A Reading on

NURSE AS A TEACHER

In Partial Fulfillment of the

Requirements in NCM 219 - RLE

PRACTICING CLINICAL INSTRUCTOR ROTATION

Submitted to:
KRISTINE MONICA REYES, RN
Clinical Instructor

Submitted by:
CLARISSA S. TORRES, St.N
BSN 4F - GROUP 1

September 20, 2021

TITLE

Pedagogical Nursing Practice: Redefining nursing practice for the academic nurse
educator

BIBLIOGRAPHY

Bono-Neri, F. (2019). Pedagogical Nursing Practice: Redefining nursing practice for the
academic nurse educator. Nurse Education in Practice. 105-108.
https://doi.org/10.1016/j.nepr.2019.04.002

SUMMARY

Nurse educators have complex roles in enhancing the students’ knowledge, skills
and attitude. Nurse educators’ roles does not only include those relating to being an
effective teacher, but also have the skills which an expert nurse possess. Academic
nurse educators (ANE) are an integral part of the nursing profession, that are seen to
have been distanced from the ‘hands-on’ practice. Thus, Bono-Neri (2019) intended to
bring them back into the nursing profession’s scope. Five themes were revealed from
the findings of Morrison and Symes’ research, which the author linked in all aspects of
the nurse educators’ role ,or the ‘Pedagological Nursing Practice’ that was proposed by
the Bono-Neri. First theme is ‘knowing the patient’ which can be related to the ANE’s
role in knowing and caring for their students that includes assessing, recognizing, and
familiarizing their academic performance. ‘Reflective practice’, the second theme, is
described in the academic setup as the nurse educators utilization of their previous
experiences both in academic and clinical areas in promoting the learning process of
students. The third one is ‘risk taking’ where the nurse educators take risks to ensure
the greatest outcomes for their students. Intuitive knowledge that includes pattern
recognition refers to ANEs’ skill in recognizing cues that students may present which
requires intervention for an effective learning experience. Finally, the ‘skilled know how’
is described as the nurse educators’ ability to to mobilize resources, adapt, and respond
to students’ needs. In conclusion, nursing educators are integral in the nursing
profession as they continue to be identified as part of the same discipline which is in
nursing, just in a different realm of practice.
REACTION

There is nothing disagreeable with the article, for it was direct and relatable to
many nurses in the clinical area, student nurses, and nurse educators. Instead of simply
describing the roles of academic nurse educators, the author focused on linking these to
the researches nurses have to abide by all these years. The author utilized five themes
to relate to the nurse educators’ roles in the academe. They made it simple to
understand but were specific enough to touch almost all aspects of nursing education.

I would like to acknowledge the author’s intention to negate the view of others
regarding nurse educators as “previously nurses,” for they are still considered nurses
and will always be, just in the different areas of practice. It emphasizes how significant it
is to understand the several regions we can be assigned. The goals might differ
between these areas, but they are similar in many ways as findings from a study
regarding expert nursing practice were on the same page with the roles of nurse
educators. The correlation made me realize the importance of possessing these
characteristics mentioned from the five themes to be flexible in any area.

Many educators have surrounded me. My parents, more than five of my aunts,
and two of my grandparents are teachers themselves. I have witnessed how tiring it is
to deal with students but fulfilling at the same time. Although they were not nurse
educators, they are similar in a lot of ways. It was even a dream of mine to be a teacher
someday. I was even a catechist in high school because of my love for teaching at that
time. It was fun, exciting, but tiring. It was challenging to deal with students, especially in
assessing or evaluating what they have learned, thinking of ways or methods to make it
more interesting for them, and doing all of these whiles also preparing a lot of paper
works. In addition, as this article focused on nurse educators, I can relate differently as
a student nurse. Since we mostly listened and comprehended what they were teaching
us, I could not profoundly empathize with their role as nurse educators. Not until I
became a practicing clinical instructor myself, even with just a short period. I realized
how one’s experience and thorough lesson review would make a difference as we teach
others. Just like what the author mentioned, past experiences yield effective learning.
As I am now a fourth-year student nurse, I can say that it helped me a lot, even with
limited experience, in teaching basic ones to lower year levels.

The article provided a positive impact on its readers. It helped enlighten some
people on this area of nursing practice and that they are part of the same discipline, with
roles similar to those of expert clinical nurses. It also highlighted the significant roles of
nurse educators that may also be related to assessing patients in the clinical area and
implementing interventions to yield a positive response or effective learning for the
student nurses.

The nursing practice will benefit from a discussion focused on nurse educators
and the five themes in the research regarding expert nurses: knowing the patient,
reflective practice, risk-taking, intuitive knowledge including pattern recognition, and
skilled know-how. The author discussed all these themes briefly but concisely, which
will be easier for nurses to understand and comprehend. The roles presented as
descriptions for the following themes may help effect a change, especially in providing
care for patients in the clinical area. The article may also be a basis for future research
regarding new themes added to this flexible learning experience. Studies emphasizing
nurse educators’ roles during the pandemic may also recognize findings that can help
improve the nursing academe. Finally, nursing education is the area of nursing that has
the most benefit out from this article. It negated the view on the title given to nurse
educators as ‘previously nurses.’ The author highlighted the nurse educators’ essential
roles in producing novice nurses working in different areas of this discipline.
 Nurse Education in Practice 37 (2019) 105–108

Contents lists available at ScienceDirect

Nurse Education in Practice

journal homepage: www.elsevier.com/locate/nepr

Issues for Debate

Pedagogical Nursing Practice: Redefining nursing practice for the academic T

nurse educator
Francine Bono-Neri (MA, RN, PNP)
The Barbara H. Hagan School of Nursing, Molloy College, USA

A B S T R A C T

The role of the nurse educator in the academy is one that is very complex in nature. It involves skills not only to be an effective educationalist, nurse researcher and
active scholarly academic disseminating findings and new knowledge to enrich the healthcare arena, but still requires those skills that belong to that of an expert
nurse. Academic nurse educators seem to have been distanced from the nursing discipline along the way. It is the author's intention to bring them back into the scope
of the nursing profession, introduce and define her concept of Pedagogical Nursing Practice, and illustrate how much of a beacon the academic nurse educator truly
is, in order for the profession to perpetuate and prosper.

1. Introduction
Today's academic nurse educator (ANE) has a complex role. Facets
include mastering numerous teaching methodologies and technological
tools, promoting student learning and critical thinking, continuous
student managing, advising, and developing/enhancing curricula. In
addition, embedded in the role are maintenance of professional devel-
opment and pursuit of scholarly activities to produce and generate
knowledge. Yet, too often, ANEs are asked if they still “practice”.
Therefore, only direct, ‘hands-on’ practice is viewed as practicing, leaving
ANEs with a sense of inadequacy in their credibility/capabilities as a
nurse and educator. Why is the role of the ANE not considered practi-
cing? To add insult to injury, these educators are additionally seen as
excommunicated from nursing. “Nurse educators work as teachers ….
The fact that nurse educators previously belonged to a specific profes-
sion, namely, nursing, with its own professional identity makes their
situation unique” (Pennbrant, 2016, p. 430). This direct quote illus-
trates how ANEs, seen as teachers, were previously nurses, indicating a
loss of nursing identity. This is especially so if complete transition into
academia has occurred. Why has this lack of nursing identity occurred
and what can be done to change it?
As any profession is linked to the unique body of knowledge,
practices, and values of the discipline to which they belong, nursing has
its own unique identity, as well (Johnson and Webber, 2015). There-
fore, through its centuries of existence, nursing continues to evolve,
expand and be redefined to depict its unique identity. It is an art and a
science with ever-changing adaptation and reacclimatization to the flux
of today's healthcare demands. With local and global changes seen in
healthcare, the nursing profession must align and undergo metamor-
phosis, too. In The Future of Nursing: Leading Change, Advancing Health
(2011), the Institute of Medicine urges ANEs to prepare graduates for
comprehensive care management, quality improvement, and inter-
professional practice (Dreher et al., 2014). Various degrees are now
attainable, disciplinary boundaries are dissolving and a plethora of
innovative job options are available. Challenged to reillustrate its un-
derpinnings and redefine its content, the profession must firmly plant
its feet in the ground and visit the author's concept of Pedagogical
Nursing Practice for its academic constituents.
2. Background
Nursing was once a predominantly hands-on profession with an
apprenticeship-style hospital training. Through the years, it has become
a graduate exit profession as a result of academicalization due to as-
similation of most nursing education into the university arena (Andrew
and Robb, 2011; Thompson and Watson, 2008). With numerous career
opportunities for master and doctorally prepared nurses, many choose
to work outside of academia (Evans, 2013). As the shortage of nursing
faculty remains a global concern, the supply of registered nurses is di-
rectly impacted by this deficit (Laurencelle et al., 2016). Perhaps, it is
the lack of nursing identity that is less appealing. In order to explore
this avenue, one must delve into expert nursing practice, where ANEs
exist.
Morrison and Symes conducted and published their Integrated
Review of Expert Nursing Practice (2011). The purpose was to assess
common characteristics of expert nursing practice across the span of
clinical nursing specialties and work settings globally. One of the im-
petuses for the review was derived from a major study done by Patricia
Benner and colleagues, Expertise in Nursing Practice: Caring, Clinical
Judgement, and Ethics (2009). Morrison & Symes' findings revealed five

