64 NURSING RESEARCH Developing Leadership in Nurse Managers: The British Columbia Nursing Leadership Institute Maura MacPhee, RN, PhD Assistant Professor, University of British Columbia School of Nursing Academic Lead and Evaluator, British Columbia Nursing Administrative Leadership Institute for First Line Nurse Leaders Vancouver, BC France Bouthillette, RN, DNSc Adjunct Professor, University of British Columbia School of Nursing Executive Lead, British Columbia Nursing Administrative Leadership Institute for First Line Nurse Leaders Vancouver, BC Abstract The British Columbia Nursing Administrative Leadership Institute for First Line Nurse Leaders (BC NLI) is a collaborative partnership among British Columbia’s Chief Nursing Officers, the Ministry of Health Nursing Directorate and the University of British Columbia School of Nursing. This initiative consists of a four-day residential program and a year-long leadership project between BC NLI participants and their organizational mentors. The evidence-based curriculum covers universal leadership and management concepts, but it also addresses leadership issues of relevance to nurse leaders in today’s complex healthcare environments. The BC NLI is part of a provincial health human resources endeavour to ensure sufficient nursing leaders – for now and in the future. This paper will discuss the development, implementa- tion and evaluation of the BC NLI. Unique aspects of the program, such as its online networking component, will be described, and its role in nursing leadership research will be briefly examined. Introduction Effective nursing leadership has been credited with improved work environments, greater nurse satisfaction, lower nurse turnover and better quality of patient care Developing Leadership in Nurse Managers: The British Columbia Nursing Leadership Institute 65 (CNAC 2002). There is a serious shortage of nurse leaders in Canada (Kilty 2005). Laschinger and Wong (2007) recently completed a national study on the status of nursing leadership in hospitals in which they found a significant reduction in leadership positions resulting from 1990s downsizing activities and an average age of 50 years for present nurse leaders (all levels). As these leaders retire, with- out thoughtful human resources planning, the nursing leadership shortage will worsen (O’Brien-Pallas et al. 2001). Formal leadership development programs have become one strategy for devel- oping nurse leaders (Contino 2004; Loo et al. 2003; Simpson et al. 2002). In this paper, the authors describe a collaborative, evidence-based initiative between British Columbia Chief Nursing Officers (CNOs), the Ministry of Health Nursing Directorate (MoH) and the University of British Columbia School of Nursing (UBC-SON). We also address the evaluation of the BC Nursing Administrative Leadership Institute (BC NLI) and associated research. Support for Leadership Development Programs In business and government, leadership development programs are considered a vital component of management training (Hamlin 2004). There are significant financial payoffs for companies that invest in leadership training and develop- ment (Krohn 2000). A meta-analysis of managerial leadership development programs found that leadership training can result in significant knowledge and skills improvement, although this outcome depends on matching the right learn- ing opportunities to the right leaders (Collins and Holton 2004). The meta-analysis included 103 leadership development studies with a range of interventions: 80% were formal programs; other interventions included coaching/mentoring and on- the-job training. The majority of these programs employed a 360-degree evalu- ation approach with supervisors, peers and subordinates. The researchers of this meta-analytic study concluded that successful leadership outcomes may depend on matching participants’ educational objectives to an organization’s strategic vision and goals. Organizational leadership needs assessments prior to training also increase the probability of successful outcomes (Collins and Holton 2004). Nursing leadership development programs have utilized a variety of theoretical models and training strategies. A paper by Tourangeau et al. (2003), evaluating the Toronto-based Dorothy M. Wylie Nursing Leadership Institute (DMW NLI), provides an excellent overview of nursing leadership development programs from the United States and the United Kingdom. Although leadership outcomes varied by intervention and the focus of the evaluation, all the programs cited by Tourangeau and colleagues demonstrated positive, significant short-term outcomes from formal leadership training. 66 Nursing Leadership Volume 21 Number 3 • 2008 Background In response to the recommendations of the Canadian Nurse Advisory Committee (CNAC 2002), the BC collaborative partners established a formal leadership devel- opment program, the BC NLI, for first-line nurse leaders within the province. The partners agreed that the objectives of the BC NLI would be (a) to assist novice first-line nurse managers with the development of a set of core management and leadership competencies and (b) to facilitate the application of management and leadership concepts and skills to real-life situations. To support the identification and development of current and future first-line nurse managers, the partners hired a consultant to conduct an extensive provincial needs assessment of first-line nurse leader competencies (Arcand 2003). A needs assessment prior to the development of a leadership program is seen as a way to better tailor curricular content and delivery to the needs of an intended audience (Collins and Holton 2004). The provincial needs assessment identified