E d ucational

i n n o vat i o n s

The Development of the Next Generation of Nurse Leaders

Kathie A. Aduddell, EdD, RN; and Genie E. Dorman, PhD, APRN, FNP-BC

Abstract

This article explains the development of a value-added leadership focus to a graduate nursing program.
With the changes to and complexity within the health care system,
advanced practice nurses need academic preparation in advanced care
management of populations and
leadership competencies. Strategic
environmental scanning suggested
that some revisions could better prepare future nurse leaders. Through
literature review and focus groups,
facultys analysis provided evidence
for development of a different kind
of advanced practice nurse. This process led to a graduate program that
prepares nurse leaders who are competent 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 individuals educational needs. Grounded

Received: May 7, 2008

Accepted: February 4, 2009
Posted: November 25, 2009
Dr. Aduddell is Associate Professor, WellStar School of Nursing, and Director, Center
for Community Health Care, WellStar College of Health and Human Services, and Dr.
Dorman is Professor of Nursing, WellStar
School of Nursing, Kennesaw State University, 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

168

in practicum experiences and guided

by health care theory, policy, and research, graduates possess the knowledge and competencies to assume the
advanced leadership roles required
in future health care systems.

lthough a school of nursing at a

southeastern university had a
successful primary care nurse
practitioner program since 1996, a
strategic environmental scan indicated the need for a non-nurse practitioner 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, diverse 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 focus, with approximately 40 students
admitted each fall. Graduates of the
nurse practitioner program demonstrate 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 convenient practicum site assignments are
cited as strengths by the programs
graduates.
Through review of the evaluations
of the current graduate nursing program and an assessment of its graduates 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 populations in a variety of health care settings. These advanced practice nurses
would possess the knowledge, skills,
and competencies necessary to successfully navigate the ever-increasing
complexity of todays health care environment. The purpose of this article
is to describe the processes used in
developing a new focus for the graduate nursing program that included
curriculum design and pedagogy, program implementation, and evaluation
strategies.

Literature Review

A call continues to be issued for

preparation of nurses with advanced
clinical and conceptual competencies in care management, ethical
and value-based decision making,
and leadership. In Health Cares Human Crisis: The American Nursing
Shortage, Kimball and ONeil (2002)
reported that the current model of
nursing practice requires change to
address the structural nursing shortage 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 education 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 leadership to handle the challenges and
complexities of the ever-changing
health care system (Barker, Sullivan,
& Emery, 2006; Boyatzis & McKee,
2005; Kerfoot, 2006; McGuire & Kennerly, 2006; Nickitas, Keida, Nokes, &
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Educational Innovations

Neville, 2004; Porter-OGrady & Malloch, 2003; Senge, Scharmer, Jaworski, & Flowers, 2004).
Nurse leaders need to thrive and
embrace change as they effectively
and efficiently guide their organizations through turbulent and chaotic
times (Porter-OGrady & Malloch,
2003). A new era of resonant leaders is emergingleaders who inspire
organizations, are mindful, and instill hope (Boyatzis & McKee, 2005).
This new era of leadership requires
presence, a skill process of suspending, 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 interpersonal and intrapersonal abilities,
such as coaching employees, managing a team of colleagues, educating
coworkers, managing conflict, and
caring for self (Porter-OGrady & Malloch, 2007).
According to Kerfoot (2006), in our
21st century world:
the successful leader and manager have two very important challenges: to scan the horizon and not
be thrown into crisis by not seeing
predictable surprises, and to recognize the longer, more pervasive
trends that are in the distant future
(pg. 47).

Kerfoot suggested competencies in

developing an annual plan that incorporates four parts:
l Review any changes in the organizations plan.
l Determine
changes required
from an annual autopsy.
l Review goals already outlined
in the long-range plans for the coming year.
l Alter the plan based on evidence so as to avoid predictable surprises.
The leaders of the 21st century
must envision new and different realities and futures. Of critical importance is the emotional competence
required as one functions in a leadership 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 development 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 College of Healthcare Executives, 2005).
In preparing nurse leaders, Cardin
and McNeese-Smith (2005) stated
that the goals of an effective nursing 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 emergence of new advanced practice specialties need to be deliberately shaped
to posses core competencies that are
standardized and meet national certification and regulation requirements.
Unfortunately, Senge et al. (2004) indicated 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 literature provided evidence of the need
for new competencies. In light of this
review, faculty conceptualized an advanced practice role that incorporates
components of the various advanced
practice specialties, as well as establishes a possible career-track pathway for more individuals obtaining
a doctorate in nursing. The new competencies inherent in the role include
the following:
l Care management and leadership.
l Information and health care
technology systems.
l Research process and evidencebased practice.
l Human resource use.
l Conflict resolution and negotiation.

