posits that for leaders to grow, they need three elements at all times: new and important challenges, awareness of their current skill base, and support from strong supervisors in healthy work environments,” said Brown.
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| Joanne Ayoub: “Participation is increasing, and they are bringing concepts from workshop to workshop.” |
Ayoub, the director of organizational development at BIDMC, helped lead a day-long workshop that addressed how to build effective, high-performing teams. The faculty used the four-phase Tuckman model of team development to instruct the nurses on the competencies required to transform their teams from those with high dependence on the leader, to a strategically aware group with a shared vision and a high degree of autonomy.
Folcarelli, director of professional practice development at BIDMC, has led numerous initiatives focused on improving quality and patient safety. She facilitated a session with charge nurses on team dynamics, communication, and patient safety using teaching cases generated from adverse events. The session was very interactive as nurses reacted to real cases and were able to strategize on better ways to manage and communicate within a team.
“These charge nurses are often leading a team, or mentoring their staff to be effective team members or team leaders. They have a key role in not only developing their team, but also making the case to their staff for effective teams in health care, such as better coordination of care, improved patient safety, higher staff and patient satisfaction, and financial gains,” said Folcarelli.
Brown says the entire program has benefited from tremendous support from Acibadem chairman Mr. Mehmet Aydinlar. His commitment to the nursing staff, says Brown, has helped to motivate the program’s facilitators and participants alike. “Mr. Aydinlar recognizes the key role that the nursing staff plays in setting Acibadem apart from other hospitals in the region, as well as how the performance of the nurses impacts clinical quality and influences how patients view their stay in the hospital,” said Brown.
Ayoub noted a great deal of enthusiasm among the charge nurses involved in the program. “Participation is increasing, and they are bringing concepts from workshop to workshop,” she said. “For me the real learning that takes place during these programs comes from colleague-to-colleague stories about the challenges they are facing, and what strategies are working or not working.”
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| Patricia Folcarelli facilitated a session with charge nurses on team dynamics, communication, and patient safety, using teaching cases generated from adverse events. |
During the visit, Brown also facilitated a strategic planning session to follow-up on work started in Boston and to assist the executive nursing team in refining their goals and action plans, which they will present to Acibadem’s leadership in the fall. Given the priority given to certain goals within the strategic plan, Ayoub and Folcarelli also facilitated additional sessions with key colleagues. Ayoub worked with Acibadem’s human resources department to help them figure out how they can partner with the network’s nursing staff to achieve strategic goals related to retention and leadership development, and to help them as they develop a performance management system for the overall network. Folcarelli worked with the nurse educators on preceptor development.
Copyright 2006 Harvard Medical International
The HMI-Acibadem partnership is a great example of a multidisciplinary collaboration aimed at improving overall quality of care. HMI encourages its hospital partners to consider the pivotal role played by the nursing staff in developing patient-centered care, and to include nurses in quality improvement initiatives. To learn more about HMI’s work in the area of Nursing Leadership in Education, visit the HMI website.
The global nursing shortage is one of the most glaring health care crises of our time, and its impacts will only grow more acute as the population continues to age and the burden of chronic and non-communicable diseases escalates. The nursing workforce is aging too, and yet in many countries there is inadequate funding available to bring new recruits into the profession.
The list of factors contributing to the difficulty of recruiting and retaining nurses is extensive: inadequate staffing and heavy workloads; excessive overtime; inflexible scheduling; exposure to occupational hazards; lack of autonomy; poor human resource management practices and leadership; inadequate supplies, medication, and technology; and poor career development opportunities. No doubt the problems eroding the workplace and job satisfaction of nurses must all be considered detriments to overall quality of care and threats to patient safety.
Research suggests that nursing workforce retention increases when nurses are provided opportunities to advance professionally, to gain autonomy, and participate in decision-making. And there is some evidence to suggest that participative management styles, flexible employment opportunities, and access to continuing education and professional development can improve retention of nursing staff as well as patient care. Many of these issues are addressed in the "forces of magnetism" which were identified in organizations that were successful at retaining employees. In the context of nursing, the Magnet hospital recognition emphasizes the need for well prepared and qualified nursing executives.
To learn more about the global nursing shortage and approaches to addressing the problem, read “The Global Shortage of Registered Nurses: An Overview of Issues and Actions” (2004), which was developed by James Buchan and Lynn Calman for the International Council of Nurses. See also “Hallmarks of the Professional Nursing Practice Environment” from the American Association of Colleges of Nursing.