An increased number of RNs are returning to earn their bachelor's degrees in nursing. As a result, clinical experiences in leadership for these students are in demand, which has led to decreased availability of clinical opportunities and nurse preceptors at hospital sites.1,2 In addition, the increasing complexity of the delivery of health care has led to a myriad of challenges that require strong organizational leadership.3 Population health, new technology, performance-based reimbursement, and uncertainty stemming from regulatory changes are a few that necessitate learning new leadership skills in addition to traditional leadership principles. Therefore, there is a demand for the development of experiences outside the hospital setting that support the curriculum, especially in the leadership and management course.

To meet these challenges, the author developed an educational innovation, the Giordano Opportunities for Leadership Development in Educating Nurses (GOLDEN) strategy. Guided by the American Association of Colleges in Nursing white paper, Expectations for Practice Experiences in the RN to Baccalaureate Curriculum,1 and current trends in health care and simulation education,3-5 the GOLDEN clinical experience strategy was implemented and evaluated in 1 clinical section for 2 semesters to appraise its effectiveness before potential expansion in future sections.

GOLDEN Strategy

Strategies that support growth and development of the various roles of nurses are paramount in meeting future health care needs.3,6 This preferred future necessitates early shaping of nursing leaders through innovative and experiential educational experiences that incorporate affective, psychomotor, and cognitive dimensions; demonstrate immediate relevance to adult learners; provide long-term benefits; complement previous learning; and create foundational concepts and motivation for graduate nursing education.

The GOLDEN strategy incorporates innovative experiences in practice environments corresponding to weekly course topics. Some of the experiences include simulation, attending malpractice trials, lobbying at the state level for political advocacy, developing quality improvement and management programs for local governmental health initiatives, actively participating in human resource activities outside the health care industry, and discussing the financial impact of policy on hospice organizations. The carefully selected clinical experiences and other learning activities matched with weekly course topics provide students with immediate opportunities to observe theory in practice, develop their critical thinking, and further their professional development. Written clinical activities included describing what they observed during the experience, briefly describing the tenets of the theory or topic of the week, and analyzing the relation of theory to what they observed using critical thinking skills. In addition, at least 1 reference from a peer-reviewed journal that relates to the topic discussed needs to be included (Table, Supplemental Digital Content, http://links.lww.com/NE/A513).

Each week, students participate in a postconference related to their clinical learning experiences in leadership. The postconferences are designed as an additional leadership experience for students, in that they are conducted by one of the students in the group who distributes an agenda 3 days before the conference. Another student takes minutes and distributes them as well. Templates regarding how to run an effective meeting, agenda setting, and minute taking are included in the syllabus. This postconference experience supports the topic of organizational communication. The culmination of the course includes a quality improvement and management group project with structure, process, and outcome audits guided by topics discussed throughout the semester.

Outcomes

Formative and summative measures were created to assess learning and other course outcomes that reflected the Essentials of Baccalaureate Education for Professional Nursing Practice.7 Students participating in the GOLDEN strategy (n = 19) met or exceeded outcomes in comparison with students participating in the traditional approach (n = 35). For the final course grade, the average for the innovation group was 90.8 as compared with the traditional group average of 88.9. Notably on the course survey, students in the GOLDEN strategy group provided comments related to the clinical experience activities being motivating, interesting, relevant, and thought-provoking. They reported that the activities supported learning leadership roles and management functions and meeting course outcomes. Examples include "This clinical prepared us for leadership roles," "This day [lobby day] made me want to continue being involved in nursing bills [legislation]," and "Experiencing leadership and management in different settings opened my eyes to the expanding role of nurses." Students reported that the new learning opportunities outside the traditional hospital setting increased their understanding of policy, politics, finance, and structure in business and health care organizations and contributed to developing their role as a leader in health care, the community, and government.

Outcomes shared with the other leadership and management course faculty documented the value of using the GOLDEN strategy in practice environments; consequently, the strategy is now integrated within all leadership clinical sections. Modeling and leading by example included preparing poststrategy reports and discussing challenges encountered, solutions that worked, student satisfaction and other qualitative feedback, agency liaison or preceptor feedback, and quantitative student learning outcomes.

Problem solving and developing solutions to challenges in teaching RN-BS students about leadership required faculty perseverance, skills, and creativity. First, identifying and scheduling innovative clinical leadership experiences were time consuming and required developing new relationships outside hospital organizations. Second, students initially were apprehensive about how they would complete assignments and meet course objectives, yet later, students described how the experiences enriched and shaped their role development as nurse leaders and managers. Third, engaging clinical faculty in the leadership course required several course meetings and individualized follow-up meetings. At the curricular level, the author shared the GOLDEN strategy and led a guided discussion about incorporating innovative leadership experiences throughout the curriculum as an opportunity to enrich student learning, particularly in clinical courses.

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