E-mail address: fbono-neri@molloy.edu.

https://doi.org/10.1016/j.nepr.2019.04.002
Received 29 June 2018; Received in revised form 21 January 2019; Accepted 2 April 2019
1471-5953/ © 2019 Elsevier Ltd. All rights reserved.
F. Bono-Neri
Fig. 1. Pedagogical Nursing Practice. This figure illustrates the five integral themes of Pedagogical Nursing Practice, along with those environmental factors of
autonomy, control over practice, positive relationships, role models, and recognition.
themes as characteristics of expert nursing practice: knowing the pa-
tient, reflective practice, risk taking, intuitive knowledge and pattern
recognition, and skilled know-how. In addition, grounding these themes
was emotional involvement, which can be identified as caring
(Morrison and Symes, 2011). Benner et al. (2009) defined nurses’
emotional involvement as caring, which is fundamental to expert nur-
sing practice. It is characterized by being present with, connecting and
knowing their patients (Benner et al., 2009).
3. Themes
3.1. Knowing the patient
The theme of knowing the patient was a central finding. Having this
strong sense of knowing allowed for individualized care yielding op-
timal outcomes for the patients across varied settings and acuity levels.
Knowing the patient results in comprehensibility and saliency, having
an ability to recognize cues to guide the nurse's judgement and future
actions. In one particular study, it enabled special recognition of social
and psychological aspects, which encouraged wider context of care and
greater depth which might have otherwise been overlooked (Morrison
and Symes, 2011).
3.2. Reflective practice
The theme of reflective practice is described as a self-directed ap-
proach to learning from past experiences, including those that produced
errors or undesirable results. Paralleling that of an empiricist philo-
sophy, this theme displays actions congruent with a critical reflective
mindframe as the hallmark of the nurse's practice. Identified as an
106
Nurse Education in Practice 37 (2019) 105–108
essential aspect of their expertise, reflective practice is utilized in expert
nursing practice (Morrison and Symes, 2011).
3.3. Risk taking
Described as actions that are deemed unconventional or even
prompting negative feedback, all done in the name of advocacy, risk-
taking behaviors may produce options that may not be the easiest or
most uncomplicated to execute. Expert nursing practice encompasses
assessment of manifestations that yields risk-taking actions which per-
haps may precipitate negative responses. Risk taking also includes
speaking and advocating for those that may not have a voice or be able
to correctly perceive the situation themselves (Morrison and Symes,
2011).
3.4. Intuitive knowledge, including pattern recognition
Intuition is the ability to, consciously and unconsciously, process
information that inevitably becomes innate in expert nursing practice
(Morrison and Symes, 2011). Findings of the studies illustrated and
delineated intuition as 1) cognitive, 2) a “gut” feeling and 3) trust in
their experience rather than knowing based on concrete data (Morrison
and Symes, 2011). Using intuition appears to be a logical and ordered
development of practice (Lyneham et al., 2008). Pattern recognition
reveals the underlying, repetitive occurrences that seem consistently
present in similar situations.
3.5. Skilled know-how
Included in expert practice is the ability to mobilize resources,
F. Bono-Neri
adapt, and respond to individual situations which is known as skilled
know-how. It is an observational ability allowing for close attention to
subtle cues which adds depth to understanding the patient's condition
and permits selection of appropriate interventions. Expert nurses collect
a broader scope of clues to support decisions in expert care by using
professional knowledge of the interventions available (Morrison and
Symes, 2011).
3.6. Environmental factors supporting expert practice
In addition to the aforementioned five themes, environmental fac-
tors were found to be paramount in supporting nurses’ development of
expertise and expert nursing practice. They are autonomy, control over
practice, positive relationships, role models, and recognition (Morrison
and Symes, 2011). Each encourages and advances the growth of expert
nursing practice, which in turn, allows for further evolvement, self-
actualization, and self-satisfaction.
4. Integration of the findings and application to the ANE
Expert nursing practice, with its five central themes, are manifested,
illustrated and utilized in all aspects of the role of the ANE. They pos-
sess these unique qualities that are linked to expert nursing practice in
what the author proposes to be known as Pedagogical Nursing Practice
(PgNP) (Fig. 1). The following will illuminate the direct correlations
seen in expert nursing practice and PgNP.
ANEs know and care for their students. Although a brief encounter
may exist, such as a nursing simulation experience or perhaps a long-
term relationship may occur, such as that of an advisory position, the
ANE is present and assesses, recognizes and becomes familiar with the
students’ academic performance, in some form. The ANE gauges and
recognizes important cues that support or facilitate optimal student
outcome. Knowing the patient is an element of expert clinical practice
which can develop without the advantage of graduate or doctoral
education. Therefore, the advanced education required of ANEs provide
an additional layer, giving them an advantage to know the student more
expertly.
Regarding reflective practice, ANEs use previous experiences from
both the academic and clinical arenas to promote the learning process.
They reflect on practices that yielded success, as well as those with less
successful outcomes. ANEs continuously remodel their tactics, offering
the most effective learning strategies for the student body. With the
additional insight gained by an advanced degree, the ANE's ability to
navigate such reflection is broader and deeper. Academic practice,
which depends on higher levels of formal education, should only re-
inforce the ANE's credibility/capability, rather than discredit it.
Risk taking is also employed by the ANE. Students learn in various
ways and through various methods, perhaps in unconventional or un-
traditional manners. ANEs take risks to ensure the greatest outcomes for
their students. As an advocate, not only for the student and nursing
profession, but for the future patients that will be cared for by their
students, ANEs must act accordingly.
Intuitive knowledge and pattern recognition are innate in the ANE
because he or she is, first and foremost, a nurse. The ANE can recognize
those subtle cues which students manifest that require intervention or
implementation to assist in learning. The ANE also intuitively re-
cognizes those students who are not in full possession of the cardinal
traits leading to success in a nursing program and can proceed ac-
cordingly, as per the institution's recommendations and policy.
Skilled know-how is also included in PgNP, as it is central to the
skills needed to effectively deliver the content or material required. In
addition, ANEs must assess student learning in the moment, therefore it
is not just delivery of content, but assessment of learning, too. ANEs
have the same unique capability of using professional knowledge to
provide engaging measures that yield effective learning. They prepare
to understand how things go wrong so that they can teach their students
107
Nurse Education in Practice 37 (2019) 105–108
all aspects of a clinical situation. Skilled know-how is not exclusive to
clinical practice, but rather is a factor related to one's thinking, which is
increasingly developed during graduate and doctoral education re-
quired of ANEs.
The five themes described are deeply woven into the very fabric of
the ANE, although they are not the sole support of PgNP. Those en-
vironmental factors of autonomy, control over practice, positive re-
lationships, role models, and recognition are the pillars for the ANE's
strength and success. Autonomy and control over practice are seen with
academic freedom, which is most desired for the ANE's individual
teaching preferences and methodologies. In addition, support, an af-
firmative collegiate environment, and recognition for superior perfor-
mance foster productive employees (Gruppen et al., 2017). Role models
and mentors further acclimatize and promote the ANE to attain a
standing that is esteemed and reputable. Only with support, will ANEs
be able to practice and sustain the production of novice nurse collea-
gues.
5. Pedagogical Nursing Practice as Praxis
Praxis is a term that has been used by theorists when referring to
practice, work or action, in contrast to activity that is philosophical in
nature (Powers and Knapp, 2010). Praxis in nursing describes theory-
based nursing practice, which must be viewed upon as a multi-
dimensional activity. It involves both theory of praxis in the didactic
models, as well as practice, in which action and self-reflection reinforce
the fit between awareness and autonomy (Powers and Knapp, 2010).
To fully engage in praxis, the ANE is required to act and reflect
above and beyond practice. Through PgNP, the ANE and student allow
for exchange and sharing of knowledge that transcends traditional
learning. Through this, praxis becomes a clinical scholarship linking
educator, student and student body to a platform that will engage and
result in high quality learning, promoting critical thinking and shared
social purpose.
6. Future implications
ANEs in PgNP allow for scholarly work in nursing, which is para-
mount to the development and perpetuation of the discipline, both in
relation to theory and practice. They are the stewards of the profession
which emulate the quintessence of nursing and all it represents.
Although some research and scholarly advances may seem esoteric to
the practice of nursing, the concept of PgNP has a significant impact
upon nursing's existence. The ANE shortage is a valid concern with
significant deleterious consequences, should this issue not be rectified.
7. Conclusion
All nursing care is provided in a social environment with special
attention being paid to the clients and their surroundings, which is
crucial to providing quality care (Swartz, 2014). The quality care being
provided by the ANE is PgNP yielding individualized optimal student
achievement. As an integral part of the nursing profession, despite
partial or total separation from ‘hands-on’ practice, ANEs continue to
exist as nurses. Ingrained are those strong underpinnings that evolved
from clinical nursing practice to what should be embraced as perpe-
tuation of the discipline by means of Pedagogical Nursing Practice.
Every profession remains linked by the unique identifiers of the
discipline to which they belong, creating a unifying bond to meld its
constituents. ANEs are no different. They should not be viewed upon as
previously being a nurse. They must continue to be identified as part of
the same discipline that produced them, for they are still practicing; it's
merely in a different realm.
F. Bono-Neri
Acknowledgments
The author would like to thank her global, brilliant colleagues of the
academy who ceaselessly inspire her on a daily basis. In particular,
she'd like to thank and dedicate this piece to her leader, mentor and role
model, Dr. Veronica D. Feeg, for she has illuminated a path that the
author never dreamed possible to travel.
References
Andrew, N., Robb, Y., 2011. The duality of professional practice in nursing: academics for
the 21st century. Nurse Educ. Today 31, 429–433. https://doi.org/10.1016/j.nedt.
2010.08.013.
Benner, P., Tanner, C.A., Chesla, C.A., 2009. Expertise in Nursing Practice: Caring,
Clinical Judgement, and Ethics, second ed. Springer, New York, NY.
Dreher, M.C., Clinton, P., Sperhac, A., 2014. Can the institute of medicine trump the
dominant logic of nursing? Leading change in advanced practice education. J. Prof.
Nurs. 30 (2), 104–109. http://doi.org/10.1016/j.profnurs.2013.09.004.
Evans, J.D., 2013. Factors influencing recruitment and retention of nurse educators re-
ported by current nurse faculty. J. Prof. Nurs. 29 (1), 11–20. http://doi.org/10.1016/
j.profnurs.2012.04.012.
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Gruppen, J., Lamour, K., Bharat, M., Jitendra, M., 2017. Being more productive. Advances
in Management 10 (5), 1–6.
Institute of Medicine, 2011. The Future of Nursing: Leading Change, Advancing Health.
The National Academies Press, Washington, DC.
Johnson, B.,M., Webber, P.B., 2015. An Introduction to Theory and Reasoning in Nursing,
fourth ed. Wolters Kluwer Health, Philadelphia, PA.
Laurencelle, F.L., Scanlan, J.M., Brett, A.L., 2016. The meaning of being a nurse educator
and nurse educators' attraction to academia: a phenomenological study. Nurse Educ.
Today 39, 135–140. http://doi.org/10.1016/j.nedt.2016.01.029.
Lyneham, J., Parkinson, C., Denholm, C., 2008. Explicating benner's concept of expert
practice: intuition in emergency nursing. J. Adv. Nurs. 64 (4), 380–387. https://doi.
org/10.1111/j.1365-2648.2008.04799.x.
Morrison, S.M., Symes, L., 2011. An integrative review of expert nursing practice. J. Nurs.
Scholarsh. 43 (2), 163–170. https://doi.org/10.1111/j.1547-5069.2011.01398.x.
Pennbrant, S., 2016. Determination of the concepts “profession” and “role” in relation to
nurse educator. J. Prof. Nurs. 32 (6), 430–438. http://doi.org/10.1016/j.profnurs.
2016.02.003.
Powers, B.A., Knapp, T.R., 2010. Dictionary of Nursing Theory and Research, fourth ed.
Springer Publishing Company, New York, NY.
Swartz, M.K., 2014. Critical theory as a framework for academic nursing practice. J. Nurs.
Educ. 53 (5), 271–276. https://doi.org/10.3928/01484834-20140408-01.
Thompson, D.R., Watson, R., 2008. Academic nursing – what is happening to it and where
is it going? J. Adv. Nurs. 36 (1), 1–2. https://doi.org/10.1046/j.13652648.2001.
01999.x.
 A Reading on

