Eloise Cathcart

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The new nurse manager survival guide, part III.

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Leading in a time of crisis.

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Aim: To illustrate through the interpretation of one representative nurse manager's narrative how the methodology of practice articulation gives language to the ways practical wisdom develops in leadership practice and facilitates learning. Background: Patricia Benner's corpus of research has demonstrated that reflection on clinical narratives comes closer than other pedagogical methods to replicating and enhancing the experiential learning required for the development of practical wisdom. Method: Using Benner's methodology of practice articulation, 91 nurse managers wrote and read to a peer group a narrative of their lived experience in the role. The groups interpreted the narratives to extract the skilled knowledge and ethics embedded in the practice of the nurse manager authors. One narrative was chosen for this paper because it is a particularly clear exemplar of how practical wisdom develops in nurse manager practice. Results: Articulating and reflecting on experiential learning led to an understanding of how practical wisdom developed in one nurse manager's practice. Conclusion: Interpretation of the narrative of one nurse manager illustrated how reflection on a complex ethical dilemma was a source of character development for the individual and the peer group. Implications for nursing management: Describing and interpreting how practical wisdom develops for individual nurse managers can be a source of learning for the narrative author and other role incumbents who need to make sound decisions and take prudent action in ethically challenging situations.

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An important domain that emerged from the interpretation of 91 nurse manager (NM) narratives was achieving the right relationship between a NM and a recalcitrant staff member. This article depicts the qualitative distinctions in 2 stages of NM practice to show the importance of reflection on experiential learning in the development of expertise. This work confirms that NM development is more complex than teaching a curriculum of business and management theory and should include teaching for mastery of the skilled know-how of clinical leadership practice and formation of the person as manager.

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The discipline of nursing continues to evolve in keeping with the dramatic expansion of scientific knowledge, technology, and a concomitant increase in complexity of patient care in all practice settings. Changing patient demographics require complex planning for co-morbidities associated with chronic diseases and life-saving advances that have altered mortality in ways never before imagined. These changes in practice, coupled with findings from sophisticated nursing research and the continuous development of new nursing knowledge, call for realignments of the relationships among academic faculty in schools of nursing, advanced practice nurse administrators, and staff nurses at the forefront of practice. This article offers a model designed to bridge the gaps among academic settings, administrative offices and the euphemistic "bedsides" where staff nurses practice. Here we describe the nurse attending model in place at the New York University Langone Medical Center (NYULMC) and provide qualitative data that support progress in our work.

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Aim: To articulate the experientially acquired knowledge, skill and ethics embedded in nurse manager practice and describe the ways in which they were developed. Background: The role of the nurse manager is usually described in lists of competencies, talents and traits which fail to capture the experience-based judgment and practical knowledge in this pivotal organizational role. Method: Using Benner's methodology of practice articulation, 32 nurse managers wrote and interpreted first person narratives of their practice. The experience level of the group ranged from new nurse managers to those with more than 10 years' role tenure. The seminars were facilitated by a seasoned nurse executive and nurse manager with expertise in narrative interpretation. Results: Interpretation of the paradigm case of one nurse manager suggests that complex leadership challenges can be a source of significant experiential learning for the individual and for the group. Conclusions: Articulating and reflecting on experiential learning elucidates the skilled knowledge and judgment embedded in nurse manager practice which cannot be accessed in any other way. Implications for nursing management: Articulating the practical knowledge which is necessary for effective nurse manager practice can hasten the development of role incumbents.

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There is a real danger that measurable tasks and procedures can be misconstrued for nursing practice in contemporary healthcare organizations focused on the measurement of quality, safety, and productivity. This study uses the work of Patricia Benner to address the complex nature of nursing practice and discusses why the chief nursing officer must create an environment within the organization for the practice to be fully lived out if he or she is to be successful as the leader of the discipline.