Abstract
One of the quality nursing necessities in nursing training and curriculum development is the incorporation of leadership skills teaching amongst nursing students. The present study reviews the previous research studies on the role of nursing leadership curriculum development and performance appraisals in the nursing educational systems based on articles from 2016 to 2020. There is a gap in knowledge in the research methodology, implementation, and utilization of various leadership strategies. Academic databases (CINAHL, PUBMED, SCOPUS, and Google Scholar) were searched for quality articles in science and leadership for the inclusion and exclusion criteria using such keywords as leadership, strategies, nursing, and education. A total of 20 peer-reviewed articles were identified for the review. The fundamental theme acknowledged in the appraisal encompassed the implementation of active learning strategies for leadership development. Moreover, such subthemes as peer-group learning, the role of multidisciplinary groups, organizational partnerships, and curriculum reforms were identified.
Background
The nursing role in the control of hospital care facilities is a diverse complex area of study. Health-related leadership strategies in administration and supervision are lacking, hence, there is an increased demand for nurses and other healthcare providers to establish leadership roles and organizational skills in monitoring the health care system (Wiig et al., 2018; Oldenhof, Stoopendaal and Putters, 2016). In recent years, more nursing students and trainees are being encouraged to participate in management workshops, seminars, career developments and planning.
Organizational leadership has remarkably been identified as a robust inducing factor in the recognition and application of evidence-based practice (EIP) (Aarons et al., 2016). According to Aarons et al. (2016), the instrumentation of leadership in the context of organizational performance has been getting amplified attention because of the acknowledgment of the significance of leadership operational determinants. To understand the concept of leadership, the application of theories is important to underpinning organizational excellence. For instance, behavioral leadership theory (BLT) proposes that competent leadership encompasses such behaviors as change-driven, relation-driven, and task-driven (Salihu, 2019). Change-driven leadership behaviors are principally used in the delivery of the mission and objectives of a company for foreseeable future innovation, through support and formation of a sense of need for change enactment. Relation-driven leadership behavior deals with the objectification of the quality of employees as a resource for building trust and togetherness for work-related commitments. On the other hand, task-driven leadership behaviors include such roles as planning, key performance indicator (KPIs), and efficient use of both human and assets resources.
According to a report by Ginter, Duncan and Swayne (2018) and Waite and Nard (2019), there is an urgent need for improved and better leadership categorization in almost all sectors of health care decision-making processes and management. Based on a contemporary Future of Nursing Report, it is recommended that student nurses and other healthcare providers institute leadership at all levels of healthcare processes with the integration of such programs into the educational curriculum (The Institute of Medicine [IOM], 2010). Therefore, this literature review determines to harmonize the state-of-the-art leadership training in the nursing curriculum for articles published from 2016 to 2020. Furthermore, the critical review is aimed at identifying the gaps in knowledge with regard to leadership strategies and establishing possible implications and recommendations for workable strategic leadership approaches.
Critical Review
The 20 peer-reviewed journal articles documented in this critical review included descriptive articles, mixed-method research designs, qualitative analysis, and quantitative study. The articles fundamentally concentrated on the technological leadership behaviors and character building in response to the advanced training and governance policies as a response to the IOM recommendations. The fundamental theme recognized throughout the articles was the implementation of active learning leadership strategies. Furthermore, the study identified subthemes within the context of leadership roles and positions which included such topics as peer-group training, multidisciplinary group, managerial partnerships, and curriculum educational improvements.
Peer-group Training
In the review, several articles utilized peer-group training as a teaching methodology to deliver the nursing students with necessary career opportunities which reflect managerial skills. For instance, the use of safety-focused simulation experiences for peer-group training was applied by nursing student groups (Karlsen et al., 2017; La Cerra et al., 2019; Viljoen et al., 2020). In this case, the student developed a web-based workshop in the U.K. (Viljoen et al., 2020). Furthermore, the three articles demonstrated how peer-group training was used in the assessment of clinical settings and other practical and hands-on experiences training (Karlsen et al., 2017; La Cerra et al., 2019; Viljoen et al., 2020). Notably, based on their reports, the students in peer-group learning experienced positive behavior changes. They acknowledged increased confidence levels in their nursing capacities, critical thinking behaviors, and improved involvement in collective responsibilities that involved skills acquisitions (Karlsen et al., 2017; La Cerra et al., 2019; Viljoen et al., 2020). Overall, the nursing student-led simulation accomplishments lead to the improvement of student information, acquaintances, and an understanding of the various qualities and welfare of the nursing educational competencies.
