NUR 5094 Module 1 Administrator Practicum Plan Example

A Semester Beside the Director of Medical Nursing: Six Objectives Tied to Program Outcomes and Executive Competencies, and a First Look at Turnover on Three Medical Units

Student Name

American College of Education

NUR5094: Capstone Practicum Experience for Role of the Nurse Administrator

Module 1 Assignment

Instructor Name

January 16, 2029

The Organization and the Mentor

The practicum takes place in a composite 240-bed nonprofit community hospital in a suburban county, part of a four-hospital regional system. Its division of nursing employs about 620 registered nurses. The medical service line comprises three inpatient units with 90 beds in total, a 32-bed general medical unit, a 30-bed unit for patients with renal and endocrine conditions and a 28-bed unit that combines medical and oncology care, staffed by 128 registered nurses, 41 nursing assistants and three nurse managers.

The mentor is the director of medical nursing, who holds a master's degree in nursing administration, is board certified as a nurse executive and has led the service line for six years. She reports to the chief nursing officer, oversees the three nurse managers and a budget of about 19 million dollars, and sits on the hospital's operations, quality and workforce committees. She has agreed to meet with the author weekly, to include the author in her meetings except where personnel matters are discussed, and to supervise a project addressing a problem she considers a priority for the service line. The author works as a charge nurse on the general medical unit, and the practicum hours will be separate from the author's scheduled shifts.

Objectives

The practicum has six objectives, each tied to one of the MSN Nurse Administrator outcomes and to one of the five domains in the national framework of executive competencies for nurse leaders, which covers communicating and building relationships, understanding the healthcare environment, leading, professional conduct and business management (American Organization of Nurse Executives [AONE], 2015).

First, analyze the medical service line's workforce, quality and financial data and present a summary to the mentor, mapped to the program outcome on the healthcare environment and the business skills domain. Second, design, implement and evaluate a leadership project that addresses a priority problem for the service line, with measurable targets and a budget impact, mapped to the leadership outcome and the leadership domain. Third, participate in the service line's operating budget review and explain one variance to the mentor, mapped to the financial management outcome and the business skills domain. Fourth, attend at least four system-level committee meetings with the mentor and write a brief analysis of how decisions are made at the executive level, mapped to the communication outcome and the relationship building domain. Fifth, lead at least one meeting of the three nurse managers on the project, mapped to the same outcome and domain. Sixth, rate the author's own performance on the executive competencies in the first week and again in the last, and keep a reflective journal throughout, mapped to the professionalism domain.

Activities, Evidence and Timeline

The semester divides into four stretches. The first three weeks are for learning the service line: its data, its committees and the organizational assessment that Module 2 reports. Weeks four through six produce the project proposal, which goes first to the mentor, then to the three nurse managers, and is revised after both conversations. Implementation runs from week seven to week twelve, the same period in which the quarterly budget review and most of the committee meetings fall. The final three weeks are reserved for measuring results, writing the report for the executive team and closing the practicum with the second self-assessment.

Evidence will be collected for each objective: the data summary and the mentor's feedback for the first; the proposal, data and final report for the second; a written variance explanation for the third; the committee analysis for the fourth; the managers' meeting agenda and notes for the fifth; and the self-assessments and journal for the sixth.

What the Mentor Expects

In the first meeting, the mentor added expectations of her own that shaped the plan. She asked that the project produce something the service line would keep after the practicum ends, not a report that would sit in a folder, which is why the second objective requires a budget impact and an evaluation her managers can repeat. She asked the author to present data to the nurse managers rather than to her alone, because a change in the service line would depend on them, and because presenting to experienced managers as a charge nurse would be the practicum's most useful discomfort. She also asked the author to shadow her through one full budget cycle meeting with the finance department, which is where, in her words, most nursing plans are either funded or quietly abandoned. Finally, she set a standard for the committee analysis: it should describe not only what was decided but who spoke, who stayed silent and what was decided before the meeting began. The author accepted each expectation and folded it into the objectives above. Each expectation also points to a gap the author recognizes, since a charge nurse's work rarely involves budgets, executives or persuading peers who outrank them.

Confidentiality and Ethics

An administrator practicum exposes the student to information that is confidential in ways a clinical practicum is not: personnel matters, salaries, budgets and strategic plans. The author will sign the hospital's confidentiality agreement for administrative trainees, will use only aggregate workforce data without names, will not attend discussions of individual employees' performance or discipline and will not share financial information outside the practicum. Because the author is also an employee of one of the units, the project will be designed so that the author does not collect identifiable information from colleagues; where individual input is needed, it will be gathered by the managers or through anonymous methods. The hospital's nursing research council will be asked whether the project requires review, and its determination will be followed.

A Preliminary Project Focus

During the opening days of the practicum, the mentor walked the author through the service line's workforce dashboard. Over the past twelve months, registered nurse turnover on the three medical units averaged 24%, compared with 15% across the hospital, and 19 of the 31 nurses who left had less than three years of service on their unit. The units spent about 1.9 million dollars on travel nurses during the year. Turnover is costly and consequential; a comprehensive review of the nurse turnover literature found that it carries substantial costs to organizations and is associated with effects on the remaining staff and on patient care, and that its causes include management style, workload and opportunities for development (Hayes et al., 2012). Exit interviews on the medical units, which the mentor reviewed with the author in aggregate, cited scheduling, relationships with managers and workload most often. By the time an exit interview is held, the nurse has already decided; the question the project will ask is how to hear those reasons while the nurse is still here. One approach described in the recent literature is the stay interview, a structured conversation in which a manager asks a current employee what keeps them and what might lead them to leave. In one hospital, leaders completed 75 stay interviews on two units and learned that unit culture, peers and scheduling kept nurses in their positions while salary, development and travel opportunities drew them away (Snyder et al., 2023). Module 2 will assess the medical units' turnover in detail before a project is chosen.

References

American Organization of Nurse Executives. (2015). AONE nurse executive competencies.

Hayes, L. J., O'Brien-Pallas, L., Duffield, C., Shamian, J., Buchan, J., Hughes, F., Spence Laschinger, H. K., & North, N. (2012). Nurse turnover: A literature review: An update. International Journal of Nursing Studies, 49(7), 887-905. https://doi.org/10.1016/j.ijnurstu.2011.10.001

Snyder, A., Whiteman, K., DiCuccio, M., Swanson-Biearman, B., & Stephens, K. (2023). Why they stay and why they leave: Stay interviews with registered nurses to hear what matters the most. Journal of Nursing Administration, 53(3), 154-160. https://doi.org/10.1097/NNA.0000000000001261