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Doctor of Nursing Practice Scholarly Projects Student Research & Creative Work
Spring 4-29-2017
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Tamara Montgomery
[email protected]
Follow this and additional works at: https://digitalcommons.otterbein.edu/stu_doc
Part of the Nursing Administration Commons, and the Pediatric Nursing Commons
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Montgomery, Tamara, "Staff Nurse Perception of Professional Role Modeling for Student Nurses in the
Clinical Learning Environment" (2017). Doctor of Nursing Practice Scholarly Projects. 25.
https://digitalcommons.otterbein.edu/stu_doc/25
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Running head: STAFF NURSE PERCEPTION OF PROFESSIONAL ROLE MODELING 1
Staff Nurse Perception of Professional Role Modeling for Student Nurses
in the Clinical Learning Environment
Tamara Montgomery, MS
Doctor of Nursing Practice Final Scholarly Project
In Partial Fulfillment of the Requirements for the Degree
Doctor of Nursing Practice
Otterbein University
2017
Final Project Committee:
___________________________________________________ ___________
Dr. Jacqueline Haverkamp, DNP, MBA, DNP Committee Chair Date
___________________________________________________ ___________
Dr. John Chovan, PhD, DNP Date
___________________________________________________ ___________
Cheryl Boyd PhD, RN Community Member Date
Running head: STAFF NURSE PERCEPTION OF PROFESSIONAL ROLE MODELING 2
Executive Summary
Acute care settings continue to be the primary setting for undergraduate nursing
education clinical experiences. Staff nurses in acute care settings are expected to provide
nursing care with pre-licensure nursing students at their side (even though there are little to no
incentives for staff nurses to provide mentoring leadership), which most often takes the form of
professional role modeling. In addition, there is no clear evaluative expectation that motivates
staff nurses to provide contextual role modeling. Without stated expectations, staff nurse
perception of the significance of role modeling for pre-licensure non-precepted nursing students
may be deficient.
Because fifty-six percent of registered nurses are employed in hospital settings, the
purpose of this DNP project was to assess staff nurse perception of professional role modeling
for pre-licensure nursing students in the hospital-based clinical learning environment.
Information gleaned was used to create a tool to be used by nurse administrators to evaluate staff
nurses who work with non-precepted nursing student that includes role modeling expectations.
A mixed method design was used to explore staff nurse perception of professional
role modeling in the clinical learning environment. A convenience sample of staff registered
nurses (RNs) employed on a number of medical and surgical inpatient units at a Midwest
pediatric hospital was the target population.
A 10-item questionnaire containing a 5-point Likert type scale was accessible using an
online survey platform to determine the participant’s perception of each statement about
professional role modeling. Participants also had the opportunity to comment on the statements
to offer further insight. Analysis of the data resulted in descriptive and inferential statistics of
quantitative data. Content analysis was used to interpret qualitative data.
Running head: STAFF NURSE PERCEPTION OF PROFESSIONAL ROLE MODELING 3
Staff Nurse Perception of Professional Role Modeling for Student Nurses
In the Clinical Learning Environment
Problem Identification
From the mandates of the Affordable Care Act to the recommendation of the Institute of
Medicine Report: The Future of Nursing, change is the new norm more than ever (Institute of
Medicine [IOM], 2011). The IOM report (IOM, 2011) specifically recommends, as follows, that
nurses function at their fullest potential and all nurses must develop leadership related-
competencies through professional growth which should be embedded throughout nursing
education:
“1) Nurses should practice to the full extent of their education and training; 2) Leadership
competencies need to be imbedded throughout nursing education, leadership
development and mentoring programs and need to be available for nurses at all levels,
and a culture that promotes and values leadership needs to be fostered.” (pp.4;8)
The American Association of Colleges of Nursing (AACN, n.d.) defines working at one’s fullest
potential in nursing and in the definition, includes mentoring those in clinical settings who are
less experienced, such as student nurses. Staff nurses, however, are not incented to provide
mentoring leadership, a form of role modeling conducted in contextual learning environments
(clinical). I addition, no clear evaluation processes motivates staff nurses to provide contextual
education for student nurses in the clinical learning environment. Without stated expectations
staff nurse perception of the significance of their need to role model for student nurses could be
deficient. The problem, therefore, is that staff nurses have little to no incentives to provide
contextual learning in the form of role modeling and no clear evaluative expectations for role
Running head: STAFF NURSE PERCEPTION OF PROFESSIONAL ROLE MODELING 4
modeling. The PICOT question is: What are staff nurse perceptions of professional role
modeling when working with pre-licensure nursing students.
Significance of the Problem
Acute care settings continue to be the primary setting for undergraduate nursing
education clinical experiences. The clinical setting is where identification of working to ones’
full potential begins (Billings & Halstead, 2012, p. 314). Staff nurses in acute care settings are
expected to provide nursing care with undergraduate students paired with them. Typically,
students interact with staff nurses providing care alongside the patient’s assigned nurse,
concentrating on clinical skills without particular attention given to systems thinking or the
development of other leadership traits (Fletcher & Meyer, 2016, p. 122).
