Registed Nurses' Association of Ontario

Building Capacity of Leadership in Registered Staff (RNs and RPNs) in Long Term Care incorporating a Shared Governance Model

Valerie Jensen RN, HBScN
Bethammi Nursing Home, St. Joseph's Care Group

The Advanced Clinical Practice Fellowship (ACPF) created was an opportunity for the fellow to develop enhanced leadership knowledge and skills, for engaging and mentoring the leadership development of RNs and RPNs within our Long Term Care (LTC) home.

The fellowship project involved a variety of self-guided learning activities, including literature reviews, sharing compiled learned information with peers through informal and formal education sessions, shadowing of mentoring team members and other knowledge experts, regular meetings for collaborative discussions, review of activities, outcomes and support for ensuring an optimal experience and success of the fellow.

A mentoring team consisting of the St. Joseph’s Care Group (SJCG) Vice President of Seniors' Health and Chief Nursing Executive, Clinical Manager, Director of LTC, Best Practice Spotlight Organization Lead, and LTC Coordinator of Collaborative Practice and Learning provided ongoing support, insightful knowledge and rewarding experiences throughout the fellowship. Collaborative activities with the RNAO Regional LTC BP Coordinator also provided engaging opportunities relevant to the LTC practice setting and the fellowship. Front line staff including RNs, RPNs, PSWs, and other members of the LTC interdepartmental team were integrated in all fellowship activities.

Building capacity of leadership practices of RNs and RPNs was an identified gap in our LTC homes. The need for role clarity, nursing leadership development, and consistent leadership practices of registered staff (RNs and RPNs) including supervisory and team lead activities, collaboration, and delegation, were identified as required leadership activities, while ensuring the needs of our residents are met. Influencing these practices was also varied RN/RPN LTC experience, workplace morale of interdisciplinary team members, conflict, and ongoing change within our LTC practice settings.

The needs within the fellowship was also identified with the upcoming opening of the Hogarth Riverview Manor Expansion (HRME) LTC Home (a newly built 440 bed LTC home of St. Joseph’s Care Group) amalgamating 3 existing nursing homes (of 2 different organizations) into one, with varied scope of practice of the Registered staff (RNs, RPNs) within the previous homes.

Activities within the fellowship were also in line with SJCG organizational goals, Nursing Strategy (Role Clarity), and current SJCG BPSO activities (Professionalism).

The learning goal was to increase the fellow’s confidence, knowledge and skills, in becoming an effective leader in Long Term Care (LTC), for engaging and supporting RNs and RPNs with their leadership development. Objectives included building upon the fellow’s current leadership knowledge, skills, and practice for mentoring and supporting peers; promoting leadership competencies; shared governance and its impact on a healthy work environment; RNAO Healthy Work Environment (HWE) Best Practice Guidelines (BPGs), and implementation strategies.

Knowledge gained by the fellow through the fellowship includes leadership practices including transformational leadership integral for optimal outcomes and a healthy work environment. Increased knowledge of CNO Practice Standards, our RN and RPN job descriptions, role expectations, home and organization policies. Enhanced knowledge of MOHLTC standards and LTC Homes Act. RNAO BPGs including Developing and Sustaining Nursing Leadership. Educational resources of SJCG, RNAO, and CNO. The RNAO Nursing Orientation eResource for Long Term Care. Processes’ impact for clarity, consistency of practice, optimal team function, and outcomes. Mentoring programs for staff. Identified needs of individuals and our team(s) through our HWE initiative. The RNAO Toolkit for project support.

Skills gained include strategies and communication for optimal results and disseminating of knowledge. Activities for engaging staff. Heightened awareness of the busyness of staff and management. Utilizing unit huddles as effective strategies for education. Increased awareness of staff emotional sensitivity, its impact on staff morale and team function. Flexibility in project dissemination, balancing competing priorities based on activities occurring within the home, staff and resources. Creating and providing presentations, education materials, and resources for staff. Teaching strategies for optimal uptake. Creating feedback and evaluation forms and presenting results. Strategies for success from the RNAO Summer Institute. Networking skills.

Expertise gained includes ongoing connecting with front line staff to be a visible and engaged leader and to identify individual and team needs. Continued lead of our Home’s HWE initiative, with activities based upon individual, team, and organizational needs. Support and mentoring of individual RN and RPN leadership through one-to-one and group interactions. Ongoing activities and passion for enhancing individual and organizational practices, staff and resident outcomes and experiences.

