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TL 6 - Advocacy and Influence

 

The CNO advocates for organizational support of ongoing leadership development for all nurses, with a focus on mentoring and succession planning.

Provide one example, with supporting evidence, of each of the following activities:
  1. Mentoring or succession planning activities for a clinical nurse
  2. Mentoring or succession planning activities for nurse managers
  3. Mentoring or succession planning activities for for nurse leaders (exclusive of nurse managers)
  4. Mentoring or succession planning activities for the chief nursing officer

Example A: Clinical Nurse Mentoring Activities

Background/Purpose

Career development is the ongoing refinement of skills and knowledge, including job mastery and professional development, coupled with career planning activities (Baldwin, Duffield, & Roche, 2014). Jackie Gonzalez, DNP, MBA, ARNP, NEA-BC, FAAN, Senior Vice President & Chief Nursing Officer is an avid supporter of career development activities such as mentoring.  Research shows that mentoring results in an increase in professionalism, self- confidence, and self-worth (ANA, 2017). In addition, mentoring provides employees the opportunity to contribute of their profession, which increases job satisfaction and retention (Mariani, 2012).
 

Interventions

Mentoring a Clinical Nurse

Float Pool clinical nurse, Jennifer Fernandez BSN, RN, was actively engaged in the Float Pool Unit Council and always offered to provide the float pool with additional support for special projects. During her project time she was taken out of staffing and had dedicated project time. One of the nursing administration projects in support of the unit clinical outcomes boards was led by Nursing Excellence & Magnet Program Director, Jenny Cordo MSN, ARNP, NE- BC. The clinical unit outcomes boards specify clinical excellence metrics per department. Cordo recognized the value clinical nurse Fernandez brought to the team and appreciated her work ethic, skill set, and effectiveness.

Clinical nurse Fernandez expressed her desire to further her skill set and grow professionally. She expressed her desire to professionally grow and be involved in special projects during her 2016 performance evaluation as seen in Appendix TL6A-1. She offered to continue to support Cordo in other initiatives as needed. Cordo collaborated with Christina Mellon, MSN, RN, Float Pool nurse manager, to have clinical nurse Fernandez work one 12 hr shift with Cordo and her other two shifts in direct patient care. The intent was to establish a formal mentoring relationship in which Fernandez could further develop her leadership skills, in analyzing quality outcome data, enhancing communication, and networking opportunities.
 

Mentoring on Understanding Quality Outcome Data and Benchmarking

Cordo mentored Fernandez on quality data collection and submission into the National Database of Nursing Quality Indicators (NDNQI) and how to create data graphs in Excel.  The first time Fernandez created NDNQI unit specific graphs she requested feedback from Cordo. Cordo provided feedback on ways to change the graphic display to clearly demonstrate the organization’s data in comparison to the benchmark as seen in Appendix TL6A-2.

In addition to the clinical quality indicators data, Cordo guided Fernandez (seen in Appendix TL6A-3) to get 1:1 training to learn how to run patient satisfaction reports to create the data presentation graphs for the unit clinical outcomes boards. To familiarize herself with patient satisfaction and navigate the Healthstream reports, Cordo arranged for Fernandez to meet with  with Marisol Calero, the Service Excellence Facilator, who was able to guide Fernandez on how to effectively navigate the Healthstream system.
 

Professional Development Mentoring on Clear Communication

Through mentoring, Cordo has helped Fernandez’s professional development and enhanced her communication skills. Cordo has provided guidance in several communication areas such as email etiquette/clarity and non-verbal communication.  An example of Cordo assisting Fernandez with email communication is seen in Appendix TL6A-4.
 

Professional Growth Mentoring through Networking Opportunities

In helping to foster Fernandez’s continued growth in leadership and nursing excellence, Cordo provided her with the opportunity to present at the University of Miami’s School of Nursing as a guest lecturer in the Concepts of Advanced Practice Nursing. Cordo was requested to presented NCH’s practical application of Dr. Kolcaba’s Comfort Theory within the organization. Cordo had a scheduling conflict and  extended this opportunity to Fernandez, as she recognized the unique perspective Fernandez could bring to the class in her role as a clinical nurse describing how she has embedded the comfort theory into her nursing care at the bedside Appendix TL6A-5. Cordo recognized the opportunity to expand Fernandez’s presentation audience externally to the community on November 7, 2017.