NURSE AS A LEADER

In Partial Fulfillment of the

Requirements in NCM 219 - RLE

PRACTICING CLINICAL INSTRUCTOR ROTATION

Submitted to:
KRISTINE MONICA REYES, RN
Clinical Instructor

Submitted by:
CLARISSA S. TORRES, St.N
BSN 4F - GROUP 1

September 25, 2021

TITLE

Nurse Leader Emotional Intelligence

BIBLIOGRAPHY

Coladonato, A. & Manning, M. (2017). Nurse Leader Emotional Intelligence. Nursing

Management. https://doi.org/10.1097/01.NUMA.0000522174.00393.f2

SUMMARY

Emotional intelligence (EI) refers to the ability of an individual to accurately

perceive, appraise and express emotion, to control impulses, regulate one’s mood and
showing empathy when frustrating situations arise. EI is believed to be one of the
factors in an effective nursing leadership such as in helping organizations create a
competitive advantage and understanding the professional or personal well-being of
their nurses that includes staff engagement and job satisfaction. This descriptive cross-
sectional study aims to demonstrate how clinical nurse job satisfaction and nurse
manager ability, leadership, and support of nurses are connected. Moreover, the
authors aim to know how a nurse manager’s self-perception—one of five EI
subscales—may predict nursing job satisfaction. The study was conducted at a 245-bed,
not-for-profit community hospital in southeastern Pennsylvania, with 20 nurse leaders
as participants. Results showed a total EI score from 81 to 129 which is in the midrange,
and clinical nurse job enjoyment scores ranged from 49.77 to 75.20 which means
moderate satisfaction. This means that most of the participants of this study have
average-to-high EI, and a clinical nurse job enjoyment scores between moderate and
high satisfaction. The result indicates that there is no significant relationship between
nurses’ job enjoyment and the EI of their nurse leaders. However, staff members
reported a favorable rating of their nurse leader’s ability, leadership, and support of
nurses. Furthermore, nurse leaders who were good at knowing themselves well were
more likely to have staff members who enjoyed their jobs and believed that their nurse
manager’s ability, leadership, and support of nurses were strong. In conclusion,
although there were limitations in this study, results were supported by various literature
on its implications to nursing practice.
REACTION

I can neither agree nor disagree with the study since it was quantitative,
measured through a survey. However, I really think that emotional intelligence is a
significant factor in the leadership ability of nurse leaders even though results showed
that there was no relationship between the EI of nurse leaders to the job satisfaction of
nurse leaders. Beyond the ‘job satisfaction, I think one of the ways EI of nurse leaders
may affect the team will be on becoming a more effective leader and influencing the
staff members. If nurse leaders can empathize, manage and understand the nurses,
they will expect a good relationship between them. As a result, there is a good impact
on the nurses’ environment and the patients.

Through this study, I realized the importance of knowledge of nursing concepts,

the skills on nursing procedures, and the attitude towards becoming an effective leader.
Emotional intelligence is also necessary for the team or organization members to trust
you as their leader. If there is enough trust within the group, then the leader will
positively influence its members to promote workflow organization. Understanding,
managing, and being aware of your emotions as a leader will be significant in making
decisions, communicating effectively with others, empathizing with nurses, and
overcoming the challenges.

When we talk about leadership alone, I think most of us have been leaders in
many ways. I was never the ‘leader’ type in our school, especially with organizations
and classroom setups. I am more of the follower type in a group before. But now,
especially during this journey towards becoming a nurse, I experienced a lot of being a
leader during group works. I admit I am a very anxious person, so I try my best to do the
tasks ahead of time. Some of my group mates were procrastinators, so I think I
pressured them a lot with our group requirements. I can’t say it was a bad thing, but
when I think about it, I realize that I should have been more understanding, especially
when we all have different problems.

With all these realizations and insights I have thought about after reading this
article, I can say that it will benefit those in the nursing practice, specifically the nurse
leaders in their area. Self-awareness is one thing, but being emotionally intelligent is a
good attitude towards becoming a practical nurse leader, especially in a pandemic.
Teamwork and understanding with each other will be things we need right now to fight
this pandemic. Through this article, nurse leaders might empathize more with the staff
and be aware of how much an emotionally intelligent individual affects the nursing
workforce in general.

Furthermore, as student nurses are also nurse leaders in the making, reading
this study would be beneficial to recognize the importance of emotional intelligence on
leading a team. Even nurse educators may apply these results to guide the students
and teach them the importance of emotional intelligence in leadership and management.
Finally, future researchers may utilize this study’s results as a basis for future research,
specifically on the relationship of level of emotional intelligence of nurse leaders and
staff nurses’ on more institutions; and the relationship of other factors on the job
satisfaction of nurses.
 Get connected to www.nursingmanagement.com!
See page 32.