Journal of Nursing Education Vol. 49, No. 3, 2010

l Advanced assessment and disease management principles.

l Teaching-learning
strategies
and curricular patterns.
l Health policy and health systems thinking.

Initial Program Development

This university provides strong

undergraduate and graduate education programs that prepare students
for advancement in their chosen professions. This preparation includes
critical thinking, effective communication and interpersonal skills, leadership development, social responsibility, and lifelong learning. Faculty
inculcated these concepts through the
process of program development. The
Master of Science in Nursing, Advanced Care Management and Leadership 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 surveys with surrounding health care
institutions through advisory boards
and meetings with nurse leaders. The
findings of these surveys and meetings indicated that nurses did not
have an adequate understanding of
the policy, power, financial, and care
management issues inherent in todays health care environment.
A second phase involved interviews with interested faculty who had
expertise in specific curricular areas.
The faculty were invited to participate 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 analyzing and incorporating nationally
recognized nursing education standards 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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Educational Innovations

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. Because the literature review indicated
the need for curricular instruction in
team building, conflict management,
human resource focus, and management 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 nationally recognized expert on leadership
in nursing, which led to further refinement of the curriculum design.

Curriculum Design

The next stage of program development consisted of the curriculum

design, which included the development of specific courses and course
sequencing to achieve the overall program 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 framework 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, research).
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 requirements from AACN and NACNS
resulted in the development of the following core courses: Advanced Health
Assessment, Health Maintenance,
170

and Health Promotion; Pharmacology for Advanced Practice Nursing;

Pathophysiology for Advanced Practice Nursing; Professional Advanced
Practice Role Development and
Health Care Issue; Healthcare Theory, and Research Application and
Outcome Evaluations in Advanced
Practice Nursing. These courses are
taught jointly to students in the Primary Care Nurse Practitioner Program and the Masters in Advanced
Care Management and Leadership
Program to maximize the use of resources.
A review of the American Nurses
Associations Code of Ethics for Nurses with Interpretive Statements (2001)
and the Scope and Standards of Advanced Practice for Registered Nurses
(1996) resulted in the development of
the following courses: Ethics of Leadership for Advanced Practice Nursing, 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 emphasized ethical leadership, health
systems, and health policy in client
care situations and from a global perspective.
Finally, work by Tanner (1998;
1999) and Youngblut and Brooten
(2001) provided a framework for establishing a strong foundation of
evidence-based practice principles.
For this reason, the research, advanced care management, and leadership courses were designed to focus
on evidence-based practice and outcomes 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 Applications and Leadership Skills for
Advanced Practice Nursing, and Advanced Care Management Project.

sion on Collegiate Nursing Education and the American Nurses Credentialing Center (ANCC, 2009) for
graduate programs and certification
eligibility. The curriculum design provides for appropriate practicum experiences to allow students to apply for
specific national certification. In addition, the program has specific outcomes based on curriculum foci and
graduate competencies and skills. An
example of this process relates to the
curriculum focus of budgetary and fiscal knowledge. After completion of the
program, students have acquired the
knowledge and skills needed to oversee budgets and participate in the financial planning process. Another example 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 development.
Another aspect of the evaluation
process is the opportunity for students, alumni, and the graduates employers to provide ongoing feedback
to the program. Students are given
the opportunity to evaluate the program 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 graduates are also asked to evaluate the
program at 1-year, 3-year, and 5-year
intervals. As faculty and administrators 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 benefits of the program from alumni and
employers indicated that many of the
graduates are obtaining promotions
to leadership positions.

Evaluation Strategies

Conclusion

The school of nursing uses the universitys assurance of learning model

that is based on outcome evaluation
strategies. The program also adheres
to the requirements of the Commis-

The Master of Science in Nursing in Advanced Care Management

and Leadership Program incorporates several innovative strategies,
as evidenced in literature and enviCopyright SLACK Incorporated

Educational Innovations

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 nursing program. The program prepares
graduates to be expert clinicians and
outstanding leaders equipped to manage and improve client care outcomes.
Students have the opportunity to focus their studies in a particular area
of interest via the practicum courses,
which provide an overall value-added
educational experience. They can customize their educational experiences
to best meet their learning needs and
overall professional goals.
Other value-added experiences include geographically diverse opportunities for practicum experiences, clinical
experts, and facilities, as well as the
opportunity to participate in practical experiences in the community. The
delivery model of the program allows
students to complete advanced practice education with a minimum of career disruption. The 40-semester hour
cohort program provides the flexibility
of online and alternate-weekend class
delivery and is built around core graduate 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 knowledge and competencies to assume the
advanced leadership roles required in
future health care systems.

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