Week 2 discussion

In each discussion question response, provide a substantive response that illustrates a well-reasoned and thoughtful response; is factually correct with relevant scholarly citations, references, and examples that demonstrate a clear connection to the readings.

Discussion Question 1

Answer the following:

    Coaching and mentoring should be a core competency of nurses prepared at the graduate level. Do you agree or disagree with this statement? Defend your response.

    Based on your graduate specialization, identify one coaching activity that you can do in this advanced practice role. What strategies would you employ for this activity?

    Describe one mentoring activity you might complete with a mentor that would help you to acclimate to your new advance practice role. Should this activity be structured or unstructured?

Discussion Question 2

Consultation is a core competency of graduate nursing. Answer the following:

    Differentiate consultation from supervision?

    Are consultation and collaboration synonymous? Defend your response.

    Give an example on how you have seen the consultation competency practiced in your current nursing area. Explain if the practice followed the graduate competency criteria.

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Assigned course readings references:

Domains and Competencies

Nursing has come a long way and has now evolved as a science-based profession as well as an art. One of the challenges in nursing is the development of a common language about who you are and what you do. Merriam-Webster online dictionary (2009) defines "domain" as "a sphere of knowledge, influence, or activity." There are domains in practice and domains relative to competencies. Review the following:

Competencies are the skills, abilities, and knowledge required for performing the functions of the roles in advanced nursing practice. These competencies further delineate the APRN role and help differentiate the APRN practice from registered nurse (RN) and specialty RN practices and other advance nursing roles.         

Hamric’s Model Direct Care,Guidance/ Coaching &Consultation

This week, you will focus on six of Hamric’s Model (2013) of core competencies that are inherent in the APRN role, but may apply to other advance practice roles.

Direct Care:  The central competency of advanced practice nursing is direct care, regardless of the specific APRN role. APRNs are currently providing direct health care services that affect patients' health care outcomes positively and that are qualitatively different from those provided by other health care professionals. Of importance, these services are valued by the public and are cost-effective.

Six characteristics comprise APN direct care:

i.

i.

i. Use of a holistic perspective

ii. Formation of therapeutic partnerships with patients

iii. Expert clinical performance

iv. Use of reflective practice

v. Use of evidence as a guide to practice

vi. Use of diverse approaches to health and illness management 

Guidance and coaching by APNs have been conceptualized as a complex, dynamic, collaborative, and holistic interpersonal process mediated by the APN-patient relationship and the APN's self-reflective skills (Clarke &Spross, 1996; Spross, Clarke, & Beauregard, 2000; Spross, 2009). The APN guidance and coaching model includes patient education, APN guidance, anticipatory guidance, and a revised definition of APN coaching (to distinguish it from professional coaching) (Hamric, p. 185).

Consultation is the third Core competency (Hamric, p. 213). Consultation is a role function used by APNs to offer clinical expertise to other colleagues, as a specialty consultant, or to seek additional information to enhance their own practice.. Essential core skills for consultation, as identified by Carter and Berlin (2007), are as follows:

 (1) Establishing and maintaining good rapport;

 (2) Structuring the consultation;

 (3) Obtaining and gathering relevant information;

 (4) Prioritizing;

 (5) Using clinical reasoning and judgment;

 (6) Providing information; and

 (7) Developing a management plan.

Hamric’s Model Evidence Based, Leadership & Collaboration

Continuing Hamric’s Model of competencies:

Evidence-based practice (EBP) utilization is a core competency supporting AP and is defined as the conscientious, explicit, and judicious use of current best research-based evidence when making decisions about the care of individual patients (Sackett et al., 1996). It has evolved into a dominant approach for clinical decision making and a core competency for advanced practice nursing.  Although components tend to overlap, three levels of this core competency can be identified distinctly: (1) interpretation and use of EBP principles in individual clinical decision making; (2) interpretation and use of EBP principles to determine policies for patient care; and (3) use of EBP to evaluate clinical practice. Evidence-based practice is based on a four-step process: (1) formulation of a clinical question; (2) identification and retrieval of pertinent research findings based on literature review; (3) extraction and critical appraisal of data from pertinent studies; and (4) clinical decision-making based on the results of this process (Hamric, p. 237).

Leadership is a core competency of advanced practice nursing. Our conceptualization of APN leadership involves three distinct defining characteristics: mentoring, innovation, and activism (Hamric, p. 266). Leadership will be expanded upon in the next section.

Collaboration competency is important in that it is fundamental to successful APN practice. The presence or absence of collaborative relationships affects patient care, including the cost and quality of care. Patients assume that their health care providers communicate and collaborate effectively; thus, patient dissatisfaction with care, unsatisfactory clinical outcomes, and clinician frustration can often be traced to a failure to collaborate with other members of the health care team (Hamric, p. 299).

Leadership in AP

Leadership in Advance Practice and in Health Systems

Leadership, one of the core competencies, deserves further exploration and discovery. Leadership is both a formal and an informal aspect of advance practice. However, nurses in advance practice are expected to exhibit leadership qualities daily.

Contemporary definitions of leadership generally fit into one of two categories, transformational (Vance & Larson, 2002) or situational (Grohar-Murray &DiCroce, 1992).

Transformation Leadership

Barker (1994) has defined the term transformational leadership as a process whereby “the purposes of the leader and follower become fused, creating unity, wholeness, and a collective purpose” (p. 83). Transformational leadership can lead to changes in values, attitudes, perceptions, and/or behaviors on the part of the leader and the follower and lays the groundwork for further positive change. Thus, transformational leadership occurs when people interact in ways that inspire higher levels of motivation and morality among participants (Hamric, p. 272). Successful transformational leadership is relational, driven by a common goal or purpose, and satisfies the needs of leader and follower. It is the leadership style often associated with effective change agents (Hamric, p. 272).

Situational Leadership is defined as the interaction between an individual's leadership style and the features of the environment or situation in which he/she is operating. Leadership styles are not fixed and may vary based on the environment. Situational leadership depends on particular circumstances, with leaders and followers assuming interchangeable roles according to Hamric (p, 272).