Edward H. O'Neil

Developing Nursing Leaders: An Overview of Trends and Programs

Nurses need to acquire new leadership skills to meet the demands of their positions. Until recently, the healthcare industry has focused on continuing education to meet licensure requirements and to achieve advanced clinical certifications. Given increasingly complex leadership challenges, we are seeing the emergence of leadership development programs designed to enhance leadership effectiveness in the service of broader strategic objectives. By learning more about these opportunities, nurse executives can make better decisions for themselves and other nursing colleagues.

Health Care Reform and Medical Education: Forces toward Generalism.

The transformation of U.S. health care is driven by underlying principles. The tensions between what exists now and what will emerge over the next 15 years pervade health care delivery and financing, the doctor-patient relationship, the provider-payer relationship, and the atmosphere within educational institutions for the health professions. The institutions that early on develop the capacity to forge and sustain strategic partnerships will be well positioned to take advantage of the opportunities of a rapidly changing system, but those that do not will risk being isolated without the diversity of resources needed to make meaningful contributions to health care. The tensions also drive major changes in the way health professionals are educated, trained, and deployed. Health care reforms will dramatically change the culture of the medical school in areas of patient care, research, and education programs. These institutions face external pressures to change and internal barriers to change, not the least of which are the lack of sustained leadership and collective vision. Academic medical centers must take active steps now to assess their strengths and weaknesses objectively, look realistically at options, and construct new, mutually beneficial partnerships that will be the keys to success.

MIDWIFERY IN THE 21ST CENTURY: Recommendations from the Pew Health Professions Commission/UCSF Center for the Health Professions 1998 Taskforce on Midwifery†

Unprecedented changes in the delivery and financing of health care have produced angst and opportunity, criticism, and innovation. To explore the effects of these market-driven changes on midwifery, the University of California at San Francisco Center for the Health Professions convened a Taskforce on Midwifery in 1998. Consisting of eight experts from across the country, the Taskforce was charged with exploring the impact of health care system developments on midwifery, and identifying issues facing the profession and the roles midwives play in womens health care. The Taskforce answered its charge by offering 14 recommendations related to midwifery practice, regulation, education, research, and policy. The recommendations incorporate the Taskforce vision that the midwifery model of care should be embraced by, and incorporated into, the health care system in order to make it available to all women and their families. Midwives, educators, collaborators, and policymakers can use the recommendations to develop curricula, practice sites, and laws for an improved health care system that fully includes midwives and encompasses the midwifery model of care.

Four Factors That Guarantee Health Care Change

The process of health reform policy will create new and demanding opportunities for nurse leaders in the academy. While it is difficult to predict the eventual outcomes of such reform, it is important to have a broad overview of the emerging trends. To fully engage in the political process, nursing educators need to become engaged in these discussions at the local, state and national levels as there are definitive implications for new roles for nurses across all health care settings. The education of current and future nurses should be an integral component of any health reform-making this call for involvement nothing short of an imperative.

A PROPOSED FRAMEWORK for Differentiating the 21 Pew Competencies by Level of Nursing Education

Now nearly a decade old, the original Pew Health Professions Commission Competencies have stood up well to the test of time. The competencies were designed to provide all health professionals, from physicians to physical therapists, with a general guide to the values, skills, and knowledge they would need to be successful in the health care system that was beginning to emerge in the late 1980s. They have been used across the range of health professions and in many practice settings to create a framework for curricular change, work redesign, and assessment of professional competence. The interpretation of the competencies offered here should prove to be a useful tool to nurses and health system leaders as they carry on the hard work of adapting the current model of nursing practice to the demands and realties of the contemporary and continually evolving health care environment. This work is important for two reasons. First, many of the skills and attributes of the professional nurse are not adequately used or valued by the health care system because the profession is both fragmented and poorly differentiated and articulated. Without markers that define and promote collaborative practice within nursing, the full potential of nurses at all levels of preparation will continue to be inadequately and inappropriately deployed. This model exacerbates the current nursing shortage because it fails to use nurses in appropriate, well-delineated, and challenging roles. Without this kind of differentiation, one that can be owned and supported by all nurses, there will continue to be suboptimal use of the nursing workforce in the United States. The framework of differentiated Pew competencies and the companion teaching-learning strategies proposed here offer one approach to rationalizing both nursing education and practice, with the potential for improving the quality of care, and reducing fragmentation, cost, and public confusion.

Combining service and learning in partnership with communities.

No abstract available.