Noting this fact and understanding that fifty-six percent of nurses are employed in
hospital settings (Budden, Zhong, Moultom, & Cimiotti, 2013), this nurse executive student
focused the scholarly project on gathering staff nurse perceptions on what it means to be a
professional role model for students in the clinical learning environment within an acute care
setting at Nationwide Children’s Hospital. Information gleaned was used to develop an
evaluative staff nurse tool to be used by nurse administrators that includes role modeling
expectations of the staff nurse. Ongoing use of this evaluative tool should promote
transformational leadership, an essential component of Magnet designation (American Nurses
Credentialing Center, 2017)
Clinical Needs Assessment
Staff nurse role modeling can have a direct effect on the student experience
(Brammer, 2006, p. 971). Since the literature provides a variety of clinical experience models
evaluation should be conducted by nurse administrators of staff nurses’ role modeling behaviors
Running head: STAFF NURSE PERCEPTION OF PROFESSIONAL ROLE MODELING 5
exhibited with nursing students in hopes of creating a culture that values and promotes
professional role modeling and enhances student learning (Patrick, Spence Laschinger, Wong, &
Finegan, 2011).
An effective tool to evaluate staff nurse perception of role modeling for student nurses
would be developed using the Clinical Learning Environment, Supervision and Nurse Teacher
(CLES+T) scale (Saarikoski, Isoaho, Leino-Kilpi, & Warne, 2005). Originally used to evaluate
student nurses’ and clinical teachers’ perceptions of effective clinical learning environments, the
tool could be adapted to determine what staff nurses perceive as effective components of role
modeling for students in the clinical learning environment.
To determine if nurse administrators would support the DNP project, Unit Managers of
four medical and surgical acute care units were contacted: Kathy Mohlman RN, MS, Jamie
Hillier RN MS, Pamela Creech RN MS, Rhonda Humphrey RN MS as well as the Director of
Professional Development, Cheryl Boyd RN, PhD, at Nationwide Children’s Hospital. The plan
to conduct a survey about professional role modeling and using the information learned to
develop a tool to be used by nurse administrators to evaluate staff nurse behaviors of role
modeling for pre-licensure nurses was presented. All believed that identified role modeling
behaviors could be imbedded in to the staff nurse evaluation process.
Literature Review
Clinical Learning Environment Tools
Evaluation of the clinical learning environment using validated tools is supported in the
nursing literature (Dunn and Burnett, 1995; Saarikoski, Isoaha, Leino-Kilpi and Warne, 2005;
Chan, 2003). Tools developed by afore-mentioned authors were used to evaluate the pre-
Running head: STAFF NURSE PERCEPTION OF PROFESSIONAL ROLE MODELING 6
licensure nursing student perceptions of the clinical learning environment. Dunn and Burnett
(1995) identified 5 sub-dimensions within their instrument. These included staff-student
relationships, nurse manager commitment, patient relationships, interpersonal relationships and
student satisfaction (Dunn & Burnett, 1995). The tool Chan (2003) used to evaluate pre-licensure
nursing students’ perceptions of the clinical learning environment described domains. Domains
of involvement with the highest degree of importance are by the student are, students’ ability to
actively participate in hospital activities and personalization, which focuses on students’ ability
to interact with staff and feel their welfare is important. The Clinical Learning Environment and
Supervision Scale instrument created by Saarikoski et al. (2005) supports the subscales identified
by Dunn and Burnett (1995) and the domains described by Chan (2003) but emphasized that
leadership from both staff and nurse managers were the most important factors perceived by pre-
licensure nursing students in determining satisfaction with the clinical learning environment.
More recently, an integrative review published by Hooven (2014) included the above mentioned
tools as well as two others. Hooven’s conclusion also supports that staff nurses have an impact
on the clinical learning environment and their elicited perceptions on what learning is important
to convey during students’ clinical experiences would be valuable.
Overall, the tools found in the literature to evaluate the clinical learning environment of
pre-licensure students are largely based on student perceptions and include themes related to
staff-student relationships, nurse manager involvement, student feelings of inclusion,
environment/attitudes, faculty involvement and student feedback. The results of the surveys
conclude that student perceptions are directly related to interactions with the staff nurse and
effect their perceptions of the unit, nurse and the system as a whole. While all of the tools asked
students’ their perceptions of clinical learning experiences, including the impact staff nurses had
Running head: STAFF NURSE PERCEPTION OF PROFESSIONAL ROLE MODELING 7
on learning, none inquired from staff nurses their perception of the effect professional role
modeling had on students’ clinical learning environments. Although assessment tools to validate
staff nurses’ effect on the clinical learning environment and student nurse learning as perceived
by pre-licensure nursing students are available and well documented, staff nurse perception of
their effect on the clinical learning environment is nominal.
