The purpose of this study was to explore the experiences and impact of peer-to-peer shadowing as a technique to develop nurse middle managers’ clinical leadership practices. A qualitative descriptive study was conducted to gain insight into the experiences of nurse middle managers using semi-structured interviews. Data were analysed into codes using constant comparison and similar codes were grouped under sub-themes and then into four broader themes. Peer-to-peer shadowing facilitates collective reflection-in-action and enhances an “investigate stance” while acting. Nurse middle managers begin to curb the caring disposition that unreflectively urges them to act, to answer the call for help in the here and now, focus on ad hoc “doings”, and make quick judgements. Seeing a shadowee act produces, via a process of social comparison, a behavioural repertoire of postponing reactions and refraining from judging. Balancing the act of stepping in and doing something or just observing as well as giving or withholding feedback are important practices that are difficult to develop.
A Magnet-related program has been recently adopted in the Netherlands. Support for staff nurses from nurse middle managers (NMMs) is a key component of such a program. A Bourdieusian ethnographic organizational case study in four hospitals in the Netherlands and the United States (Magnet, Magnet-related and non-Magnet) was conducted to explore NMMs’ supporting role behavior. Bourdieus concepts of habitus, dispositions, field and capital guided the analysis. Eight dispositions constitute NMMs habitus. A caring, clinical and scientific disposition enhance NMMs’ capital in particular organizations-as-fields. Further research is necessary to link Magnet (related) program characteristics to various configurations of dispositions of NMMs habitus.
Bachelor-prepared nurses are expected to be competent in moral deliberation and decision-making (MDD) in clinical practice. It is unclear, however, how this competence develops in nursing students. This study explores the development of nursing students’ competence for participating in organized forms of MDD in clinical practice, with an eye to improve nursing education. A cross-sectional descriptive survey was conducted by a questionnaire among first and fourth year bachelor nursing students and two cohorts of novice nurses of one bachelor program in nursing. Items included the variables knowledge, attitude and skills in relation to the nurse as professional, to the nursing process, and to the organization. Data collection took place in March 2009. Across 179 respondents, scores in MDD knowledge and skills are significantly higher for students later in nursing education, especially with regard to the variable ‘nursing process’. Attitudes towards MDD score significantly higher after completing nursing training, but lower scores appeared for MDD knowledge and skills, particularly in relation to the organization. Results suggest nursing education should reinforce students’ attitudes to structural forms of MDD, and clinical practice should reinforce nurses’ MDD knowledge and skills. Both education and practice should reinforce nurses’ MDD competence in relation to the organization.