Nurse leader
emotional intelligence
How does it affect clinical nurse job satisfaction?
By Angela R. Coladonato, DNP, RN, NEA-BC, and Mary Lou Manning, PhD, CRNP, CIC, FAAN, FNAP

Effective nurs-
ing leadership is criti-
cal to successful organizational
outcomes and employee job satisfaction.
Strong leaders are skillful in relating to oth-
ers and creating relationships that are essential
to achieving their goals.1 Emotional intelligence (EI)
has been recognized in the social psychology literature
and is now receiving attention in the nursing theoretical
and empirical literature as having a significant impact on
leadership success.2 The concept of EI is defined as the abil-
ity to accurately perceive, appraise, and express emotion.3
EI encompasses the ability to control impulses and delay
gratification, regulate one’s mood, and continue to be
motivated and empathize with others when faced with
frustrating situations.4
There’s evidence that emotionally intelligent
nurse leaders can help their organizations
create a competitive advantage through
improved retention of top talent,
intraprofessional team-
work, use of time
and resources, and
increased motivation
and innovation of team
members, as well as estab-
lished trust among nurs-
ing and leadership.5 Nurse
leaders who possess high EI
understand the impact of oth-
ers on both their professional and
personal well-being, showing an
appreciation of their contributions
and fostering a healthy environment
that supports staff engagement, job sat-
isfaction, continuous learning, information
sharing, and decision making.6,7 High EI
results in the ability to motivate employees
to do their jobs more effectively and increases

26 September 2017 • Nursing Management www.nursingmanagement.com

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

www.nursingmanagement.com Nursing Management • September 2017 27

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

Nurse leader emotional intelligence

employee job satisfaction, in Methods (NDNQI®) survey completed at

addition to leading to transfor-
mational leadership practices
that ultimately influence quality
patient outcomes.8,9
We demonstrate how clinical
nurse job satisfaction and nurse
manager ability, leadership, and
This descriptive, cross-sectional
study was conducted at a 245-
bed, not-for-profit community
hospital in southeastern Pennsyl-
vania. Following Institutional
Review Board approval, a conve-
nience sample of nurse leaders
the same institution were
included in this study.
The EQ-i 2.0—an assessment
tool based on the Bar-On Model
of Emotional-Social Intelligence
(ESI)—measured participant EI.18
The EQ-i 2.0 is an electronic

Nurse leaders with high EI tend to develop positive

relationships with clinical nurses and are
better able to manage emotions in the workplace.
support of nurses are connected, (inpatient nurse directors and self-report instrument containing
as well as how a nurse manag- nurse managers) were invited via 133 items scored on a five-point
er’s self-perception—one of e-mail to participate in a confi- Likert scale: 1 = never/rarely,
five EI subscales—may predict dential, anonymous EI question- 2 = occasionally, 3 = sometimes,
nursing job satisfaction. (See naire. In addition, existing data 4 = often, and 5 = always/almost
How do we define nursing from the National Database of always. The instrument includes
job satisfaction?) Nursing Quality Indicators® five composite scales that reflect
various characteristics of EI and
How do we define nursing job satisfaction? are further divided into three
Job satisfaction for nurses encompasses a feeling of value, meaning, subscales each. (See Figure 1.)
and happiness in the workplace.10 When nurses experience high lev- The tool is internally consistent
els of job satisfaction, they have increased morale and organizational as measured by Cronbach’s alpha
commitment, and are more inclined to stay at the organization and in at .97 for the total EI scale, from
the profession.11 Nursing job satisfaction is also important to patients, .88 to .93 for the composite
families, and healthcare practitioners because it’s been linked to positive
patient outcomes and quality care.12 Although there’s no one definition scales, and at .77 or higher for
of nursing job satisfaction, for nurses working in acute care hospital the subscales.19
settings, contributing factors include the intrapersonal, such as age, the The instrument’s raw scores
interpersonal, such as autonomy, and the extrapersonal, such as pay.13 are converted into standard
Nurse managers can be instrumental in influencing nurse job satisfac- scores based on a mean of 100 and
tion by providing positive leadership, role-modeling, and understanding the
unit-based issues and challenges important to nurses.13 The more that a standard deviation (SD) of 15.
nurse managers appear transparent and self-aware, the more clinical nurses This facilitates comparison of the
show satisfaction with their work.14 And clinical nurses who perceive their respondents’ scores to the scores
nurse managers as transformational display overall higher job satisfaction.15 of the normative sample and,
However, nurse managers often take on a great deal of emotional theoretically, to the rest of the
burden due to staff demands.16 Managers handle personal, professional,
and emotional issues from staff members, as well as field queries and population. EQ-i 2.0 scores above
complaints from both internal and external constituents. Additionally, 110 are considered in the high
nurse managers are expected to utilize their expertise to ensure intrapro- range and indicate emotionally
fessional collaboration with other disciplines, healthcare policy makers, intelligent people. The midrange
and the community to improve care quality and transitions, and inspire scores fall between 90 and 110,
new leadership.17
whereas lower scores indicate a

28 September 2017 • Nursing Management www.nursingmanagement.com

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

 Figure 1: EQ-i 2.0
Total EI

Decision Stress
Self-perception Self-expression Interpersonal
making management

Emotional Interpersonal Problem

Self-regard Flexibility
expression relationships solving

Self- Stress
Assertiveness Empathy Reality testing
actualization tolerance

Emotional
Social
self- Independence Impulse control Optimism
responsibility
awareness

need to improve emotional skills
in specific areas (less than 90).19
For the purposes of this study,
the researcher accessed only two
subscales within the NDNQI sur-
vey: the job enjoyment scale and
the nurse manager ability, leader-
ship, and support of nurses
scale.20 The job enjoyment scale
consists of seven questions on a
six-point Likert scale, from
strongly agree to strongly dis-
agree. Results are reported as
modified T-Scores, with 50 as the
midpoint. Less than 40 indicates
low satisfaction; 40 to 60, moder-
ate satisfaction; and greater than
60, high satisfaction.20 The nurse
manager ability, leadership, and
support of nurses scale consists of
five questions on a four-point Lik-
ert scale, from strongly agree to
strongly disagree. This scale mea-
sures important nurse manager
qualities and the ways in which
the manager supports the nurse.
Results are reported as mean
scores. The higher the score, the
more positive the rating.20
The EQ-i 2.0 instrument was
completed in approximately 20 to
30 minutes of uninterrupted time.
Participation implied consent.
Demographic queries couldn’t
be added to the EQ-i 2.0 tool
because the scores are computer
generated. Before EQ-i 2.0 data
collection, the NDNQI survey
was completed by full or part-
time RNs who spend 50% of their
time in direct patient care and
were employed at the hospital for
a minimum of 3 months.
Results
Data were analyzed through var-
ious parametric tests using SPSS.
Descriptive statistics were calcu-
lated for demographic variables,
total and composite EI scores; job
enjoyment scores; and nurse
manager ability, leadership, and
support of nurses scores. Twenty
nurse leaders participated in the
EQ-i 2.0 instrument. They were
homogenously female, between
ages 35 and 69, and worked full
time. Educational levels ranged
from a diploma or associate
degree through doctoral degrees.
(See Table 1.) Existing data from
the NDNQI survey included the
results of 79% (476/621) of eligi-
ble direct care RNs.
The nurse leader total EI scores
ranged from 81 to 129, spanning
all three ranges, but the mean
total EI score was 104.76 (SD
10.549) in the midrange (90 to
110). The clinical nurse job enjoy-
ment scores ranged from 49.77
to 75.20 (moderate satisfaction,