In an effort to provide Fernandez with more leadership opportunities, Cordo suggested that Fernandez assist the Wound Care Coordinator in presenting to staff on NDNQI on September 6, 2017. Fernandez was able to teach employees how to properly complete the pressure injury prevelance form and the submission process.

Participant List

Jenny Cordo MSN, ARNP, NE-BC Nursing Excellence & Magnet Program Director Nursing
Christina Mellon MSN, RN Float Pool Nurse Manager Nursing
Jennifer Fernandez BSN, RN Clinical nurse Nursing
Name Credentials Role / Title Discipline

Significance and Impact

Under Cordo’s mentorship, Fernandez has grown both professionally and personally. Throughout Cordo and Fernandez’s ongoing relationship, Fernandez has further developed her communication skills and has had the ability to network with various leaders and colleagues throughout the organization. Fernandez has expressed her desire to return to school to obtain a master’s degree in leadership to further advance her professional development.

Example B: Succession Planning Fellowship Program to Transition a Nurse Manager to a Nurse Director Role

Background/Purpose

Nicklaus Children’s Hospital (NCH) values the importance of mentoring and career development.  The Nursing Leadership Fellowship is the standardized succession planning program for nurse managers to further enahnce their leadership skills and prepare them for the responsibilities of the Nurse Director role.  On November 2014, NCH initiated its first nursing leadership fellowship. This fellowship enrolled a Nurse Manager of Minor Procedure Suites (MPS) & Inflammatory Bowel Disease (IBD) Center, Zoila Araica, BSN, RN, who was identified by Jackie Gonzalez, DNP, MBA, ARNP, NEA-BC, FAAN, Senior Vice President and Chief Nursing Officer (SVP/CNO) as high potential candidate. The fellowship succession planning program was coordinated between Loubna Noureddin (Director of Learning & Development Services), Magaly Barroso (Director of Talent Management  and Effectiveness), Michael Kushner (SVP and Chief Talent Officer), and Dr. Gonzalez (SVP/CNO).
 

Interventions

Description of the Nursing Leadership Fellowship Program

All identified leaders at NCH were involved in supporting the Fellowship program.  They were expected to partner with the Fellow in order to familiarize the Fellow with their role and operational responsibilities. The Fellowship provided leadership support and ongoing interaction that prepared the candidate for a future in an advanced leadership role. The role of the identified fellow was to spend time in both clinical and non-clinical areas in order to better understand the process.  The expectation of the fellow was to assist with projects and provide their clinical expertise when needed in any area.
The objectives of the Fellowship Program were to:

  • Provide identified leader with continuous hands on leadership in both clinical and non-clinical areas
  • Provide regularly scheduled mentoring sessions
  • Prepare identified leader with a further understanding on the hospital’s strategy and operations for both clinical and non-clinical areas
  • To provide a fostering environment where the young leader can develop


Selection of Candidates for the Nursing Leadership Fellowship

Barroso incorporates career path interviews, during which she and her team interviewed emerging leaders in order to determine their career aspirations, alignment with the organization, current leadership competencies, learning agility, experience and background.  During the interview process, several nurse managers surfaced as candidates for the new Fellowship Program. The selection criteria included:

  • Ability to have a good balance between people and process
  • Clinical knowledge
  • Willing to accept challenges
  • Highly recommended by their Director


Succession Planning to Transition Zoila Araica RN, BSN from Nurse Manager to Clinical Director

The first Nursing Leadership fellow was Zoila Araica BSN, RN, Nurse manager of MPS & IBD Center.  Loubna was assigned to Araica as her coach to guide and facilitate her throughout the fellowship.  Loubna initiated a standing weekly meeting with Araica in order to ensure continuity with the mentoring process.  Loubna provided Araica with a schedule of all the areas that she was expected to experience from across the organization in order  to broaden her perspective and familiarize her with the director role. Araica gained knowledge and leadership advice from numerous leaders and shadowing experiences. Over the span of 6 months Araica was able to shadow and collaborate with both clinical and non-clinical leaders within the organization. Leaders shared expectations of their roles and familiarlized Araica with their strategic and operational responsibilities as highlighted in Appendix TL6B-1 demontrating Aracia’s Nursing Leadership Succession Planning Fellowship Experiences from Novemer 2014 - April 2015. Loubna and Araica met weekly over coffee to discuss what she had experienced and learned. Upon completion of the 6 month fellowship program, Loubna sent Araica the following email (Appendix TL6B-2) demonstrating Araica’s positive experience during the succession planning fellowship program.