A pharmacy leadership action study

OBJECTIVES To report on the creation of a leadership development program targeted exclusively at pharmacists working in management in the professional community. SETTING Large staff-model health maintenance organization (HMO) in California between 2004 and 2008. PRACTICE DESCRIPTION The Pharmacy Leadership Institute (PLI; a joint effort of the School of Pharmacy and the Center for the Health Professions at the University of California, San Francisco) tested a program in a large staff-model HMO with hundreds of pharmacists in leadership roles. This program included learning seminars, psychometric assessments, leadership goals, intersession activities, coaching/mentoring, and leadership projects. PRACTICE INNOVATION Not applicable. MAIN OUTCOME MEASURES PLI collected survey data in order to evaluate the effectiveness of the institutes leadership development program. In addition, an external evaluator was hired to conduct interviews with the pharmacy directors of the organization which chose to pilot the program. RESULTS The evaluations from the participants indicate that the leadership development program met many but not all of its initial objectives. Consistent with action research methodology, the faculty of the institute met to redesign some sections of the program in order to meet the established goals. Adjustments were made to different components of the program over the next 4 years. Evaluation data show that these revisions were successful. In addition, follow-up evaluations with participants showed a lasting impact of the program on both individual leadership skills and organizational outcomes. CONCLUSION Given the positive outcomes indicated by the evaluation data used in this study, the work of PLI indicates that broader leadership skills can be identified and enhanced within a group of pharmacy managers.

Differences in curriculum emphasis in US undergraduate and generalist residency education programmes

Little attention has been paid to the differential emphasis undergraduate and graduate medical education programmes place on the broad competencies that will be needed for practice in an increasingly managed health care environment. The purpose of this study was to determine differences in emphasis that undergraduate and primary care graduate medical education programmes are currently placing on 33 broad practice competencies, compared with the emphasis they ideally would like to give them, and the barriers they perceive to curriculum change.

Responses of Baccalaureate and Graduate Programs to the Emergence of Choice in Nursing Accreditation

Specialized accreditation in nursing is a widely recognized and respected hallmark of program quality. The advent of a second specialized accrediting agency for baccalaureate and higher degree programs in nursing prompted a survey of these programs to determine their choice of nursing accreditation agency, factors influencing their choice, their perceptions of the value added by nursing accreditation, and the difficulties encountered with the accreditation process. These study variables and the relationships between choice of accrediting agency and types of degree-granting nursing education programs offered by the institution, agency membership in the National League of Nursing (NLN) or the American Association of Colleges of Nursing (AACN), expected date of next accreditation visit, geographic region, public versus private status, and type of institution (Carnegie classification) were analyzed. Findings revealed that nearly a quarter (24%) of respondents intend to continue with the NLN Accrediting Commission (NLNAC), whereas 30% indicated they have already switched to the Commission on Collegiate Nursing Education (CCNE) or intend to do so prior to their next accreditation cycle. However, nearly a quarter (24%) of respondents said they plan to be accredited by both agencies for the immediate future, and 21% indicated they are still undecided. Study findings suggest an end to single-source accreditation, and the beginning of a new market-oriented approach.

Collaborative practice, regulation, and market forces: A changing health care agenda

C ollaborative practice issues inform and shape every dimension of health care delivery. By and large, the dynamics and tensions of collaborative practice are by-products of the U.S. regulatory system, which relies on professionally dominated practice boards to define entry standards and on politically dominated state legislatures to determine scopes of practice. The United States allocated 5% of the gross domestic product to health care in 1960; by 1994 it had grown to 14%. Even during this period in which the health care system was expanding, this system created competition and conflict between professional groups for control or dominance over practice domains. We can anticipate that as the health care system rationalizes itself to meet new performance criteria of lower costs and higher quality, within an environment oversupplied with physicians, nurses, nursemidwives, hospital beds, and insurance plans, there will be even more tension among the professions to define and control scopes of practice. Any effort to understand the public policy agenda of promoting collaborative practice must accommodate this reality. The policy agenda for promoting collaborative practice has two essential elements: traditional public polices for regulating and educating the professions and newly emerging market forces that are redefining many of the characteristics of health professional work. To understand the prospects for collaborative practice we must address both. The regulatory process affecting education and professional practice offers three levers for promoting collaborative practice. The first and relatively most available is the process of changing the scope of practice of a regulated profession. Enlarged domains of practice can create opportunities for expanded, overlapping, and collaborative practice. Public policy motivations for such action might be better access, cost reductions, or improved quality. While appearing simple and straightforward, such adjustments have been historically difficult to achieve as the expansion of one professional scope of practice usually has meant an encroachment on another. There is little, if any, evidence that the movement to managed systems of care is doing anything but heighten the insecurity felt by professionals over perceived threats to exclusive scopes of practice. :D 1997 by The Jacobs Institute of Women’s Health Published by Elsevier Science Inc 1049-3867/97/