www.nursingmanagement.com Nursing Management • September 2017 29

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

Nurse leader emotional intelligence

40 to 60; high satisfaction, greater nurses; clinical nurse job enjoy- played average-to-high EI. Clinical
than 60), with a mean score of ment; and nurse leader total EI nurse job enjoyment scores
61.60 (SD 7.6962). was obtained. In this instance, showed variability between
The nurse manager ability, there was a strong correlation moderate and high satisfaction,
leadership, and support of nurses between job enjoyment and indicating that clinical nurses on
scores ranged from 2.46 to 3.62, nurse manager ability, leader- some units were less satisfied
with a mean score of 2.96 (SD ship, and support of nurses than staff on other units. Consis-
0.3144). A favorable rating is a (r = .82, P < .01). tent with this, there was no sta-
mean score that exceeds 2.5. A In addition to the total EI tistically significant relationship
one-way analysis of variance was score, the EQ-i 2.0 results are bro- between clinical nurses’ job
calculated on clinical nurse job ken down into five composite enjoyment and the EI of their
enjoyment related to nurse leader scores, which, in turn, are broken nurse leaders.
total EI. The analysis wasn’t sig- down into a total of 15 subscale Most staff members reported a
nificant: F (3,30) = 31, P = .822 scores. All mean composite favorable rating of their nurse
(P > .05). Alternately, the Pear- scores fell into the midrange manager’s ability, leadership,
son correlation coefficient and (90 to 110) and included self- and support of nurses. Further,
P value of nurse manager ability, perception (101.41, SD 11.335), the more that nurses enjoyed
leadership, and support of self-expression (102.97, SD 12.511), their job, the more they believed
interpersonal (106.6, SD 9.7450), that their nurse managers pos-
Table 1: Sample characteristics decision making (104.41, SD sessed strong ability, leadership,
11.980), and stress management and support. Finally, nurse lead-
Variable n %
(105.15, SD 10.944). ers who were good at knowing
Age group The scores for the 15 subscales themselves well (self-perception)
20-29 0 0 were also in the midrange, with a were more likely to have staff
mean score of 103.56 (range 97.88 members who enjoyed their jobs
30-39 1 5
to 109.82). (See Table 2.) The sub- and believed that their nurse
40-49 4 20 scales of self-actualization (97.88, manager’s ability, leadership,
50-59 10 50 SD 11.7) and problem solving and support of nurses were
(98.41, SD 12.033) had the lowest strong.
≥60 5 25
scores, whereas the subscales of EI is considered to be an
Education empathy (109.82, SD 9.233), opti- important facet of effective lead-
Diploma/associate 2 10 mism (107.5, SD 12.755), and ership. Nurse leaders are faced
degree in nursing emotional self-awareness (107.15, with the daunting challenge of
SD 11.024) had the highest scores. not only managing unit clinical
Bachelor’s degree 11 55
A multiple linear regression and administrative activities,
Master’s degree 6 30 was calculated to predict job but also playing a significant
Doctoral degree 1 5 enjoyment and nurse manager role in translating and achieving
ability, leadership, and support of organizational goals within their
Position
nurses based on all five composite defined areas of responsibility.7
Nurse manager 13 65 scales. Only the self-perception Nurse leaders with high EI tend
Nurse director 7 35 composite scale significantly pre- to develop positive relationships
dicted job enjoyment (beta = -.75, with clinical nurses and are
Gender
t = -2.373, P < .05) and nurse better able to manage emotions
Female 20 100 manager ability, leadership, and in the workplace.21 Clinical
Male 0 0 support of nurses (beta = -.72, nurses who feel that their nurse
t = -2.360, P < .05). leader demonstrates high EI
Employment status report significantly greater job
Full-time 20 100 Discussion satisfaction.22
Part-time 0 0 The overwhelming majority of Results of this study add to
nurse leaders in this study dis- the limited, but growing, body

30 September 2017 • Nursing Management www.nursingmanagement.com

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

of literature exploring nurse
leader EI. Although the majority
Table 2: Nurse leader EQ-i 2.0 subscale scores (n = 20)
of nurse leader total EI scores Subscale Mean Range SD
were in the midrange, findings Self-regard 100.53 63-123 15.375
demonstrated a strong correla-
Self-actualization 97.88 71-125 11.729
tion between clinical nurse job
enjoyment and nurse manager Emotional self-awareness 107.15 84-126 11.024
ability, leadership, and support
Emotional expression 102.32 68-121 9.975
of nurses. Midrange results,
which some would consider Assertiveness 103.15 67-127 11.032
average, aren’t always viewed in Independence 102.32 70-120 13.334
a positive light; however, aver-
Interpersonal relationships 103.35 81-125 13.282
age to above average EI scores
suggest that the respondent is Empathy 109.82 97-124 9.233
effective in emotional and social Social responsibility 101.53 80-124 10.607
functioning.23 This study’s find-
ings are consistent with one Problem solving 98.41 70-123 12.033
sample of 206 ED nurses that Reality testing 107.91 86-130 11.36
found leadership played a criti-
Impulse control 104.85 62-125 13.725
cal role in creating work envi-
ronments that promote nurse Flexibility 102.53 94-122 7.325
retention.24 Stress tolerance 104.24 76-124 13.296
The EI subscales of empathy
and emotional self-awareness Optimism 107.5 77-124 12.755
are considered by many
researchers to be two of the A few factors may limit the iting passion to motivate their
most important components of results of this study. It was con- staff members to achieve goals
emotional-social intelligence.23 ducted at a single acute care insti- and aspirations that may not
Nurse leaders in this study tution and the sample size was have otherwise surfaced.
showed the highest mean sub- small, limiting the generalizability Acknowledging emotions can
scale score in empathy (109.82) of findings. Response bias may often be thought of as a “soft”
and an emotional self-awareness be of concern because the instru- side of leadership; however, it’s
mean score in the top third of all ments were self-administered one skill that nurse leaders must
15 subscale scores (107.15). and nurse leaders were direct possess to ensure that employee
Empathy and emotional self- reports of the author. Nurse guidance is based on a recogni-
awareness findings from this leaders weren’t homogenous, tion of both the emotional and
study are consistent with the including both nurse managers critical-thinking processes that
results of a research study in and directors. Because of the are part of every decision.
which 75 stories written by importance of participant confi- The literature supports the
nurses about nursing were ana- dentiality, comparisons between importance of nurse leader EI
lyzed to determine evidence of the groups couldn’t be estab- skills to create a supportive envi-
EI attributes.24 The author con- lished. Finally, the NDNQI ronment and facilitate staff
cluded that empathy was the survey and the EQ-i 2.0 were empowerment, leading to staff
highest EI attribute occurring administered at different time job satisfaction. The ESI model is
most frequently in the stories, periods. both teachable and learnable.23
with emotional self-awareness in There’s emerging agreement
third place. Critical to nursing Practice implications that EI competencies can be
care, empathy is regarded as a Emotionally intelligent nurse improved, which may spark
vital component of any form of leaders inspire individuals by subsequent interest in EI devel-
caring relationship.25 challenging emotions and exhib- opment through leadership

www.nursingmanagement.com Nursing Management • September 2017 31

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

Nurse leader emotional intelligence

17. Ellis P, Abbott J. The emotionally resil-

Bonus content
Head to www.nursingmanagement.com for additional resources on EI.
How does your emotional intelligence measure up?
http://journals.lww.com/nursingmanagement/Fulltext/2017/01000/
Leadership_Q_A.13.aspx
Making the case for emotionally intelligent leaders?
http://journals.lww.com/nursingmanagement/Fulltext/2014/01000/
Making_the_case_for_emotionally_intelligent.10.aspx
training. For nurse leaders in the
complex healthcare arena, it
makes sense that EI compe-
tencies will become increas-
ingly important for effective
leadership.
Empathy—thoughtfully con-
sidering employees’ feelings,
along with other important fac-
tors, in the process of making
intelligent decisions—is the most
easily recognized dimension of
EI.26 Empathy appears to be an
extremely important leadership
quality to develop and retain tal-
ented staff, leading to reduced
turnover costs. The concept of EI
is gaining recognition in the
healthcare environment; how-
ever, more study is needed to
acquire a better understanding of
EI academically, professionally,
and personally. NM
REFERENCES
1. Stichler JF. Social intelligence: an
essential trait of effective leaders. Nurs
Womens Health. 2007;11(2):189-193.
2. McQueen AC. Emotional intel-
ligence in nursing work. J Adv Nurs.
2004;47(1):101-108.
3. Salovey P, Mayer JD. Emotional intelli-
gence. Imagin Cogn Pers. 1990;9(3):
185-211.
4. Goleman D. Emotional Intelligence: Why
It Can Matter More Than IQ. New York,
NY: Bantam Books; 1995.
6. Snow JL. Looking beyond nursing for
clues to effective leadership. J Nurs Adm.
2001;31(9):440-443.
7. McCallin A, Bamford A. Interdisciplinary
teamwork: is the influence of emotional
intelligence fully appreciated? J Nurs
Manag. 2007;15(4):386-391.
8. Amendolair D. Caring behaviors and job
satisfaction. J Nurs Adm. 2012;42(1):
34-39.
9. Feather R. Emotional intelligence in
relation to nursing leadership: does it
matter? J Nurs Manag. 2009;17(3):
376-382.
10. Spano-Szekely L, Quinn Griffin MT,
Clavelle J, Fitzpatrick JJ. Emotional intel-
ligence and transformational leader-
ship in nurse managers. J Nurs Adm.
2016;46(2):101-108.
11. Ma JC, Lee PH, Yang YC, Chang WY.
Predicting factors related to nurses’
intention to leave, job satisfaction, and
perception of quality of care in acute
care hospitals. Nurs Econ. 2009;27(3):
178-202.
12. Newman K, Maylor U, Chansarkar B.
The nurse retention, quality of care and
patient satisfaction chain. Int J Health
Care Qual Assur Inc Leadersh Health
Serv. 2001;14(2-3):57-68.
13. Aiken LH, Clarke SP, Sloane DM, Sochal-
ski J, Silber JH. Hospital nurse staffing
and patient mortality, nurse burnout,
and job dissatisfaction. JAMA. 2002;
288(16):1987-1993.
14. Hayes B, Bonner A, Pryor J. Factors
contributing to nurse job satisfaction
in the acute hospital setting: a review
of recent literature. J Nurs Manag.
2010;18(7):804-814.
15. Wong CA, Laschinger HK. Authentic
leadership, performance, and job
satisfaction: the mediating role of
empowerment. J Adv Nurs. 2013;
69(4):947-959.
16. Bormann L, Abrahamson K. Do staff
nurse perceptions of nurse leadership
behaviors influence staff nurse job satis-
faction? The case of a hospital applying
for Magnet® designation. J Nurs Adm.
2014;44(4):219-225.
ient renal manager: understanding the
language of emotion. J Renal Nurs.
2013;5(5):256-257.
18. Marshall ES. Transformational Leader-
ship in Nursing:From Expert Clinician
to Influential Leader. New York, NY:
Springer Publishing; 2011.
19. Multi-Health Systems, Inc. The EQ-i 2.0
model. http://ei.mhs.com/EQi20The
Science.aspx.
20. Multi-Health Systems, Inc. Emotional
Quotient Inventory 2.0 User’s Manual.
Multi-Health Systems, Inc; 2011.
21. National Database of Nursing Qual-
ity Indicators. RN Survey Scoring and
Glossary Guide. NDNQI; 2014.
22. Cummings G. Investing relational
energy: the hallmark of resonant
leadership. Nurs Leadersh (Tor Ont).
2004;17(4):76-87.
23. Bono JE, Foldes HJ, Vinson G, Muros JP.
Workplace emotions: the role of super-
vision and leadership. J Appl Psychol.
2007;92(5):1357-1367.
24. Young-Ritchie C, Spence Laschinger
HK, Wong C. The effects of emotion-
ally intelligent leadership behaviour
on emergency staff nurses’ workplace
empowerment and organizational
commitment. Nurs Leadersh (Tor Ont).
2009;22(1):70-85.
25. Codier E, Muneno L, Franey K, Mat-
suura F. Is emotional intelligence an
important concept for nursing prac-
tice? J Psychiatr Ment Health Nurs.
2010;17(10):940-948.
26. Reynolds WJ, Scott B, Jessiman WC.
Empathy has not been measured in
clients’ terms or effectively taught: a
review of the literature. J Adv Nurs.
1999;30(5):1177-1185.
Angela R. Coladonato is the senior
vice president of nursing/CNO at Penn
Medicine Chester County Hospital in West
Chester, Pa. Mary Lou Manning is an
associate professor at Thomas Jefferson
University Jefferson College of Nursing in
Philadelphia, Pa.
The authors have disclosed no financial
relationships related to this article.
DOI-10.1097/01.NUMA.0000522174.00393.f2