In June 2015, Zoila successfully transitioned into the role of Clinical Nurse Director of Surgical Services. Refer to Appendix TL6B-3 to view the TM&E action form reclassing her role from nurse manager to Operating Room Director.

Example C: Mentoring Activities for Nurse Leader Patrick Manos, BSN, BA, RN, CPN, Operations Administrator

Background/Purpose

In August 2016, Patrick Manos, BSN, BA, RN, CPN, transitioned into a nurse leader role as an Operations Administrator (OA) under Susan Fornaris, BSN, MHSA, RN, SCRN, CMSRN, Administrative Director of Nursing Operations and Medical-Surgical Nursing. Manos’ new OA role was a hybrid nurse leader role to oversee the unit secretaries in addition to the OA role nurse leader role expectations.  The OA role provides hospital wide operational oversight and acts independently to handle crisis management, issues and interprets policies to makes timely decisions that directly impact patient care. OAs acts as the administrative liaison to patients, families, employees, and external customers.

Fornaris felt providing Manos with direct management of the unit secretaries provided opportunity to strengthen his leadership and communication skills. Fornaris took Manos under her wing and committed to provide ongoing guidance and mentorship for Manos’ development. Fornaris conducted various formal and informal meetings with Manos in order to continuously mentor Manos on various aspects of nursing leadership with a specific focus on his professionalism, communication skills, collaboration, and employee oversight. In addition to scheduled meetings, Fornaris meets with Manos on an as needed basis when an opportunity for real time coaching and mentoring presented.

Below is a description of various mentoring activities between Fornaris and nurse leader, Manos during their yearlong mentoring relationship which still continues today.
 

Interventions

Mentoring through Quarterly Performance Meetings

During the March 2017 quarterly performance meeting with Manos, Fornaris sat with Manos to review his progress to date. She expressed his strong performance in his role and provided feedback (highlighted in Appendix TL6B-1) in order to promote further growth. Fornaris expressed she would like to see Manos demonstrate softer communication and focus on relationship building. Manos expressed his desire to grow within the organization, and gain the respect of his nurse leader peers and the unit directors. Fornaris mentioned that Manos had to further develop relationships and the engagement of the unit clerks/secretaries. She expressed the importance of having monthly meetings with the unit secretaries allowing them to feel included and empowered. Starting in March and to date, Manos has conducted monthly unit secretary meetings. Since Manos began the monthly meetings, he has gained valuable feedback from the unit secretaries to improve their workflow processes and engagement. In the spirit of continuous growth and mentoring, Manos had invited Fornaris to some of the meetings to receive direct feedback from Fornaris regarding his communication and relationship building with the unit secretaries. Refer to Appendix TL6B-2 to view an email Fornaris sent Manos with feedback after the meeting regarding his positive communication.

During the June 2017 quarterly performance meeting Fornaris shared with Manos the improvements seen in his communication skills among the unit secretaries, nursing staff and other leaders across the organization. Fornaris recognized him for improving his communication of all concerns identifying patient safety, visitors, and protocols. As his mentor, Fornaris continuously guides Manos in his professional growth. She opened the conversation regarding his future career goals and recommended advancing his formal education to help him in his career growth. Fornaris discussed the various aspects among different programs. Manos shared his interest in enrolling into a Master’s in Business Administration program in the spring of 2018. Manos recognized his weakness in financial acumen and requested that Fornaris seek out opportunities to expose him to budget and financial initiatives. Fornaris additionally reviewed the NCH leadership catalog with Manos and recommended he register for the 3 hour Leadership Fundamentals course, “Finance and Business Acumen for Leaders”. Refer to Appendix TL6B-3 to view Fornaris’ suggestion during the June 2017 quarterly meeting for Manos to take the leadership course and completion of the course in Mano’s development plan.
 