This can be identified by the student receiving positive recommendations from their staff and other nursing departments especially after receiving blended learning of both web-based learning and lecture instructions (Viljoen et al., 2020). According to La Cerra et al. (2019), student tutors noted new awareness creation among the student leadership roles with some highlighting that they would pursue advanced nursing leadership upon graduating. Research by Cable and Graham (2018) also established that peer group training with co-active coaching increased confidence levels amongst clinical nurse leaders. Therefore, advances in self-confidence and ability for reflection were described to provide improvement in team and facility performance.
Multidisciplinary Groups
The utilization of a multidisciplinary group in the nursing career development and nursing curriculum is greatly understudied. Multiple training methodologies on the leadership strategies have incorporated the use of collective training with various carrier roles and positions. For instance, in the clinical settings, students incorporated, developed, and implemented the importance of using multidisciplinary teams in certifying an all-around nursing student leadership. The students worked in groups from several nursing disciplines to manage and control care through duty delegation and task implementation associated with multiple simulated patient care (Bae et al., 2019; Balsanelli, David and Ferrari, 2018). Two other researchers studied the grouping of nursing students with multidisciplinary career majors in various role plays (Kim, 2018; Nieuwboer et al., 2018; Reeves, Xyrichis and Zwarenstein, 2018). Results from these studies recognized that nearly all the learners in the investigation had an improved level of confidence in the management of nursing responsibilities and duties, enhanced communication abilities, and increased mindfulness for the advancement of collaborative teamwork that is engrossed in patient-centered care, well-being, and proficient nursing care.
In the studies, the nursing students described gained information on duty delegation and care prioritization in the provision of nursing care that ensures safe and effective practice. For example, students in the research by Kim (2018) who were instructed to take a simulation leadership role of guiding a multidisciplinary team through a role play coupled with a simulation exercise for the quality initiative, acknowledged improved critical thinking abilities. Therefore, before student nurse graduates enter into an active nursing career, it is imperative for them to understand the mobilization of multidisciplinary groups in care planning joined with the application of leadership skills that promote collaborative working.
Managerial Partnerships
Multiple technical training strategies require that educators implement the incorporation of partnerships with several interdisciplinary organizations within the school settings or community-based partnerships for effective leadership roles. According to a study by Valli, Stefanski and Jacobson (2018), a collaboration between schools and the surrounding local community provided both community leadership opportunities and student preparations for career developments through enhanced student learning. The study reported that the students who participated in the research developed awareness and effective information with regards to how to affect change within the community and health care systems using community engagements. Moreover, the research study conducted by Brewster et al. (2016), involved the university, the community, and the student in exploring the effectiveness of using a conceptual model of university-community engagement and partnership that incorporates leadership skills into education. In another study conducted by Forsyth and Mason (2018), partnerships through interprofessional teams reported the greatest agreement with shared leadership compared to non-partnerships. In this sense, the collaborative partnership enhanced the knowledge of the student about the community and improved their perspective on civic practices.
Curriculum Educational Reform
Three journal peer-reviewed articles analyzed the utilization of curriculum educational reforms which aimed at incorporating leadership as a course or unit in nursing programs. For instance, one study defined the development and application of management courses into the existing nursing curriculum (Amestoy et al., 2017; Starr et al., 2017). However, another research study implemented the use of service-learning content in various nursing courses and curricula for the advancement of student leadership (Muraraneza and Mtshali, 2018). Specifically, Amestoy et al. (2017), Muraraneza and Mtshali (2018), Thomas et al. (2017), and Mokshagundam et al. (2018) established that there was a need for curriculum revisions with updated content. The content should fundamentally be focused on personal healthcare, anxiety management, ethical and ethical concerns, leadership and nursing problems, and health care policy implementations. As such, processes for the purposes of decreasing nursing student burnout which reduces the general nursing turnover, while displaying principles of mentorship and collaboration are achieved.