32 September 2017 • Nursing Management www.nursingmanagement.com

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

 A Reading on

NURSE AS A MANAGER

In Partial Fulfillment of the

Requirements in NCM 219 - RLE

PRACTICING CLINICAL INSTRUCTOR ROTATION

Submitted to:
KRISTINE MONICA REYES, RN
Clinical Instructor

Submitted by:
CLARISSA S. TORRES, St.N
BSN 4F - GROUP 1

October 1, 2021
TITLE

Describing Nurse Manager Role Preparation and Competency: Findings From a

National Study

BIBLIOGRAPHY

Warshawsky, N. & Cramer, E. (2019). Describing Nurse Manager Role Preparation and
Competency: Findings From a National Study. The Journal of Nursing Administration.
Volume 49, pp 249-255. https://doi.org/10.1097/NNA.0000000000000746

SUMMARY

The number of nurse managers or leaders retiring annually is increasing which

may lead to a significant loss of leadership wisdom in organizations, especially in
training or mentoring novice nurses who enter the workforce. Since nurse managers are
important in the performance of the organization, it is given that they must be competent
in their work. Thus, this study aimed to describe the role preparation and competency
development of nurse managers. An electronic survey was utilized to collect
cross sectional data between September 25 and November 3, 2017. Eighty hospitals
were selected, and those who agreed to participate were 647 nurse managers. Nurse
Manager Competency Assessment, questions on role preparation, and qualitative
comments regarding the participants’ experiences with role preparation and
competency development were assessed. Results showed that 59% of them have 4
years or less experience in a nurse manager role, and that inexperience of these
managers was reflected in their competency scores. Finance, strategic management,
and performance improvement are competencies with lowest scores, which is of
concern for these are critical for leading transformation of the healthcare organization.
Another concern is that it seems it takes nurse managers more than 7 years to become
proficient.Finding also suggest that that nurse managers learn primarily through
experience. In conclusion, current nurse manager workforce has limited experience and
competence, which is also due to absence of educational requirements and structured
competency development programs that led them to base and learn solely through
experience.
REACTION

The concern on understaffing has been evident for years now. I believe that the
researchers are concerned about the competence of novice nurses in becoming nurse
managers, especially that many nurses are retiring. The study findings showed that
most nurse managers have fewer years of experience, which is the primary concern
since this stage is still under the novice or advanced beginners. Furthermore, it is true
what they said about the solutions to overcoming these problems. Nurse administrators
also have to ensure that nurses must be well-equipped with skills first and guided well
before they transition to that role.

Reading this article made me reminisce when we were interviewing novice

nurses for our research regarding their experiences. I can feel their struggle to cope
with their transition with every statement they say, especially since they just graduated
and passed the board exams. When these nurses were assigned in the COVID wards,
they felt like they were now like their seniors, even with just a short time. Sometimes,
their seniors are not around or have their quarantine, so they feel pressured to go on
duty without their senior’s guidance. Although this experience does not relate to being a
nurse manager, our study’s findings significantly relate to this study on the competence
of nurse managers who were usually novices. That’s why I believe in the importance of
training programs, continuing education, and other forms of mentorship because we
need to ensure that nurses are competent enough to be nurse managers.

This study shifted our perspective, not just on our problem with understaffing but
also on our nurse managers’ competency. The study suggested that hospital
administrators need to evaluate the quality of this role. Its impact can positively
influence the head of organizations or hospitals to take necessary actions to better the
organization and the nursing staff.

Nurse administrators are the ones who need to be aware of the results of this
study. The findings may inspire them and make them realize the importance of
assessing their nurse managers. The study showed that nurse managers are concerned
with time and money resources to attend these training or continuing educations. Thus,
Nurse administrators need to evaluate the workloads of nurse managers, which may
interfere with their ability to complete their coursework. Moreover, nurse executives
should also assess their educational requirements for the nurse manager position. As
stated in the study, competencies needed for successful nurse manager performance
are not taught in the undergraduate curriculum but being a practical nurse manager is
conducted at the graduate level.

Nursing education is an excellent part of this competency appraisal or improving

the competence of nurse managers. Graduate schools should consider those who
cannot afford the tuition fees. They may also apply a flexible schedule for those nurse
managers who want to continue their education but with concerns about their resources.
As much as nursing administrators or executives wanted to hire nurses at the graduate
level, the situation in our country is worsening when it comes to nurses leaving the
profession. It is especially evident during the pandemic, where older people decided to
retire due to the increased risk of contracting the virus. Thus, nursing educators at the
undergraduate level may need to include activities or possibly programs that will
enhance the leadership of student nurses. The course nursing leadership and
management is an excellent avenue for this to be possible.

