Definition/Introduction
The Nursing Professional Development (NPD): Scope and Standards of Practice outline seven roles for NPD practitioners, which are: learning facilitator, change agent, mentor, leader, champion for scientific inquiry, advocate for NPD specialty, and partner for practice transitions. The standards also outline competencies for leadership in standard 12, which states, “the nursing professional development practitioner leads within the interprofessional practice and learning environments and the profession. p. 98. It should be noted that although NPD practitioners may not hold formal leadership positions within their organization, they are always leaders, and leadership competencies exist across all disciplines.
The standards differentiate competencies for the NPD practitioner and NPD specialist. The NPD practitioner has a minimum of a baccalaureate degree, or an international equivalent, in nursing without NPD certification OR a graduate-level prepared nurse without NPD certification. The NPD specialist is a nurse trained at the graduate level in nursing or a related field and certified in NPD who develops tools, theories, skills, and knowledge to advance the practice of the NPD specialty. If the graduate degree is in a related field, the baccalaureate degree must be in nursing. Both the NPD practitioner and the NPD specialist can function in a leadership role.
A couple of examples of the differences between practitioner and specialist competencies are provided to differentiate the two roles. NPD practitioners support a culture of innovation, inquiry, and reflective learning where the specialist advances a culture of innovation, organizational learning, and continuous professional development. The NPD practitioner acts as a change agent in the interprofessional practice and learning environment where the specialist leads change initiatives. The complete list of competencies for both the practitioner and specialist roles can be found in the standards.
The Institute of Medicine’s (IOM) report, The Future of Nursing: Leading Change, Advancing Health, supported education programs for leadership development to prepare nurse leaders at all levels with the leadership acumen to transform the healthcare system. Specific recommendations relating to leadership included: recommendation 2 – expand opportunities for nurses to lead and diffuse collaborative improvement efforts and recommendation 7 – prepare and enable nurses to lead change to advance health. Nurses, nursing education programs, and nursing associations should prepare the nursing workforce to assume leadership positions across all levels. Decision-makers should ensure that leadership positions are available to and filled by nurses.[1]
The importance of ongoing professional development, interprofessional education, collaborative practice, and outcome-based practice was outlined by Dickerson.[2] Dickerson encouraged NPD practitioners to embrace the expectations of the NPD standards to be change agents, collaborators, innovators, and mentors by being present, visible, and serving as a leader.
Issues of Concern
Issues impacting the NPD leader role are characteristics and skills of a leader, leadership styles, including transformational leadership, and legal and ethical responsibilities. Other considerations are demonstrating the value of NPD practice, working within a system, and using scientific rigor to advance the specialty.
Leaders share a common set of characteristics. Hughes reviewed ten national and international research studies from 2002 to 2015 to identify the characteristics of great nurse leaders.[3] The leadership characteristics identified by Hughes were integrity, accessibility, motivation of others, emotional capability, and social intelligence. Leaders must be open and approachable, with the ability to motivate others through support and empowerment.
Other qualities that nurses seek in their leaders include a commitment to excellence, passion for their work, clear vision and strategic focus, trustworthiness, respectfulness, approachability, empathy, caring, and commitment to coaching and developing staff. These qualities are essential to outstanding leadership, and organizations must learn the best ways to identify and develop these traits in existing and emerging leaders.
Skills needed to achieve these characteristics include communication, creating a healthy work environment, collaboration, shared decision-making, coaching and mentoring, and delegation. Effective leaders must have strong verbal and written communication skills and must create a healthy work environment attending to the physical, social, and mental health and well-being of patients and staff. This includes both giving and soliciting feedback. Leaders should be quick to listen, slow to speak, and react cautiously.
With the current healthcare environment and the focus on interprofessional education, the leader must develop good working relationships with members of the other disciplines comprising the healthcare team. Effective leaders implement shared decision-making practices to allow for the active and full participation of stakeholders and continuously support coach, and mentor staff members. In addition to serving as role models, leaders motivate and empower people with the tools and the resources they need to do their job, then get out of their way and let them do it. Leaders seize opportunities to motivate people by recognizing their worth, services, or contributions. However, since the leader cannot achieve strategic goals in a vacuum, delegation skills are an essential tool in the leader’s arsenal.
Many leadership texts outline similar leadership activities. These include but are not limited to strategic planning, managing human and fiscal resources, environmental scanning, delegating, quality improvement, program, and project management, and fostering innovation. The authors also emphasize the importance of being a transformational leader.[4]
Schmidt developed a transformational leadership model from data collected through a standardized interview process with 15 leaders in healthcare and non-healthcare organizations. She noted that transformational leadership could only exist in an environment of integrity, respect, and authenticity. The five attributes of transformational leadership are being visionary, risk-taking, effective communication, motivating others, and persistence. These are similar to the four components: idealized influence, inspirational motivation, intellectual stimulation, and individualized consideration.[5]
Transformational leadership is a leadership style that can inspire positive changes in those who follow. Transformational leaders are energetic, enthusiastic, and passionate. They can inspire others to change expectations, perceptions, and motivations to work towards common goals. They serve as role models, challenge the status quo, encourage creativity, have a clear vision, and offer support and encouragement as needed.