manage- ment and leadership competencies similar to those reported by Care and Udod (2003) and Hamlin (2004). The core competencies were categorized as under- standing leadership styles; team building and maintenance; organizational plan- ning and strategizing; change management process; empowerment and delega- tion; human resources planning and development; and communications (Arcand 2003). The academic partner, UBC-SON, was tasked with creating, implementing and evaluating a BC NLI program based on the leadership development literature and the provincial needs assessment. The authors of this paper proceeded to organize the identified core competencies into a conceptual framework (Table 1). The BC NLI uses a Full Range Leadership model with an emphasis on transformational leadership augmented by trans- actional leadership (Bass et al. 2003). Participants learn how these two styles complement and enhance each other. This leadership training approach is similar to training approaches in other disciplines, such as Human Resources, Business Management and Organizational Development (Kelloway et al. 2000). To promote nursing leadership succession planning within the province, we wanted to use an approach that would facilitate BC NLI participants’ entry into Master of Business Administration or Master of Health Administration programs. Reviews of other leadership programs, such as the DMW NLI (Simpson et al. 2002; Torangeau et al. 2003) and the Sigma Theta Tau International (STTI) Leadership Academy (STTI 2005) showed that the inclusion of a mentor- supported leadership project is an effective tool for practising and applying core competencies, such as change management, within an organizational context. Mentoring is a powerful tool for developing leadership potential in others (McKinley 2004). The development and implementation of a leadership project Developing Leadership in Nurse Managers: The British Columbia Nursing Leadership Institute 67 with the support of a mentor from the participant’s organization has become an integral part of the BC NLI experience. Table 1. Core competencies of the BC NLI curriculum Developing the Leader • Self-assessment • Understanding and using the power of influence • Developing your power base • Effective leadership styles • First-line nurse leaders: leading from the middle • First-line nurse leaders as change agents and innovators Leading Others • Empowering others • Team-building • Conflict management • Influence strategies • Healthy work environments Leading through Effective Planning • Change management • Project planning • Innovation strategies • Fiscal budgeting • Resource allocation • Developing work-related projects The Mentee–Mentor Relationship • Roles and responsibilities • Developing a mutual understanding • Identifying the mentee’s leadership learning objectives in relation to the project • Developing project description, goals and objectives Evaluative Responsibilities • Evaluation form • Project description, project updates, project reports • Career tracking • The portfolio (optional) The pilot BC NLI was held in March 2005 in Harrison Hot Springs, BC. Attendance was free for the participants, with conference costs covered by a CNAC grant and CNO financial assistance. Curriculum development and delivery were provided as in-kind support by UBC-SON. Twenty novice first-line nurse leaders attended a three-day residential program. These participants were either new to their leadership roles, had fewer than three years’ experience in a leadership posi- tion or were being groomed for a leadership position within their organizations. Participants were nominated by their CNOs to attend the BC NLI. In addition to nominating novice nurse leader participants, the CNOs were also asked to identify 68 Nursing Leadership Volume 21 Number 3 • 2008 a suitable expert nurse leader to act as a mentor for each participant. Participants represented a variety of healthcare settings: acute care, residential care and community and mental health. One month before the BC NLI, participants and their mentors received a prepara- tion packet asking them to identify a relevant leadership project they could work on together and realistically complete over the course of a year. This mentorship component and the project work were modelled after STTI’s original Maternal– Child Health Leadership Academy (STTI 2005). After the three-day residential program, participants returned to their respective organizations and were asked to reconnect with their mentors. Mentors were asked to commit set time periods to meet with their mentees, and to assist with the devel- opment, implementation and evaluation of mentees’ projects. They were also asked to assist their mentees with “learning the management ropes,” such as informal and formal networking channels to utilize within and outside the organization. The CNOs’ commitment to this initiative helped ensure adequate organizational support with respect to release time and resources for mentor–mentee projects. Patrick and Laschinger (2006) demonstrated significant associations among lead- ership empowerment, role satisfaction and adequate organizational support. Four months after the three-day residential program, mentor–mentee dyads were invited to attend a two-day follow-up session at UBC’s Vancouver campus. This time was solely devoted to project work, with UBC-SON faculty available for consultation. This follow-up session was also funded through the CNAC grant. At this session, participants were given portfolio templates for organizing their project materials. Although not a requirement of the BC NLI, participants were strongly encouraged to showcase their work in project portfolios. Portfolios are commonly