Mentoring on Dealing with Difficult Families

In June 2017, Fornaris meet with Manos to discuss a formal parent complaint placed regarding his communication. While working as the OA, Manos spoke to a family requesting a crib for their 13-month old child. The family requested to speak to the hospital’s administrator after the unit clinical coordinator and patient’s clinical nurse both advised the family of the hospital policy to provide a bed for the 13 month old patient due to safety reasons.  When Manos met with the family he reiterated the policy and the safety concerns. The mother filed a formal compliant stating Manos’ approach was unprofessional and condescending in his delivery of his message. Fornaris reviewed the incident with Manos and provided communication tactics in dealing with difficult parents. She also recommended that he  take a seat and be eye level with parents when communicating to convey a warmer concerned attitude that is less intimidating to parents. She also mentioned that reiterating the policy over and over, was probably not the most appropriate thing to do. She suggested the parents were likely overwhelmed with the hospitalization. She stressed the importance of active listening while communicating with families and allowing them to release their frustrations. Fornaris discussed the concept that the “customer is always right,” and validating their concerns and feelings was most important in this case. To further assist Manos in his communication skills and professional growth, Fornaris recommended that he register for the two 8 hour leadership essentials classes “communication as a leader” and “critical conversations and confrontations in Leadership”. Refer to Appendix TL6B-4 to view documentation of the above mentoring and Manos completion of the leadership courses.
 

Recognition & Professional Growth Obtained through Mentoring

Fornaris’ continuous mentorship and open dialogue has provided Manos with the courage, skills, and tools needed to successfully transition into his new nurse leader role. He is currently one of the core administrators of the OA Team and frequently recognized by other leaders throughout the organization as shown in Appendix TL6B-5. Manos was recognized by a risk manager for his collaboration and responsibility in handling a patient safety issue. She positively recognized his consistent professionalism and leadership.

The ongoing mentorship relationship between Fornaris and Manos has enhanced his professional growth through insight into his development opportunities. Manos has been open to feedback and grown through the mentoring process. He has applied his new knowledge into his leadership style and has displayed a thirst for continuous growth and development. Manos has participated in leadership courses and has established a goal to advance his formal education.

Example D: Mentoring for the Chief Nursing Officer (CNO)

Background/Purpose

Dr. Gonzalez has over 37 years of experience with Nicklaus Children’s Hospital and has held the position of SVP/CNO and Patient Safety Officer since 1998.  She is highly regarded by her colleagues and as such has been a fellow of the American Academy of Nursing for over a decade. Through her many years of leadership and collaboration among nursing leaders through bi-annual meetings of chief nursing officers of children’s hospitals and many other forums, Dr. Gonzalez has developed strong relationships throughout the country giving her access to excellent nurse leaders.  Dr. Gonzalez actively seeks opportunities for mentoring and development through these relationships and is in constant pursuit of professional growth while learning from these highly regarded nurse leaders.
 

Interventions

CNO Invited to Join Editorial Board

Dr. Gonzalez was invited to join the editorial board of Nurse Leader to begin her tenure in early 2016. Nurse Leader is the official journal of the American Organization of Nurse Executives (AONE). Prior to this invitation, Dr. Gonzalez has written several articles and book chapters throughout her years as a nurse leader; however, being asked to join the editorial board with such influence on nurse leaders was a personal career goal for Gonzalez. Leaders such as prior AONE presidents Rhonda Anderson, RN, DNSc, FAAN, FACHE, Linda Burnes Bolton, DrPH, RN, FAAN and well know leader in shared governance Tim Porter-O’Grady, DM, EdD, ScD9h), APRN, FAAN, FACCWS were among the 2016 board members.
 

CNO Mentorship for New Role on Editorial Board

Dr. Gonzalez was honored to accept the role of editorial board member of Nurse Leader. Realizing that she was a novice in this new role and would need guidance to be able to fully contribute. Dr. Gonzalez sought the guidance and mentorship of Nurse Leader Editor in Chief Rose Sherman, EdD, RN, NEA-BC, FAAN, (refer to Appendix TL6D-1 to view Sherman’s Editor in Chief role) and Professor of Nursing & Director of the Nursing Leadership Institute from Florida Atlantic University. Sherman, a long-standing board member, was mentored herself into the role by a well-regarded nurse leader, former editor and now journal columnist, Roxane Spitzer, PhD, RN, MBA, MA, FAAN.
 

CNO Mentorship and Invitation as Guest Editor for October 2017 Issue

Throughout the year, Dr. Sherman served as a mentor and guide for Gonzalez as she learned the role and contributed as a reviewer of manuscripts throughout the year.  Towards the end of 2016, Dr. Sherman asked Dr. Gonzalez to be the guest editor of the October 2017 issue of Nurse Leader, including interviewing Dr. David Zambrana, DNP, ARNP, CEO of Jackson Memorial Hospital as the cover story of Nurse Leader to Watch. Gonzalez was also asked to develop the majority of the content for the issue, including seeking approximately 7 authors on various topics.  Dr. Gonzalez kept in close communication with Dr. Sherman seeking advice throughout this process with several check-in emails and telephone calls as seen in Appendix TL6D-2.  Dr. Gonzalez was able to complete her assignment by the first week of July 2017, meeting the journal publication deadline. All articles were submitted for the October issue, including Dr. Gonzalez’s interview of Dr. Zambrana for cover and spotlight on Nurse Leader to Watch.

