Experiences of Master's Prepared Clinical Nurse Leaders at Three

Journal of Professional Nursing 35 (2019) 51–56 Contents lists available at ScienceDirect Journal of Professional Nursing journal homepage: www.elsevier.com/locate/jpnu Experiences of Master's Prepared Clinical Nurse Leaders at Three Years Post- Graduation T ⁎ Bobbi Shattoa, , Kristine L'Ecuyera, Geralyn Meyera, Anne Shagavaha, Emily Mooneyb a Saint Louis University School of Nursing, United States b Missouri Baptist Hospital, St. Louis, MO, United States ARTICLE INFO ABSTRACT Keywords: Direct Entry Master of Science in Nursing programs that incorporate Clinical Nurse Leader (CNL) education are Clinical nurse leader relatively new in the United States. Little is known about the transition to practice experience of Master's pre- Transition to practice pared CNL graduates. This evaluation explored how Direct Entry Master of Science in Nursing CNL graduates Nurse satisfaction perceived their transition to practice experience three years post-graduation. All graduates (n = 21) of an in- Student debt augural Direct Entry CNL program were invited to be interviewed 3 years after graduation; 16 (76%) opted to participate. Major findings from the semi-structured interviews included educational satisfaction, challenges in transition to practice, uneven use of CNL education, and anxiety about student debt. Satisfaction with their education and their early application of leadership skills were overshadowed by their frustrations with student debt and the preponderance of bullying experienced in the workplace. Introduction students as “confusing and stressful” (p. 335). They further described the challenges of explaining to others that they could be both a novice The Clinical Nurse Leader (CNL) role was developed in 2007 by the nurse and possess a graduate degree. American Association of Colleges of Nursing (AACN) in coordination Although Master's level CNL programs have existed for over with leaders from academic and clinical environments. Based on gui- 10 years, there is little published data on how effectively these gradu- dance from the Institute of Medicine (2000) that discussed poor and ates transition to clinical practice. A recent literature search revealed disjointed quality of care in the United States, the CNL position was only two published studies and both ended one year post-graduation designed specifically to view the patient through a holistic lens, close (Bombard et al., 2010; Shatto, Meyer, & Delicath, 2016). Further, there communication gaps, and provide lateral integration across the were no reports that addressed if and how Master's level CNL graduates healthcare system (American Association of Colleges of Nursing, 2007). were using their CNL education in practice. The CNL assumes responsibility for the overall healthcare of the patient rather than by solely administering acute care. Purpose Schools of nursing throughout the US have created Master's level direct entry CNL programs. The first programs were stared in 2007; The aim of this evaluation was to explore the transition experience within 10 years, there were 108 Master's CNL programs (American of Master's level CNLs 3 years after graduation from a private Association of Colleges of Nursing, 2017). Graduates have bacca- Midwestern University. Specifically, the evaluation sought to under- laureate degrees from other disciplines; upon graduation, they enter stand the impact of their graduate level preparation on their career nursing with a Master's degree and CNL role preparation. As new progressions and satisfaction and use of CNL education in practice. graduates they experience similar stressors and difficulties as other Three years post-graduation has been identified as the time when novice nurses. These challenges may be exacerbated by the fact that nurses begin to enter the “competent” stage of clinical practice (Benner, they have been educated to assume leadership roles among peers who 1984; Valdez, 2008). In her Novice to Expert theory, Benner (1984) have, in some cases, many more years of clinical experience, and in defines the competent stage as the third of five stages in skill acquisi- most cases, less formal education. The transition to practice as a new tion. In the competent stage the nurse demonstrates conscious delib- registered nurse and as a CNL can be daunting. Bombard et al. (2010) erate planning abilities and is capable of increasing efficiency in orga- described the first year transition experience of four direct entry CNL nization (Benner, 1984). ⁎ Corresponding author. E-mail addresses: [email protected] (B. Shatto), [email protected] (K. L'Ecuyer), [email protected] (G. Meyer), [email protected] (A. Shagavah). https://doi.org/10.1016/j.profnurs.2018.06.001 Received 11 September 2017; Received in revised form 10 February 2018; Accepted 