used in other leadership communities, such as the business sector, to demonstrate project progress and outcomes. They can also be used to track indi- viduals’ professional growth and development, including ongoing learning needs (Brown 2002). At the end of a year, when participants were asked to provide a project report or summary, some participants produced project portfolios in lieu of a project report. The projects served as a vehicle for novice first-line nurse leaders to practise change management skills, to acquire systems-level knowledge of their organiza- tions and to continue to develop their leadership skills. Many projects dealt with significant practice environment issues, such as recruitment and retention of new graduate nurses, staff assimilation of internationally educated nurses, unit mergers, changes to care delivery models and skill mix, self-scheduling, practice Developing Leadership in Nurse Managers: The British Columbia Nursing Leadership Institute 69 council development and the introduction of new technology (e.g., computerized documentation and order entry). Based on the success of the first BC NLI cohort (see below for evaluation details), funds were obtained to offer a second BC NLI in 2006. The feedback prompted a decision to extend the residential program to four days and to eliminate the two-day follow-up session. It proved to be more cost-effective to offer a fourth day in Harrison Hot Springs for mentor–mentee project work, and participants reported that it was very helpful for them to initiate the project planning process while ideas and new knowledge were fresh in their minds. In addition, the four-day residential gave all involved a rare opportunity to focus on the project without interruptions. Since the second BC NLI, the BC MoH Nursing Directorate has committed fund- ing for the BC NLI through 2010. As part of a collective bargaining agreement, the MoH has also allocated monies to create new first-line nurse leadership positions (BC MoH 2007). The CNOs continue to support the BC NLI by nominating nurse leaders and ensuring their attendance. UBC-SON has committed faculty and staff support to provide three sessions per year, with each session accommodating 35 mentee–mentor dyads. It is anticipated that over 400 new nurse leaders will bene- fit from the BC NLI over the next few years. Program Description The current BC NLI program consists of three major components: a four-day residential workshop that delivers content on core leadership and management competencies (Table 1); a mentor-supported leadership project that continues over the course of a year within participants’ respective organizations; and a leadership website that provides participants with online resources, chat space and lists of provincially based leadership projects and project leader contact information. The BC NLI faculty is typically from the UBC-SON, but guest speakers are invited from other disciplines and institutions, such as UBC’s Sauder School of Business. During each session, some time is allotted to discuss current topics and trends in leadership and management, such as patient safety, Quality Improvement initia- tives and operations management. A Sauder School business faculty recently delivered a presentation on operations management, demonstrating the impor- tance of systems analysis techniques to improve patient flow in a variety of hospi- tal systems. These topics are intended to broaden participants’ appreciation for contemporary leadership and management issues, and to sensitize them to new vocabulary in the literature and in professional and academic communities. At each BC NLI workshop, one of the BC CNOs is invited to deliver a welcom- ing presentation at the first night’s “meet and greet” session. The CNOs often use 70 Nursing Leadership Volume 21 Number 3 • 2008 this time in dialogue with nurse leaders about leadership and management issues of concern to them. Participants also provide a brief introduction to themselves, their work environment and their leadership projects. Throughout the remainder of the workshop, participants work together in round tables. The content is delivered as lectures interspersed with case studies and applied problems that require group work. Specific time is designated before and during evening meals for social and professional networking. On the last evening together, the mentors are invited to join their mentees for a buffet dinner. The following day is devoted to mentor–mentee project work, although time is also set aside to discuss BC NLI participant expectations, such as the completion of the year-long project. The importance of the mentor–mentee relationship is emphasized by the BC NLI faculty, and mentor–mentee dyads receive guidelines to develop and maintain their professional relationship, as well as a contract that details the terms of their professional commitments to each other. Successful mentor–mentee relationships depend on clear delineation of mentor–mentee roles and responsibilities, with specific terms of mentor–mentee commitment (Cox 2005; McKinley 2004). Some components of the BC NLI are similar to other programs, but there are other unique, evidence-based components, such as the emphasis on online knowl- edge networking. Online knowledge communities (OKCs) can serve as venues for continuing professional development, social supports for members and avenues for sharing and diffusing innovations (de Vries et al. 2004; Greenhalgh et al. 2004). Additional in-kind support through UBC-SON has provided the technological support necessary to create a leadership OKC at the BC NLI website (2008). There are several components to this website, including an online registration page for mentees and