Thomas et al. (2017) emphasized that the skill of a professional nurse is closely associated with a nurse’s capacity to progress intuition and to implement the use of effective inventiveness into nursing practice and management. Clinical judgment in managing is a nursing skill that is often used by health care providers to respond to emergencies in a nursing or hospital setting. As such, it is vital for the student nurses to develop certain emergency skills which require practicing the implementation of cognitive-behavioral adaptation and emotional intelligence, with the application of critical nursing judgments, which is a complex skill in unique care settings (Thomas et al., 2017). According to Trepanier and Nordgren (2017), the application of the improvisational leadership role displayed clinical promises for the development of communication skills, leadership confidence, and the improvement of empathy among nursing students. Therefore, improvisational games through leadership are useful in improving self-awareness amongst nursing students.
Problem Statement
The current literature review has discovered a noticeable lack of scientific and management research that focuses on teaching strategies to incorporate leadership competencies at a business level. Whereas one of the studies identified the implementation of active leadership strategies for students at the organizational level (Amestoy et al., 2017), several other studies lacked this merit. The student nurses, therefore, should obtain active activities while in their college level before graduation to achieve a fully incorporated leadership competency that entails skills development, knowledge acquisition, and capacity building (Muraraneza and Mtshali, 2018). The role of active leadership participation at the business and institutional level is to ensure that the student body is better empowered for effective future nursing policy changes (Starr et al., 2017). Moreover, based on the literature above, many studies acknowledged a knowledge gap in the lack of awareness amongst students conducting quality initiatives in hospital health care systems or elsewhere, where the majority were uninformed about the IOM recommendations.
As such, the low staff nurse information about such recommendations as to the IOM report, and inadequate nursing staff participation in institutional-level leadership activities reflect this knowledge gap among students. Besides, a gap also exists based on the above critical review about classroom-specific leadership training strategies designed to incorporate leadership and leadership roles in nursing care. According to Amestoy et al. (2017), practical application of learning is one of the major improvements in the nursing field for gaining clinical strengths and nursing practices, yet, this improvement is rarely applied in classroom settings. In this regard, the classroom must shift to the implementation of peer-group training, which is an interactive strategy. The peer-group training can enable interactive classroom strategies by supporting the nursing students to develop clinical reasoning from co-peers, a skill essential for effective leadership functioning and collaborative working as pertained to the various health care management systems.
Moreover, a knowledge gap exists in the literature involving research in leadership training strategies and curriculum developments to sustain the expansion of leadership competencies in learners from different cultural and ethnic backgrounds. The gap is noted to result in the omission of vital evidence from students, who apart from cultural diversity and ethnicity, identify with dissimilar gender orientations. For instance, the majority of the articles included in this review comprehensively focused on students without identifying the gender of the stated students. Therefore, for the diversification of nursing as a profession, educators should develop leadership strategies that aim to implement teaching approaches among a diverse student population.
In summary, it is evident that nursing education curriculum program has a need for educators in the sector to understand the importance of incorporating leadership management and strategies in health-related sciences. This creates awareness in the implementation of research recommendations that focus on the policies to cultivate leadership skills amongst non-management students. Therefore, the educational programs should aim to recruit, encourage, and support university departments that have an interest in inspiring leadership skills and advancement of technical teaching and training strategies. From the above-mentioned, the program implementers and educators require both time and resources from university administrators, institutions, and federal governments to nature, device, and appraise innovative and collaborative teaching strategies to successfully incorporate the much-needed leadership competencies in students.
References
Aarons, G. A., Green, A. E., Trott,.E, Willging, C. E., Torres, E.M., Ehrhart, M. G., & Roesch, S. C (2016). The roles of system and organizational leadership in system-wide evidence-based intervention sustainment: A mixed-method study. Administration and Policy in Mental Health and Mental Health Services Research, 43(6), 991-1008.
Amestoy, S.C., Trindade, L.D.L., Silva, G.T.R.D., Santos, B.P.D., Reis, V.R.D.S.S. and Ferreira, V.B. (2017) Leadership in nursing: From teaching to practice in a hospital environment. Escola Anna Nery, 21 (4), 1-7.
Bae, J., Lee, J., Jang, Y. and Lee, Y. (2019) Development of simulation education debriefing protocol with faculty guide for enhancement clinical reasoning. BMC Medical Education, 19 (1), 1-7.
Balsanelli, A.P., David, D.R. and Ferrari, T.G. (2018) Nursing leadership and its relationship with the hospital work environment. Acta Paul Enferm, 31 (2), 187-193.
Brewster, A.B., Pisani, P., Ramseyer, M. and Wise, J. (2016) Building a university-community partnership to promote high school graduation and beyond. Journal of Applied Research in Higher Education, 8 (1), 44-58.