Finally, this will be a basis for future research on the nurse managers’
competency in this time of pandemic and how they prepared for their roles in this rapid-
paced time. The findings of the study and future researches will provide the hospital
executives data on possible concerns about the transitioning towards the nurse
manager role.
 JONA
Volume 49, Number 5, pp 249-255
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
THE JOURNAL OF NURSING ADMINISTRATION
Describing Nurse Manager Role
Preparation and Competency: Findings
From a National Study
Nora Warshawsky, PhD, RN, NEA-BC, FAAN
Emily Cramer, PhD
OBJECTIVE: The aim of this study was to describe
the role preparation and competency development of
nurse managers.
BACKGROUND: Approximately 70 000 nurses are
retiring annually. This represents a significant loss of
nursing leadership wisdom. Few systematic studies of
nurse manager role preparation and competency de-
velopment have been conducted.
METHODS: An electronic survey was completed by
a national sample of 647 nurse managers managing
964 patient care units in 54 hospitals.
RESULTS: Findings suggest that nurse managers rate
themselves as competent for the 1st 6 years as a nurse
manager. They begin to reach proficiency by year 7.
Experience had the strongest association with nurse
manager competence, followed by graduate leader-
ship education.
CONCLUSIONS: Nurse executives need to evaluate
the bench strength of their nursing leadership talent
pool. They need to develop policies and strategies that
promote nurse manager competence.
Approximately 70 000 nurses are retiring annually.
Although estimates of nurses entering the profession
may offset much of the loss, nursing leadership will bear
a disproportionate loss because a greater percentage of
nurse leaders are of retirement age.1,2 Nurse leader
retirements represent a significant loss of leadership
Authors Affiliations: Professor (Dr Warshawsky), University of
Central Florida, College of Nursing, Orlando; Associate Professor
(Dr Cramer), University of Kansas School of Nursing.
This study was funded by VCAN (Versant Center for the Ad-
vancement of Nursing). The findings do not necessarily represent
the views of VCAN.
The authors declare no conflicts of interest.
Correspondence: Dr Warshawsky, 12201 Research Pkwy, UT
473, Orlando, FL 32826 (Nora.Warshawsky@ucf.edu).
DOI: 10.1097/NNA.0000000000000746
JONA  Vol. 49, No. 5  May 2019
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
wisdom in organizations. The impact is trickling down
to the nurse manager level where our Millennial nurses
are being called to step up and lead.3,4 Given the im-
portance of nurse managers to organizational perfor-
mance, it is essential that they are competent in their
role.5,6 What we need to understand is how nurse
managers develop competency for these critical leader-
ship positions.
Benner's Theory of Competency Development
According to Benner,7 nurses progress through 5 stages
of competency development: novice, advanced begin-
ner, competent, proficient, and expert. Nurses ad-
vance through these stages as they gain experience
and knowledge through nursing practice. Benner7
notes that it takes 2 to 3 years for a nurse to become
competent in practice. Benner7 studied nurses in the
1980s; however, nurses today are working in a more
complex healthcare environment, and it may prolong
nurses' progression to competence. Relying on expe-
rience alone for newly graduated nurses to develop
competence is inadequate and associated with stress
and turnover.8 To help bridge the transition from
prelicensure education to practice, residency programs
were developed to support nurses as they progress
through early stages of competency development.
Residency programs can effectively improve nurses'
confidence, organization and prioritization of work,
communication, and leadership competencies in their
1st year of practice.8
Benner's7 model can also be applied to the devel-
opment of nurse manager practice. Commonly, nurse
managers are selected for their positions based on
clinical expertise rather than leadership and manage-
ment competence. Emerging evidence suggests that,
like clinical nurses, experiential learning is an important
249
strategy for nurse managers to develop competence.9,10
In comparison to new graduate entry to practice, the
evidence supporting nurse manager role preparation
and competency development is sparse.
Nurse Manager Competency Development
Despite calls for graduate education for nurse managers
by professional organizations,11 these recommenda-
tions often go unheeded in clinical practice settings.
Quite often, nurse managers are “being thrown into
the position” and “learning on the fly.”12 It is a highly
stressful and haphazard approach to transition new
nurse managers to their roles. Nurse managers identi-
fied that formal orientation and mentorship would
facilitate the transition into their new roles, but again,
approaches to role preparation and competency de-
velopment vary by organization.12,13
Some organizations provide leadership develop-
ment programs that target either nurse managers al-
ready appointed to positions or emerging leaders who
are likely to seek nurse leader positions. It appeared that
difficulty filling vacant nurse manager positions was a
common impetus to develop programs for emerging
leaders.14-17 These programs ranged from 3 months
to 1 year in duration. The programs all included di-
dactic content in combination with an assigned men-
tor. The majority utilized the Essentials of Nurse
Manager Orientation developed by the American As-
sociation of Critical-Care Nurses.18 Additional activ-
ities included journaling, mentored evidence-based
practice projects, and in 1 residency program a precepted
3-month trial unit leadership experience.14-17 An impor-
tant outcome of these programs included a reduction
in the duration of vacant positions and costs associ-
ated with nurse manager turnover.
Other leadership development programs are fo-
cused on nurse managers after they assume their po-
sitions. The Nurse Manager Fellowship program
sponsored by the American Organization of Nurse
Executives (AONE) is the most notable example.19,20
The fellowship is a national program offered in the
United States where nurse managers apply and pay
for participation. The program includes participation
in 4 face-to-face didactic sessions, completion of a
capstone project, and development of a network of
colleagues. As a result of participation in the program,
nurse managers reported increased knowledge of the
health system, perspective, collaboration, self-confidence,
and self-awareness. A healthcare system in New York
used a participatory action research model to guide
leadership development for 43 nurse managers.21 These
managers selected the topics of teamwork, time
management, and conflict leadership as the focus
of their 1-year program. Three 3-hour sessions were
250
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
developed using an appreciative inquiry approach
to elicit best practices related to each topic among
the nurse managers. The participating nurse man-
agers reported that this program resulted in im-
proved knowledge and confidence in addressing
the challenges that they face. A 3rd model utilized an
academic-practice partnership to provide a 4-month
program for 63 nurse managers using an experiential
learning model and reflective practice.10 In this pro-
gram, a faculty member provided 30-minute sessions
that described experiential learning and reflective
journaling and emails reminding participants to com-
plete reflective journaling activities. Journals were re-
viewed and discussed with the nurse managers and
their directors who served as mentors. The program re-
sulted in improved communication, planning, decision
making, development of subordinates, and outcomes
evaluation among participants.
These successful programs shared several common
developmental strategies: didactic sessions in combina-
tion with experience-based learning, mentorship, and
reflective practice. Despite their effectiveness, questions
remain unanswered. More insights regarding the nature
of competency development, role of graduate educa-
tion, and nurse manager perspectives are needed. The
purpose of this article is to describe role preparation
and competency development of a national sample of
US nurse managers.
Methods
This study used an electronic survey to collect cross-
sectional data between September 25 and November 3,
2017. Three hundred hospitals participating in the
National Database of Nursing Quality IndicatorsW
annual RN survey were invited to participate in the
study. Of the 150 hospitals responding to the invita-
tion, 80 were selected using a stratified sampling
frame. Hospitals agreeing to participate were given
materials to encourage nurse managers within their
organization to participate in the nurse manager sur-
vey. The nurse manager survey was completed by 647
nurse managers, representing 964 nursing units in 54
hospitals. This study was approved by the institu-
tional review board at the University of Kentucky.
Nurse Manager Competency Assessment
Nurse manager competency was assessed using a new
instrument developed based on AONE's Nurse Man-
ager Competencies.22 AONE developed competencies
using job descriptions of nurse managers and classified
them according to the Nurse Manager Leadership Do-
main Framework (NMLDF).22 The NMLDF catego-
ries include the Science: Managing the Business, Art:
Leading the People, and Leader Within: Creating the
Leader in Yourself. In order to create an instrument
JONA  Vol. 49, No. 5  May 2019
that could be used for research, 27 items were devel-
oped by the lead investigator to reflect the main themes
of the competencies in the Science (18 items) and Art
(9 Items) domains. For example, AONE's Financial
Management competency consists of 10 specific skills.
These items were collapsed into 2 items: (1) knowledge
of healthcare economics and its application to the de-
livery of patient care and (2) knowledge of the unit
and departmental budgeting processes—both capital
and operational. The items were reviewed by a PhD-
prepared nurse researcher with extensive leadership
experience. Participants were asked to “assess your
level of comfort with each competency” using a 5-point
scale reflective of Benner's stages of competency de-
velopment: 1 = novice, 2 = advanced beginner, 3 =
competent, 4 = proficient, and 5 = expert. Cronbach's
a's were .97 for the total scale, .99 for the Science sub-
scale, and .94 for the Art subscale, reflecting excellent
internal consistency. The Leader Within domain was
measured using demographic questions about educa-
tion and certification.
Role Preparation
A variety of questions were asked to understand role
preparation. Participants were asked to specify their
highest level of nursing and nonnursing education,
number of continuing education credits relevant to
leadership and management over the past 12 months,
completion of any national leadership development
programs, and types of nursing leadership certifica-
tions. This study focused on nursing and leadership
graduate education.
Qualitative Comments
Participants were provided a free text comment box
at the end of the survey. Many participants provided
additional comments to illustrate their experiences
with role preparation and competency development.
These comments were analyzed to identify themes
and are presented in Table 1.
Analysis
Descriptive statistics were used to examine role prep-
aration and experience of nurse managers and mean
self-rated competency scores. Bivariate correlations
were run to explore the relationship between nurse
manager experience and competency.
Results
The majority of nurse managers were female (88%),
were white (86%), held a BSN degree or higher (62%),
and averaged 45 years of age. Table 2 presents data de-
scribing the education, experience, and role prepara-
tion of nurse managers with published comparisons.
JONA  Vol. 49, No. 5  May 2019
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Table 1. Thematic Analysis of Comments
Related to role Preparation and Competency
Development
Theme Participant Comments
How nurse • Most of what we learn is from
managers learn experience (positive and negative
lessons).
• Becoming a manager on the unit
where I've worked for 12+ y has
helped.
• I am seeking opportunities through
local leadership organizations.
• I'm currently finishing a dual MSN/
MBA program.
• Seeking continuing education.
Barriers • Professional development of
management staff is not given
a high priority.
• Had to withdraw from my most
recent courses due to work and
family needs, but mostly work.
• Managers are not all at the same level.
• Challenged to learn skills you have no
training in, nor desire to learn (eg,
finance)
• I have not been sent to any manager
or leadership classes to help me in my
current role.
Solutions • Formal mentor and onboarding
programs.
• Mentor on nights would be helpful.
• I am required to obtain my MSN but
wish my organization had better
financial reimbursement.
• My organization has provided me
with adequate support to transition
from clinician to manager.
• Live classes from human resources.
• Request incentives.
The sample of nurse managers averages nearly 20 years
of nursing experience and 6.73 years of experience as
nurse managers. However, the average time in current
nurse manager position is 4.14 years, suggesting that
many nurse managers leave their 1st leadership position
after 2 years. The majority of nurse managers (59%)
have 4 years or less of experience in a nurse manager
role (Figure 1). Thirty-nine percent of the nurse man-
agers hold a graduate leadership degree in nursing or
some other field, and only 15% of nurse managers
hold a nursing leadership certification.
Overall, nurse managers rated competency on
Art domain subscales higher than competency on Sci-
ence domain subscales. The mean nurse manager
competency scores ranged from 2.99 (financial man-
agement) to 3.72 (technology) on the Science domain
and 3.48 (human resource management) to 3.83 (di-
versity management) on the Art domain (Figure 2).
Nurse managers with less than 2 years of experience
rate their competency on both Art and Science domains
251
 Table 2. Descriptive Statistics Compared With Published Studies23,24
Characteristics n % or Mean (SD) % or Mean (SD) (n = 292) % or Mean (SD) (n = 356)