mentors, a resource centre to house leadership and management materials for participants, a discussion forum and a project page. Some pages, such as the registration pages, are accessible only to members, but other pages are publicly available. On the project page, for instance, the public and BC NLI participants can browse the site to see what types of projects are nurse-led within the province. Project access will hopefully increase networking among nurse lead- ers within British Columbia and reduce duplication of resources. Recently, for instance, members of different BC NLI cohorts discovered that they were working on similar skill mix issues. They were able to connect electronically to share a vari- ety of tools, policies and guidelines with one another. In the near future, we will be employing a knowledge broker to facilitate online networking and use of the BC NLI online resources. Knowledge brokering can enhance networking, resource utilization and the development and maintenance of OKCs (CHSRF 2007). Developing Leadership in Nurse Managers: The British Columbia Nursing Leadership Institute 71 One of the online pages under construction will significantly contribute to our provincial nurse leadership succession planning process. We are developing an online career tracking page and database to determine how our BC NLI partici- pants are evolving. Are they staying in first-line nurse leadership roles, or are they progressing to mid-level and executive positions? Are they staying within the same organization or the same Health Authority? BC NLI participants will receive annual e-mail prompts to complete the online career tracking forms. This career tracking process will provide us with valuable health human resources data. Evaluation of the British Columbia Nursing Leadership Institute There have been two forms of BC NLI program evaluation: (a) a written evalua- tion of BC NLI content and delivery at the end of the workshop and (b) project progress reports. Formal interviews were conducted with mentors and mentees as part of the BC NLI pilot evaluation in 2006. Written evaluations Open-ended evaluation questions offer participants such prompts as: “the most beneficial part of the BC NLI was…,” “I would change…,” “A new idea for me was….” Favourable written evaluations have demonstrated the relevancy of the content, the value of the delivery format, an immediate positive effect on the nurse leaders’ attitude towards their jobs and an improved sense of confidence in their leadership abilities. Several BC NLI participants have said that attendance at the workshop renewed their faith in and commitment to their work, particularly their leadership and management roles and responsibilities. One participant said: “I had my resignation ready to go in my desk. I have new confidence in myself and my ability to be an effective leader. I actually have the tools to do it!” Since the inception of the BC NLI, the authors have utilized feedback from the workshop evaluations to modify and strengthen the program’s content and deliv- ery. Some program changes have included more interactive sessions and more time for informal networking. Additional content has been added to the sessions on conflict management, team-building and fiscal planning and resource allo- cation. Notably, every BC NLI cohort has requested more content on conflict management and “dealing with power dynamics.” Project progress reports The online project page has simplified the task of recording and evaluating project progress. After the workshop, participants are asked to record their project titles and summaries on the BC NLI project page. Participants have access to one another’s information, and each participant has the option of making his or her 72 Nursing Leadership Volume 21 Number 3 • 2008 information publicly accessible. E-mail reminders are sent out to participants if they do not complete their project summaries by specific dates after the work- shop. Participants receive e-mail notices at six months to complete a brief project update online, and at the end of the year, participants are electronically prompted to complete an online project report that includes an overview of their leader- ship successes and challenges. Some participants have produced project portfolios that have been used for undergraduate or graduate academic credits. During the workshop, participants are given a portfolio binder with a table of contents and content descriptions that enable them to apply for academic credit through UBC and other provincial colleges and universities. Interviews The first cohort of BC NLI participants completed their year-long program in March 2006. A purposive sample of mentors and mentees were interviewed in the summer of 2006. Approval to conduct mentee–mentor interviews was obtained from UBC’s Institutional Review Board, and all interviewees formally consented. Mentor–mentee dyads were interviewed from each of the six provincial Health Authorities. A total of eight interviews were conducted within the mentees’ and mentors’ work environments in private locations. For each dyad, some of the questions were privately addressed to the mentee, some were privately addressed to the mentor and some were addressed to the dyad. The entire interview proc- ess averaged an hour in length. The key areas explored during the interviews were the strengths and weaknesses of the BC NLI program, the project successes and challenges and the mentoring process. The purpose of these questions was to determine how future BC NLI offerings could be strengthened to better ensure successful outcomes for participants and their respective mentors and organiza- tions. The audiotapes of the interviews were transcribed and