1 June 2018 8755-7223/ © 2018 Elsevier Inc. All rights reserved. B. Shatto et al. Journal of Professional Nursing 35 (2019) 51–56 Table 1 Interview findings of Master's level CNL graduates' impressions of transition to practice. Major findings Sub-findings Codes Educational satisfaction • Happy they entered the CNL program; • Use of research databases; • Increased ability to educate patients and other nurses; • Increased understanding of policies and implementation; • Career trajectory positively affected; • Able to present opinions confidently Transition to practice Greater emotional attentiveness • Able to handle stress of fulltime employment; • Positive ability to transition from student to nurse; • See the “big picture” better than other graduates Lack of comparable skills • Inability to perform procedures as competently as other graduate nurses; • Practical experience valued over education; • Little support for hospital education to review procedures Bullying • Negatively impacting quality of care; • Racial issues; • Supervisory unfairness; • Unsafe workplace; • Negative career impact Use of CNL education • Use of CNL education; • Use of leadership education; • Use of quality improvement education; • Lack of use of CNL education Student debt • Difficulty with large student loan repayment; • Need for education concerning debt; • Debt negatively impacting career choice Sample • In what ways are you applying your CNL education? The sample consisted of graduates of a direct entry Master's CNL The interview structure was flexible to accommodate new con- program (Model C). The program was offered in a 21-month long face versational directions. In fact, the topic of student loans was added to to face format. It relied heavily on precepted clinical experiences. the questions due to its significant presence in discussions early in the Students received over 1000 clinical hours, 750 were one on one with a interview phase. The same person interviewed all 16 participants. preceptor. The 2007 CNL White paper framed the CNL curriculum Handwritten notes as well as audio-recordings were obtained during (American Association of Colleges of Nursing, 2007). Students had the the interviews, which lasted 30 to 45 min each. All interview data were option to take the CNL certification exam at the end of the program of saved securely and were only available to members of the evaluation which 9 elected to test and 8 successfully passed the certification (89% team. pass rate). The confidentiality of the participants was maintained by applying Previous degrees of this inaugural cohort were varied and ranged the coding standard set by Glesne (2010). Each interview was tran- from photography and marketing to engineering and law. Upon gra- scribed and verified by two members of the evaluation team and clas- duation the vast majority of Model C graduates assumed entry-level sified by the participant's identification number and corresponding staff nurse positions in hospital settings. There was a mix of acute care, answers. The data were analyzed by key words (those terms that oc- critical care and pediatric settings. One graduate assumed a role in a curred frequently in the transcribed data) and expressed feelings and home health setting and one resumed her law practice and was elected experiences, which were interpreted to be beneficial, harmful, or neu- as a State Representative. All members (n = 21) of the graduating class tral to the participant, as well as by other descriptive information, such of 2012 were invited via email to participate; 16 (76%) were inter- as employment status and type of work commonly completed. The data viewed. The final group of interviewees were 14 women and 2 men were reviewed individually by each member of the evaluation team. with ages ranging 24–60 (Mean: 32); all were Caucasian. Then, in the course of 3 face-to-face team meetings, the coding was verified and findings agreed upon by all members of the evaluation Method team to ensure rigor and reliability. Due to the fact that interviews were being solicited, human subjects' Results approval was sought and obtained from the Institutional Review Board of a private Midwestern University. All participants provided informed The analysis of the interviews revealed four primary findings and a consent. Evaluative data were collected through semi-structured tele- number of sub-findings (Table 1). The four primary findings themes phone interviews with questions such as: were: educational satisfaction, issues in transition to practice, variation in use CNL education, and student debt. • Can you tell me about your transition experience from college to practice? Educational satisfaction • In what ways do you think the CNL education made you different from other graduate nurses,

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