Cable, S. and Graham, E. (2018) “Leading Better Care”: An evaluation of an accelerated coaching intervention for clinical nursing leadership development. Journal of Nursing Management, 26 (5), 605-612.
Forsyth, C. and Mason, B. (2017) Shared leadership and group identification in healthcare: The leadership beliefs of clinicians working in interprofessional teams. Journal of Interprofessional Care, 31 (3), 291-299.
Ginter, P.M., Duncan, W.J. and Swayne, L.E. (2018) The Strategic Management of Health Care Organizations (8th ed.). New Jersey: John Wiley & Sons.
Institute of Medicine (2010) The Future of Nursing: Leading Change, Advancing Health. Washington: National Academies Press.
Karlsen, M.M.W., Gabrielsen, A.K., Falch, A.L. and Stubberud, D.G. (2017) Intensive care nursing students’ perceptions of simulation for learning confirming communication skills: A descriptive qualitative study. Intensive and Critical Care Nursing, 48 (3), 97-104.
Kim, E. (2018) Effect of simulation-based emergency cardiac arrest education on nursing students’ self-efficacy and critical thinking skills: Roleplay versus lecture. Nurse Education Today, 61, 258-263.
La Cerra, C., Dante, A., Caponnetto, V., Franconi, I., Gaxhja, E., Petrucci, C.,… and Lancia, L. (2019) Effects of high-fidelity simulation-based on life-threatening clinical condition scenarios on learning outcomes of undergraduate and postgraduate nursing students: A systematic review and meta-analysis. BMJ Journal, 9 (2), 1-11.
Mokshagundam, S., Pitkin, J., Dekhtyar, M., Santen, S., Hammoud, M. and Skochelak, S.E. (2019) Engaging medical students in leadership development. Medical Science Educator, 29 (3), 849-853.
Muraraneza, C. and Mtshali, G.N. (2018) Conceptualization of competency-based curricula in pre-service nursing and midwifery education: A grounded theory approach. Nurse Education in Practice, 28, 175-181.
Nieuwboer, M.S., van der Sande, R., van der Marck, M.A., Olde Rikkert, M.G. and Perry, M. (2019) Clinical leadership and integrated primary care: A systematic literature review. European Journal of General Practice, 25 (1), 7-18.
Oldenhof, L., Stoopendaal, A. and Putters, K. (2016) From boundaries to boundary work: Middle managers creating inter-organizational change. Journal of Health Organization and Management, 30 (8), 1204–1220.
Reeves, S., Xyrichis, A. and Zwarenstein, M. (2018) Teamwork, collaboration, coordination, and networking: Why we need to distinguish between different types of interprofessional practice. Journal of Interprofessional Care, 32 (1), 1-3.
Salihu, M. J. (2019). Conceptual analysis of the leadership theories and proposed leadership framework in higher education. Asian Journal of Education and Social Studies, 5(4), 1-6.
Starr, S.R., Agrwal, N., Bryan, M.J., Buhrman, Y., Gilbert, J., Huber, J. M.,… and Johnson, C.D. (2017) Science of health care delivery: An innovation in undergraduate medical education to meet Society’s needs. Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 1 (2), 117-129.
Thomas, A., Crabtree, M.K., Delaney, K., Dumas, M.A., Kleinpell, R., Marfell, J. and Wolf, A. (2017) Nurse practitioner core competencies content. The National Organization of Nurse Practitioner Faculties, 1-16.
Trepanier, S. and Nordgren, M. (2017) Improvisation for leadership development. The Journal of Continuing Education in Nursing, 48 (4), 151-153.
Valli, L., Stefanski, A. and Jacobson, R. (2018) School-community partnership models: Implications for leadership. International Journal of Leadership in Education, 21 (1), 31-49.
Viljoen, C.A., Millar, R.S., Manning, K. and Burch, V.C. (2020) Effectiveness of blended learning versus lectures alone on ECG analysis and interpretation by medical students. BMC Medical Education, 20 (1), 1-16.
Waite, R. and Nardi, D. (2019) Nursing colonialism in America: Implications for nursing leadership. Journal of Professional Nursing, 35 (1), 18-25.
Wiig, S., Ree, E., Johannessen, T., Strømme, T., Storm, M., Aase, I.,… and Aase, K. (2018) Improving quality and safety in nursing homes and home care: The study protocol of a mixed-methods research design to implement a leadership intervention. BMJ Journal, 8 (3), 1-8.