Year data collected 2017 2011 2012

Female 559 88% 90% 91%
White, Non-Hispanic 550 86% 91% 84%
BSN 399 62% 51% 65%
Any graduate education 252 39% 34% 25%
Leadership certification 101 15%
Age, y 632 45.33 (9.99) 47.3 47.0 (8.8)
Years of nursing experience 647 19.90 (10.58) 21.4 (10.3) 21.4 (9.7)
Years as nurse manager 644 6.73 (7.13) 9.1 (7.3) 7.4 (7.3)
Years in current position 642 4.14 (5.36) 4.8 (4.7) 4.5 (5.5)
Full-time equivalents 633 66.11 (103.80) 59.8 (37.8) 64.8 (37.7)
Competency: Science domain 3.04 (0.71)
Competency: Art domain 3.62 (0.73)
Total competency 3.47 (0.70)

Comparison data for 2011 taken from reference 23; comparison data for 2012 taken from reference 24.

higher than those with 2 to 4 years of experience, but
less than nurse managers with 5 to 7 years and more
than 7 years of experience (Figure 3).
The highest correlations between role prepara-
tion and competence were between nurse manager
experience and the science of competency domain
(r = 0.46, P < .05) and experience and the art of com-
petency domain (r = 0.41, P < .05; Table 3). Nursing
education has a small but significant relationship
(r = 0.23, P < .05) to the science of competency do-
main, and any graduate-level education is signifi-
cantly related to both the science of competency
(r = 0.29, P < .05) and the art of competency
(r = 0.21, P < .05).
Discussion
Current State
Overall, this study provides evidence that nurse leaders
are retiring. In comparison to prior studies, this sample
is 2 years younger with less experience as a nurse
manager overall and less tenure in their current posi-
tions.23,24 Almost 60% of the nurse managers had
4 years or less of experience as a nurse manager over-
all. The data also suggest that nurse managers are
spending less time in their 1st nurse manager posi-
tions: about 2.6 years in this study compared with
4.3 years in 2011 and 2.9 years in 2012. These find-
ings serve as a call for nurse executives to examine
the overall bench strength of their nurse managers.
What proportion of nurse managers are novice and
where can they turn for guidance?
The inexperience of these managers was reflected
in their competency scores. The mean competency
scores for the Art of Management (mean, 3.62 [SD,
0.73]) were higher than those for the Science of
Management (mean, 3.04 [SD, 0.71]). These scores
suggest that on average these nurse managers con-
sidered themselves to be competent across nurse man-
ager skills. The lowest reported competencies were
the organizational systems competencies of finance,
strategy, performance improvement, and foundational
thinking. These are competencies that are highly val-
ued by executive leaders but less valued by nurse
managers.25 The competencies in the Science of Man-
agement subscale that were scored higher included
human resources management (mean, 3.58), clinical
practice (mean, 3.68), and technology (mean, 3.72).
In fact, across all competencies, diversity management,
technology, and clinical competencies were the 3
highest scored competencies. These findings support
the notion that nurse managers are promoted based
on clinical expertise. They also reflect our younger
nurses' comfort with technology and working with
diverse populations.
Of concern is that the competencies with the lowest
scores—finance, strategic management, and perfor-
mance improvement—are critical for leading trans-
formation of the healthcare organization. In fact, a
comment from 1 participant highlighted a lack of
Figure 1. Nurse manager experience.

252 JONA  Vol. 49, No. 5  May 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Figure 2. Mean competency scores by domain.
interest in developing expertise in finance. Fortu-
nately, there were also nurse managers actively seek-
ing to develop business skills by attaining a master's
degree in business administration.
A 2nd area for concern is that it seems it takes
nurse managers more than 7 years to become profi-
cient. Nurse managers spoke of learning through
experience—both positive and negative—reinforcing
published evidence.12 Competence scores were lower
for those with 2 to 4 years of management experience
than those in their 1st 2 years of management. This
finding may reflect an overestimation of competence
among those with less than 2 years of experience. Al-
ternatively, because nurse managers seem to change
positions after 2 years, the reduced competence may
reflect the transition to a new nurse manager position,
Figure 3. Competency mean scores by years of nurse manager experience.
JONA  Vol. 49, No. 5  May 2019
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
delaying competency development. Amid calls to
transform the healthcare delivery system, we need
nurse managers to develop expertise at a much faster
pace than over the course of 7 to 10 years.
Solutions
The correlations among role preparation and compe-
tency shed some light on how to approach compe-
tency development for nurse managers. The findings
suggest that nurse managers learn primarily through
experience (r = 0.46). Even though the correlations
were half that of experience, there were significant
correlations between competency and graduate lead-
ership education as well. We included all types of
graduate leadership education in the analysis, sug-
gesting that any graduate degree in leadership will
253
 Table 3. Correlations Among Nurse Manager Competency and Role Preparation
Competency:
Science
Competency: science 1.00
Competency: art 0.89
Nurse manager 0.46
experience
Leadership certification 0.14
Nursing education 0.23
(highest degree)
Graduate education 0.29
(leadership)
All correlations significant at P < .05 except those that are in bold font.
increase nurse manager competence. According to
our participants, nurse managers may be waiting to
be advised to return to school. Increasing the compe-
tence of nurse managers begins with professional de-
velopment plans. Nurse executives need to assess the
quality of the onboarding and role development pro-
grams and processes in their organizations. Nurse
managers are asking for structured orientation and
mentor programs. Given that nurse managers are hired
despite a lack of leadership education and experience
for the role, it is logical that plans be established to help
them develop the necessary competencies. Transition
programs, fellowships, and coaching programs are vi-
able, cost-effective solutions to facilitate nurse manager
transition.19,26,27 Given that the most experienced nurse
managers are retiring, creating innovative nurse man-
ager coaching roles may be an effective strategy to delay
the loss of nurse manager wisdom and provide novice
nurse managers with an experienced coach. Structured
continuing education is an important competency de-
velopment strategy for developing frontline nurse
managers, but it varies in scope of content across pro-
grams. Graduate education provides a more uniform
and comprehensive approach to leadership prepara-
tion yet presents challenges as well.
The participant comments indicated that resources—
both time and money—are needed to return to school.
In particular, workload interferes with completing grad-
uate degrees. Based on these findings, nurse executives
need to examine the workload of nurse managers.
Do nurse managers have quality work-life balance?
There are some nurse managers seeking graduate de-
grees that would be of benefit to the organization, but
their workload interferes with their ability to complete
their coursework. In addition to time, nurse managers
may need financial support to return to school. They
may be repaying college loans for their undergraduate
education.28 Organizations may want to examine their
education policies in comparison to the tuition costs at
254
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Nursing Graduate
Competency: Nurse Manager Leadership Education Education
Art Experience Certification (Highest Degree) (Leadership)
1.00
0.41 1.00
0.12 0.17 1.00
0.16 0.16 0.08 1.00
0.21 0.22 0.05 0.76 1.00
local universities. Alternatively, explore opportuni-
ties to create an academic-practice partnership that
helps healthcare organizations meet educational needs
and schools of nursing meet faculty needs.
Perhaps the biggest hurdle in advancing education
of your nurse managers are the educational requirements
and expectations that are established in organizations.29
Nurse executives need to evaluate the education require-
ments for nurse manager positions. Graduate degrees
should be required either on hire or within a few years
of accepting a nurse manager position. Just as we are
advancing the education of our frontline nurses, we
should expect the same of nurse managers. The compe-
tencies needed for successful nurse manager perfor-
mance are not taught in undergraduate curriculum.
The competencies needed to lead a multimillion-
dollar corporation are taught at the graduate level.
Limitations
This study used a cross-sectional design to understand
nurse manager competency. This limits the ability to
draw inferences. Although causality cannot be estab-
lished, the study does provide insights from a large,
national sample of nurse managers.
Conclusion
The long-awaited retirements of nurses have begun,
creating a significant loss of leadership wisdom in
nursing. The current nurse manager workforce has
limited experience and competence. In the absence of
educational requirements and structured competency
development programs, nurse managers are learning
solely through experience. Nurse managers are respon-
sible for leading interprofessional teams, managing
multimillion-dollar budgets and transforming care
delivery models. Reliance on trial and error represents
an inefficient and insufficient strategy to develop this
vital segment of the healthcare workforce.
JONA  Vol. 49, No. 5  May 2019
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