Outcomes for residents living within our LTC home include improved resident care coordination and quality of care as a result of the enhanced individual leadership practices of RNs and RPNs. The increased individual comfort and skill level as leaders in coordinating and providing resident care, team collaboration, and to ensure resident care needs are being met has been integral with the fellowship activities. Staff teamwork and relations has both a direct and indirect impact on resident outcomes. Team building and conflict resolutions skills integrated throughout all fellowship activities provides foundational quality care of our residents and enhanced environments in which they live.

Residents also benefit from the increased point of care leadership awareness and skills gained by all front line staff including PSWs during the fellowship activities. Such awareness includes front line staff leadership professional attributes, accountabilities, collaborative practices, and conflict resolution. Outcomes for residents’ families include increased satisfaction of resident care with individual care needs being met, improved communications with and amongst front line staff, and improved coordination of care from the integrated practices of the interdisciplinary team. Enhanced organizational systems through front line staff leadership practices has resulted in improved outcomes for our LTC residents and the population we serve.

Outcomes experienced among colleagues and staff include clarity of leadership role of RNs and RPNs, and point of care leadership information to all staff. RNs and RPNs self awareness of individual leadership skills through the completion of the RNAO leadership self assessment tool, point of care leadership information presented at team huddles, feedback and evaluation forms, and formal education provided on Leadership, Building Relationships and Trust. Ongoing leadership skill development was provided through support and mentoring by the fellow and staff colleagues. Further education resources and practice support tools were provided.

All staff were encouraged and supported to bring forth individual and team needs, through anonymous and group discussions. Staff involvement as leaders in our staff led HWE initiative. Enhanced team building with imbedding practices into daily activities. Skills for collaborative practice, conflict management and resolution are being learned and supported.

Organization outcomes include a foundation for building a healthy work environment, with point of care leaders. The fellow became an effective leader, role model, and mentor recognized by colleagues and the organization.

Increased confident and influential RN and RPN point of care leaders have emerged from fellowship activities. Increased team collaboration and engagement of all staff integral in our LTC practice settings has occurred. Enhanced dissemination of information and knowledge to all staff through education topics and activities provided through the fellowship, team daily huddles, and HWE meetings.

Continuation of fellowship activities as it relates to leadership and HWE activities is being supported. The review and discussion of role descriptions with staff is occurring. In addition to ongoing evaluation of activities and outcomes necessary for achievement of optimal client, individual, and organization outcomes. Outcomes experienced by stakeholders include support of the research that point of care leadership is a critical part of resident care, having a direct impact on individual, team, organizational, and system outcomes. Community supports including geriatric and other consultants benefit from the enhanced leadership practices of staff in quality referral and resource information. Education programs including community programs and professional organizations recognize the quality practice and outcomes of enhanced leadership in our LTC settings.

The RNAO ACPF has been an exceptional opportunity and rewarding experience! Having the dedicated time to focus on the fellowship activities, the self-guided nature of the fellowship, and the support of mentoring team members with their knowledge and expertise has been pivotal in the success of learning and outcomes. Working with all the individuals and fellowship affiliates has provided me with tremendous growth and appreciation of everyone’s roles, skills, and contributions to our health care teams, and to our team.

Highlights of the fellowship are many! Connecting regularly with the staff for keeping me grounded and as a peer was important. Completing a day in the life of, with RNs, RPNs, PSWs, provided further understanding of each role. Sharing of my passion and experiences with others, through presentations at our Nursing Expo during Nurse’s Week, our PSW Practice Council, and to registered staff of both Bethammi Nursing Home and our new HRME LTC home. Attending the RNAO Summer Institute and sharing of successful strategies from attendees. Seeing the success of putting this new-found knowledge into practice! Creating feedback forms and strategizing to obtain timely responses from front line staff and the team. Creating and providing the education session to RNs and RPNs and dialogue for sharing team successful practice strategies. Providing additional resources to all staff to support individual professional practice and in turn enhancing teamwork, collaboration, and positive experiences for staff and residents. Evaluation of education and fellowship activities, including my own leadership development!

The inclusion of all front line staff in the fellowship activities, and the activities of our HWE initiative have been very rewarding to see the impact on our team(s). The immense support by the management team of and throughout the fellowship, and HWE initiative, has aided the success of activities.

With the fellowship completed, my leadership development will continue, through involvement in our homes’ nursing leadership working group, HWE activities, Nursing Quality Practice Council, and everyday practices. Continuing to be a lead, a role model and peer mentor in our LTC practice setting, while celebrating our team, our residents, our home, and our successes!