The next part of the literature search used key terms: role modeling, staff nurse
perceptions, leadership and professionalism, and incentives.
Role modeling
Role modeling can be described as being a “positive source of influence to aspirants
through enhanced motivation or skill attainment” (Morgenroth, Peters, & Ryan, 2015, p. 468).
The staff nurse as a role model for pre-licensure nursing students has been in place since the
early years of nursing schools and is currently the most common clinical instructional
relationship in nursing education (Billings & Halstead, 2012). Billings and Halstead (2012)
indicate that faculty to student ratio in the clinical setting is 1:8 to 1:10. The ratio, used for at
least the past 30 years, necessitates staff nurses to role model professionalism and leadership
activities on the clinical unit when the faculty is not available due to being with another student.
Clinical instruction provided on acute care units decreases the ability of instructors to be readily
available to students. The staff nurse is left to role model contextual learning for the student.
Staff nurse perceptions related to expectations of role modeling for pre-licensure nursing
students can “impede or promote student learning” (Brammer, 2006, p. 971). These perceptions
can lead to nurses feeling the strain of dealing with students, not in formal preceptor contracts, in
addition to their patient assignment. Students assigned to a specific patient can also slow down
Running head: STAFF NURSE PERCEPTION OF PROFESSIONAL ROLE MODELING 8
the care to be provided by the staff nurse, as well as require the staff nurse to “balance care and
student learning” (Veltri, 2014, p. S85).
Role modeling professional and leadership qualities while in the clinical setting is well
described in the literature. Perry suggests that “outstanding role models are also exemplary
nurses” (Perry, 2009, p. 39). Role modeling is a choice that nurses make each time they are
asked to work with students assigned to patients on their unit. Perry (2009) identified four
behaviors that are performed by exemplary clinical nurses when role modeling. They include: 1)
attending to the little things 2) making connections 3) purposely modeling effective behaviors
and 4) affirming the value of others (Perry, 2009, p. 39-40). Perry’s (2009) study involved only
exemplary nurses as they were identified by their peers. Both qualitative data and narrative
comments identify numerous factors that influence role modeling by the staff nurse (Matsumura,
Callister, Plamer, Cox, & Larsen, 2004, p. 297). Qualitative data support the following factors
that affect the staff nurse perceptions of students in the clinical environment: “1) student
preparation 2) student qualities 3) level of students on the unit 4) role of the instructor and 5)
opportunities for staff nurse growth” (Matsumura et al., 2004, p. 299-300). The study describes
some of these issues both positively and negatively. The literature indicates ambivalence in
choosing to role model professional and leadership qualities by staff nurses. The ambivalence
included “staff feels insecure when challenged by students” but also “allows opportunities for
mentoring”. Staff stated that “students lighten the load” but “take too much time of staff”
(Matsumura et al., 2004, p. 301). Ambivalence may be compounded when students are being
allocated to the staff nurses’ patient assignment for the day. With little or no incentives attached
to the task, the ambivalence could be enhanced and the clinical learning environment indirectly
affected.
Running head: STAFF NURSE PERCEPTION OF PROFESSIONAL ROLE MODELING 9
Role modeling clinical leadership at the nurse manager level “has a direct positive effect
on the staff nurse ability to also role model” (Patrick, Spence Laschinger, Wong, & Finegan,
2011, p. 458). The study also reported that the impact of nurse manager leadership is more
indirect than direct on staff nurse outcomes. Students in the clinical learning environment have
the ability to observe all clinical activities occurring in the environment. This indirect impact
could have very positive or detrimental effects on student learning. Perry (2009) identified that
exemplary nurses were also exemplary role models. Students observing in these situations would
most likely have positive clinical learning experience. Keeling & Templeman (2013, p. 20)
report that “student nurses’ observation of role modeling as negative or positive can both have an
effect on their own personal view of nursing”. Role modeling leadership in the clinical
environment is reported in the literature as directly and indirectly as well as positively and
negatively effecting student learning. Role modeling by staff nurses is described within the
literature but specific expectations are not identified. It is expected that staff nurses will role
model professionalism and leadership qualities for pre-licensure student nurses but these
qualities are not clearly identified for the staff nurse. The literature also supports that many
variables can affect the staff nurse perception of role modeling.
Staff Nurse Perceptions
Perceptions of staff nurses related to role modeling are most frequently found in literature
associated with precepting. Research exploring preceptor’s perception of teaching nursing
students revealed that they felt “ill prepared educationally for the teaching role and wanted to be
recognized for the time and effort required to precept” (De Fulvio, Stichler, & Gallo, 2015, p.
21). Other findings reported that “staff nurses are aware that they need to include the students,
but pressures related to workload and lack of clarity of their role with the student were only a
