The American Organization of Nurse Executives (AONE) Nurse Manager Fellowship (NMF) is in its 10th year providing leadership development to select nurse managers (NMs). Seeking to understand and identify the outcomes of this program, a mixed-method evaluation was used to examine the NMF, years 2008 to 2013 (NMF multiclass study). This study utilizes the template designed in the study Capturing Change: Creating a Template to Examine the Educational Experiences and Outcomes of the AONE Foundation Nurse Manager Fellowship.1
Research Questions
Quantitative and qualitative measures were designed to answer the following questions:
* Did participant knowledge increase as a result of the program?
* Did the participants transfer the new learning by applying knowledge from the program in their day-to-day practice?
* Did participants change in view of self/identity as a leader?
Additional questions explored career changes, lifelong learning, and project management.
Methods of Data Collection
Quantitative measures were designed to capture data about 2 aspects of change: (1) the nurse manager fellows' (NM fellows') self-perception of their own increase in tools, knowledge and understanding as a as a result of participating in the program and (2) the NM fellows' report of application of tools and knowledge and understanding as a result of participating in the program. Through open-ended questions, quantitative measures included changes in view of self as a leader, enduring behavior changes within the organization, changes observed by others in the organization, and participation in professional organizations.
Quantitative Leadership Program Outcomes Measures
Access to an online confidential survey site was sent to 171 NM fellow multiclass study participants. Participants reported demographic data and in-depth data about the leadership program outcomes and impact. This was achieved by tracking 14 of the 30 key competencies described in the AONE Nurse Manager Competencies2 (formerly The Nurse Manager Skills Inventory). In the 1st measure, participants rated changes in their learning as a result of the program. Using a scale of 1 to 4 (with 4 being the largest increase), NM fellows rated the degree of increase in their own learning. The 2nd measure rated (with 4 being the highest level of frequency) the amount of the application of learning upon return to their home organization.
Qualitative Leadership Program Outcomes Measure
The confidential online survey asked participants to respond through an open-ended question: "How has your view of yourself as a leader and your own practice of leadership changed as result of participating in the NMF?"
Data Analysis and Key Findings
Quantitative Leadership Program Outcomes Measures
Seventy-two NM fellows completed the quantitative Leadership Program Outcomes Measures.3 Participant data from the 2 quantitative leadership program change outcome measures were computed and weighted averages calculated for each of the 14 leadership competency areas. The overall average of all competency scores was also computed. The NM fellows reported changes in the growth of knowledge and competencies and in the application of that knowledge (Table 1) in all of the 14 key leadership competencies. The data reveal a similarly strong pattern in the frequency of application of key competencies.
The difference between self-reported increase in knowledge and application of that knowledge in practice was 0.04. Notably, the top 2 rated applied competencies are identical to those in the increased learning category (coaching and communication skills). In addition, 3 of the top 5 in increased learning are the same (communication, coaching, and collaborative practice).
Qualitative Leadership Program Outcomes Measures
Fifty-nine survey participants responded to the question: "How has your view of yourself as a leader and your own practice of leadership changed as result of participating in the NM fellowship?" Data were aggregated through a process of analytic induction and summarized into 5 motifs. The NM fellows described these in terms that were both specific actionable strategies, as well as in terms of fundamental changes in their leadership practice and identity as a leader. Each motif can be linked to a crucial leadership skill that has been identified in the literature: (1) actionable confidence,4,5 (2) reflective self-awareness,6,7 (3) enlarged perspective and systems knowledge,8,9 (4) career definition and direction,10 and (5) application of learned tools.11
The examples of change described by NM fellows were specific and wide ranging and suggested growth in confidence through enhanced competence (see Supplemental Digital Content 1, http://links.lww.com/JONA/A525).
Eighty participants provided 161 responses describing enduring behavior changes within their organizations (see Supplemental Digital Content 2, http://links.lww.com/JONA/A526). Data were aggregated through a process of analytic induction and summarized into key motifs. The NM fellows described the 6 motifs in specific actionable strategies, as well as empowering changes in their view of themselves as leaders and their practice. Each of the motifs can be linked to a leadership development skill: (1) agency and initiative,12 (2) engagement and mentoring of staff,13,14 (3) communication competence,15,16 (4) interprofessional and intraprofessional communication,15,16 enlarged perspective,4 and (5) actionable confidence.12
The descriptions of enduring changes are emphatic; they speak of enhanced collaboration and generativity as well as self-reliance. Participants were asked to report comments or feedback on changes that others had observed in their leadership practice. The participant data (n = 36) from this question were aggregated through a process of analytic induction and summarized into key motifs: (1) increased confidence, (2) change leadership, (3) global outlook, and (4) recognition of leadership readiness.
Conclusion
The NM fellow multiclass study participants describe a large number of impactful changes as a result of participating in the NMF. The data reveal NM fellows' increases in knowledge and application in the spheres of self, organization, and community. The data indicate patterns of upward career movement, with 65% of the respondents (n = 71) reporting leadership progression. Data detail the direct influence of the program on enhancing the participants' sense of themselves as leaders. It also provides information about what the participants did with the skills and insights they gained from the program within their organizations.
Data from the NM fellows document the perceived value of enhanced networking among NM fellows. The program conveners facilitated a climate of shared vulnerability and trust. The NM fellows embraced and compared strengths, admitted weaknesses, skill deficiencies, and interpersonal shortcomings. The NM fellows experienced the validation of their shared experiences, common obstacles, and challenges. The programs focus on global issues in nursing, and the emphasis on developing nursing networks resulted in NM fellows joining in a variety of professional organizations and healthcare initiatives. This expansive view lessens the NM fellows' isolation and contributed to an enhanced big-picture perspective, a crucial leadership capacity detailed below.
Increases in confidence were probably the most frequent descriptor throughout the qualitative data. It was used to describe changes in leadership identity, changes as observed by others, and changes in behavior within the organization. The NM fellows described 2 kinds of confidence: confidence both as inner belief and as a driver of action. At the program's conclusion, participants described their thoughts and actions as leaders to be different in ways both they and others could recognize. Based on the outcomes, participants in the NMF multiclass study experienced personally significant and transformative shifts in their thoughts, feelings, and actions as leaders.
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