independently coded and analyzed for recurring major themes by a graduate student assistant and one of the authors (Miles and Huberman 1994). The mentee interviews yielded the following themes with respect to the BC NLI’s successes or strengths: dialogue and networking with peers, having the tools to succeed, feeling valued and time away for reflection. Pertaining to project successes, the predominant mentee theme was succeeding at change: “I learned the organizational lingo to get along – and the tools to succeed at managing change. I feel more comfortable and confident around other managers.” Mentees’ biggest project impediments were lack of organizational support, changes of priorities within the organization and picking the wrong project. Some mentees picked projects of interest to them, but if these were not part of their formal duties or responsibilities, they frequently had to abandon their projects. “I had this whole new job to learn, and every single portion of it was a learning process. And then I had the project besides. … I ran out of energy.” Developing Leadership in Nurse Managers: The British Columbia Nursing Leadership Institute 73 Mentors’ interviews focused more on project successes and challenges, and their comments mirrored their mentees’ statements. Mentors and mentees independ- ently acknowledged the importance of organizational support, especially with respect to release time and resources to work on the leadership projects. One mentor said: “There has to be protected time and resources, otherwise, you’re not going to be able to keep moving ahead.” Mentors and mentees equally valued the mentoring process and reported benefits from the relationship. Mentees particularly appreciated the opportunity to reflect confidentially on their practice with their mentors. Mentors appreciated the oppor- tunity to “to think outside the box for a change. … you get asked questions and you have to start thinking – really thinking and learning. It’s a reciprocal process.” Research While we have some evidence that supports the importance of nursing leader- ship development programs, many program evaluations have been limited to pre–post self- and other questionnaires, with post- assessments occurring within a year of program completion. Tourangeau and colleagues (2003) evaluated lead- ership outcomes from the DMW NLI. After three months, self-reports of leader- ship practices did not significantly change from a baseline assessment, but other reports (e.g., those of supervisors, peers) noted significant increases in partici- pants’ leadership behaviours. Similar findings were reported from a meta-analysis of leadership development program research from 1982 to 2001 (Collins and Holton 2004). Self-reports of leadership behavioural change were not significant, but other reports were. This variance may be due to individual leaders’ tendency to evaluate themselves more critically (Collins et al.; Tourangeau et al.). A dearth of research exists with respect to long-term outcomes of nursing lead- ership development programs. One of the authors (MacPhee) is the principal investigator for a Canadian Health Services Research Foundation (CHSRF) research grant to evaluate the structure and the process of leadership development program delivery with respect to nurse leader and nursing staff outcomes. This study is framed as a testable leadership development program logic model that includes theoretically derived program inputs, activities, outputs and outcomes. This research program is funded over four years, enabling the research team to explore long-term outcomes from the BC NLI. The BC NLI was selected for this research because it focuses on novice nurse leaders with limited preparation for their first-line leadership positions. BC NLI participants also represent nurse lead- ers from diverse practice settings across the province. The goal of this research is to add additional weight to the evidence that supports the importance of nursing leadership development. 74 Nursing Leadership Volume 21 Number 3 • 2008 Conclusion The BC NLI is an evidence-based nursing leadership development program that utilizes a variety of contemporary leadership and management theories as its conceptual foundation. The delivery format has borrowed from some exemplary nursing leadership development programs, and the content and delivery format have been honed over time through a variety of evalua- tion processes. To ensure the life expectancy of this valuable program, the BC NLI is being highlighted in a four-year research study that will enable the research team to track leadership outcomes with respect to leadership succession planning within one province, and it will help to determine the factors that significantly influence successful leadership outcomes, such as organizational supports. Acknowledgements We offer our sincere thanks for the support we have received from the collabo- rative partners for the British Columbia Nursing Administrative Leadership Institute for First Line Nurse Leaders, University of British Columbia School of Nursing, British Columbia Ministry of Health Nursing Directorate and British Columbia Chief Nursing Officers. Correspondence may be addressed to: Maura MacPhee, Assistant Professor, University of British Columbia School of Nursing, T239-2211 Westbrook Mall, University of British Columbia, Vancouver, British Columbia, V6T2B5; phone: 604- 822-2891; email: Maura.firstname.lastname@example.org References Arcand, R. 2003. “First Line Nursing Leadership Development of an Education Program: Phase I.” Unpublished report. Vancouver: University of British Columbia School of Nursing. Bass, B., B. Avolio, D. Jung and Y. 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