A Nurse Leader Residency Program: Improving Leadership Competencies

Ballad Health nurse leaders received little nursing leadership education or competency development before beginning their roles. Yet, nurse leaders are crucial to improving quality, safety, cost, patient experience, and team member engagement. Competency development is linked to improved nurse leader confidence, job satisfaction, and retention. Additionally, the organization is experiencing a shortage of prepared internal candidates to fill vacant nurse manager positions. The organization’s Chief Nursing Council (CNC) questioned if a leadership development program could improve new and aspiring nurse managers\u27 leadership competency. The CNC aimed to improve nurse leader competency by implementing and measuring the effectiveness of an evidence-based Nurse Leader Residency Program (NLRP) for new and aspiring nurse leaders. The CNC elected to base the NLRP on the American Organization of Nursing Leadership (AONL) Nurse Learning Domain Framework and Benner’s Novice to Expert Theory. The AONL Learning Domain Framework identified 12 leadership topics in three domains: The Science, The Art, and The Leader Within. Six nursing leaders volunteered to participate on the NLRP implementation team to assist the project leader with planning and decision-making. Kotter’s Change Model was used to plan the implementation. The implementation team created a Gantt chart to ensure responsible parties completed action items on time. The team identified six primary activity topics: 1) select participants, 2) develop the curriculum, 3) plan class sessions, 4) plan competency assessment and evaluation, 5) train and select mentors, and 6) plan recognition. All nursing leaders with less than one year of experience and aspiring nurse leaders were eligible to apply to the program. Applicants applied electronically through the organizational intranet site. The implementation team reviewed all applications and selected 14 qualified new nurse leaders from across the organization. Internal content experts were recruited to develop and deliver the course curriculum. Instructors addressed all AONL leadership topics during weekly education sessions and provided the curriculum through lectures, group activities, individual activities, case studies, and videos. The residents assessed 105 competencies using the AONL Nurse Leader Competency Assessment Tool before and after program participation. Finally, the residents collaborated with their Chief Nursing Officer to identify a mentor. All mentors completed a one-hour online training session. The project leader conducted a paired t-test indicating a statistically significant difference between the pre-competency and post-competency assessments data and a strong positive relationship. The project leader completed a comparative analysis of each leadership topic and participant by comparing pre-results against post-intervention results. The resident group improved its overall self-assessed nursing leadership competencies by 50%. Residents’ self-competency improvement ranged between 0.5 - 2.0 on a 5-point scale. Implementing an evidence-based NLRP improves new and aspiring nurse leader self-assessed competencies. Nurse leaders need advanced knowledge and competencies to lead in the complex healthcare environment successfully