Leaders need to understand the organizational culture in which they work. Knowing how the organization thinks is critical to aligning with its goals and helps individuals deal with the changes that occur in every organization. Departmental goals must be consistent and align with organizational goals, and leaders must be able to articulate their value to senior leadership.
All leaders must adhere to legal and ethical guidelines in performing their duties. In the ever-increasingly complex world of health care, leaders face numerous ethical and legal practice challenges. Legal requirements are specified in local, state, or national laws. Regulatory bodies also have specific requirements – leaders must ensure compliance with these standards, such as requirements for health reporting and adherence to privacy standards related to the Health Insurance Portability and Accountability Act (HIPAA). Ethical standards provide guidance for the behaviors that are expected of individuals in the practice environment. The NPD standards include a standard of ethics, which states: “the nursing professional development practitioner integrates ethics into all aspects of practice.” p. 86 Specific ethical competencies are outlined for both the NPD practitioner and NPD specialist.
Special legal/ ethical issues impacting the NPD practitioner can include issues related to copyright, content integrity, maintaining a just culture, protecting the rights and dignities of learners, intellectual property, and maintaining appropriate documentation.[6] Ethics in NPD practice includes a focus on integrating and implementing the policies of the organization and standards set by national professional organizations.
In 2021, Harper et al. replicated a study exploring the correlations between NPD staff and organizational outcomes.[7][8] Both leaders and NPD practitioners often ask the average number of individual employees and RNs for whom an NPD practitioner is responsible. What are the average numbers of NPD practitioners based on hospital beds? A descriptive, cross-sectional design was used. The survey consisted of 89 items (93 for National Database for Nursing Quality Indicators (NDNQI) participating organizations). There were 398 usable surveys for organizations from 46 states and the District of Columbia.
The first report of this study provided background information and descriptive data on organizational characteristics, NPD department structure, and NPD practitioner ratios per employee, per RN, and per hospital bed. The second part of the study looked at relationships between NPD staffing and organizational outcomes. Evidence suggested that higher levels of NPD staffing were associated with positive nursing and patient outcomes.
NPD leaders must show the value of NPD practice. Church and colleagues reported on a review of 13 transition-to-practice (TTP) programs accredited by the American Nurses Credentialing Center (ANCC) Practice Transition Accreditation Program.[9] In 2014, ANCC launched the ANCC Practice Transition Accreditation Program (PTAP), which recognizes residency and fellowship programs. Programs are assessed about 38 evidence-based standards in program leadership, organizational enculturation, development and design, practice-based learning, nursing professional development, and quality outcomes. Data were collected from 13 accredited programs’ qualitative data in their annual report.
Six overarching themes were identified: leadership support, stakeholder interest, national/state recognition, credibility, collaboration with other facilities, and funding. As leaders of TTP programs, NPD practitioners can provide value to organizations by increasing the quality of development for transitioning nurses and positively impacting the quality of care to patients and families.
Although many organizations have leadership programs that focus on transitioning nurses into leadership roles, focusing on informal leaders such as the direct care clinical nurse (CN) is not as common. Morse and colleagues described a Rising Star program developed as a CN leadership program.[10] The program was initially designed to provide high-performing direct-care CNs with skills and knowledge to support them as informal leaders. As the program developed, it was expanded to enhance the knowledge and skills of experienced nurses so they could foster exceptional patient outcomes and experiences and be role models.
This twelve-month program has 8 hours of classroom/virtual content monthly, including developing a quality improvement (QI) project. All the QI projects were completed, and 19 have been integrated at the unit, department, or institutional level. Forty-one percent worked on an abstract, and eight have been submitted for a conference. In addition, fifty-nine percent have completed advanced formal education. The response has been very positive to this program. The Rising Star facilitator is an NPD specialist that demonstrates leadership by managing the application process, chairing the selection committee, managing applicant notifications, informing executive leadership of program outcomes, and facilitating the program and classes.
With an increasing number of mergers, NPD leaders frequently are part of a multisite system. Boerger shared her perspective on the challenges in leading systems. Harper and colleagues conducted a study to gain consensus around the competencies that individuals leading multisite systems need.[11][12]
The quantitative study used a modified electronic Delphi (eDelphi) method to determine the competencies needed by multisite leaders. Twenty-four participants completed at least 50% of the initial survey, 21 completed round 2, and 17 completed the third and final round. Five domains of competencies were identified as necessary for the multisite NPD leader. These were executive nursing leadership, NPD practice, business acumen, organizational alignment, and communication/relationship building. A list of the multisite competencies in each of these five areas can be found on the ANPD website.
Nursing Professional Development Leadership