Dr. Sherman was always positive and encouraging, offering advice about potential topics and strategies to seek authors.  In February 2017, Dr. Sherman advised Dr. Gonzalez to consider seeking availability of well-known AONE Policy Director, JoAnn Webb, as well as to consider a publication from within the organization. Dr. Gonzalez acted upon Dr. Sherman’s suggestion and approached Jo Ann Webb who agreed to author a policy/advocacy article for the issue as seen in the Appendix TL6D-3 email communication. Dr. Sherman also further mentored and encouraged Dr. Gonzalez by suggesting that she not be disappointed if all accepting authors did not complete their assignments as seen in the Appendix TL6D-4 email communication.  Dr. Gonzalez, as a new and hopeful guest editor was certain that this would not happen, but in fact did disappointingly happen when 2 authors did not complete their articles. Dr. Gonzalez remembered what her mentor had shared and in spite of this challenge, was able to submit a strong guest editor issue on time.

By utilizing a strong nurse mentor, Dr. Gonzalez was able to learn the role of an editorial board member as well as the role of guest editor, facilitating authorship of several authors in the October 2017 issue of Nurse Leader. By seeking the wisdom and mentorship gained from a nationally recognized nurse leader, Dr. Gonzalez learned to fully contribute among many accomplished national peers and leaders that she has looked up to through many years.

Participant List

Name Credentials Unit/Department Title/Role
Rose Sherman EdD, RN, NEA-BC, FAAN Editor, Nurse Leader Editor & Professor of Nursing & Director of the Nursing
Leadership Institute of Florida Atlantic University/Mentor
Jackie Gonzalez DNP, RN, MBA, NEA-BC, FAAN Nursing Administration SVP/CNO /Mentee

Significance and Impact

Dr. Gonzalez is fortunate to work with accomplished mentors nationally who are experts in nursing leadership and as such she has been able to develop her own editorial skills as a board member for a nationally regarded journal.  The October 2017 issue of Nurse Leader will be published and Dr. Gonzalez’s mentorship under Dr. Sherman has allowed Gonzalez to serve as the journal’s guest editor. As a part of this continued circle of mentorship, Dr. Gonzalez encouraged one of the articles to be written by two nurse leaders, Jennifer Cordo, MSN, ARNP, NE-BC, and Deborah Hill-Rodriguez, MSN, MBA, ARNP, NE-BC, from Nicklaus Children’s Hospital. The article they collaboratively wrote titled “The Evolution of a Nursing Professional Practice Model through Leadership Support of Clinical Nurse Engagement, Empowerment, and Shared Decision Making” was selected for publication in the October 2017 issue.  Refer to Appendix TL6D-5 to view the email communication confirmed the acceptance of Cordo and Hill-Rodriguez’s article.

By enhancing her own professional growth as a CNO in becoming an active editorial board member, Gonzalez has in turn supported developing leaders as they grow, enhancing their writing skills. When Gonzalez was asked to contribute a chapter in a nursing leadership text book, she was able to mentor Susan Fornaris, BSN, RN, MHSA, SCRN, Director of Nursing Support Services & Operations, who had never published by encouraging her to write a case study within the chapter.  Gonzalez met with this young leader, reviewed and edited her content while mentoring her and teaching along the way.  As CNO, Gonzalez will continue to use her own professional growth experience to mentor and empower new nurse leaders as they test and hone their own writing skills.

References

American Nurses Association (ANA). (2013). From our readers: How mentorship affects retention rates of new nurses. Retrieved from: https://www.americannursetoday.com/from-our-readers-how-mentorship-affects-retention-rates-of-new-nurses/

Baldwin, R., Duffield, C., & Roche, M. (2014). Job enrichment: Creating meaningful career development opportunities for nurses. Journal of Nursing Management, 22(6), 697-706.doi: 10.1111/jonm.12049

Mariani, B. (2012). The effect of mentoring on career satisfaction of registered nurses and intent to stay in the nursing profession. Nursing Reasearch and Practice, 1, 1-9. doi: 10.1155/2012/168278