AbstractThe role immersion practicum is an instrument to evaluate readiness for a position in nursing administration as it combines theory and knowledge to real-life practice. The immersion experience was developed based on a self-assessment of leadership qualities within the American Nurses Association’s (ANA) Nursing Administration Scope and Standards of Practice. Aligning these goals with ANA (2009) standards allowed for the conceptualization of goals as an immersion practicum experience. Roy’s adaptation model and the transformational leadership theory supported my activities to meet outcome criteria of the identified ANA (2009) standards and provided guidance to overcome issues, concerns, and challenges experienced during the role immersion. An integral part of the role immersion practicum was guidance from my preceptor Joan Rikli, Director of the Neonatal Intensive Care Unit and Pediatric Services at Helen DeVos Children’s Hospital in Grand Rapids, Michigan. Formative and summative evaluation and self-reflection of outcomes detail my achievement of Ferris State University’s MSN program objectives. Keywords: role immersion, immersion practicum Immersion Practicum Synthesis The purpose of this synthesis is to draw insightful connections in the work I completed within my immersion practicum in order to provide evidence of completion of Ferris State University’s MSN program objectives. The information detailed shows the culmination of my efforts throughout my educational development with a role immersion experience. An immersion practicum overview discusses my activities to meet self-identified American Nurses Association (ANA) (2009) standards. Issues, concerns, and challenges encountered within my role immersion are also discussed along with methods I utilized to overcome these barriers. These methods are based on research and consultation with my preceptor. Transformational leadership and nursing theory support is evident in all aspects of the immersion practicum. A formative and summative evaluation process reflects my achievement of the practicum objectives. Immersion Practicum Overview Four ANA (2009) standards were identified through self-reflection prior to the implementation of the immersion practicum. These four standards were standard 2: Identify Issues, Problem, or Trends, standard 3: Outcomes Identification, standard 14: Resource Utilization, and standard 15: Leadership (ANA, 2009). From the self-assessment a role immersion plan was developed in conjunction with my preceptor, Joan Rikli. Each standard has two outcome criteria to measure my achievement of the identified ANA (2009) standards. These outcome criteria are explained in detail in appendix A. The outcome criteria were supported with activities to achieve practicum goals as well as necessary resources to complete these activities and a timeline to set expectations of completion. A total of eleven goals were created to complete practicum objectives. Each goal is connected to an ANA (2009) standard that I identified as being deficient in. Appendix A displays the details of these activities, resources, and timeline within my immersion practicum plan. To achieve the eleven practicum activities I completed three projects. The first project involved the creation of a swim lane to improve staff compliance in providing patients with daily hygiene as transformational leaders influence activities that highly impact quality of care and patient safety (Jones, Polancich, Steaban, Feistritzer, 2017). This included a staff education PowerPoint, creation of a problem statement, daily audit tool with associated standard work, identification of leading and lagging metrics, Pareto chart to discuss barriers to success with staff, and a Kaizen newspaper to share strategies to overcome barriers. Appendices B and C detail the work I completed in the creation of this swim lane. In order to measure success of the implementation of this swim lane I created a Gate chart, shown in appendix D, which was then shared with the director in weekly meetings. The creation of this swim lane was based on review of “The Lean Practitioners Handbook” (Eaton, 2013). A leading metric of daily hygiene compliance was used in all areas that implemented the daily hygiene swim lane as shown in appendix C. Lagging metrics included organizational National Database of Nursing Quality Indicators (NDNQIs) related to central line associated blood stream infections (CLABSIs) and catheter associated urinary tract infections (CAUTIs), overall Likelihood to Recommended scores (LTR) obtained from Spectrum Health’s Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey results, Peripheral Vascular Bypass Surgery Infection rates (PVBSI), and surgical site infection readmission rates. The activities completed through the creation of a swim lane enabled me to reflect personal and professional characteristics that are required of a transformational leader; to create a vision of the future and to engage others to accomplish organizational goals and objectives (Herman, Gish, & Rosenblum, 2015). Data shown in appendices C and D demonstrates an improvement in these leading metrics related to compliance with daily hygiene. Unfortunately due to time constraints lagging metrics do not yet reflect the work completed within this project. Areas that have implemented this swim lane continue to work to improve upon these metrics after my completion of the role immersion practicum. The second project I completed was becoming a member of the Cardio-vascular Conference Planning Committee (CVCPC). I became involved with this committee due to decreased staff satisfaction scores, called GLINT, surrounding educational opportunities within the organization. My involvement in this committee began a year ago with the foresight that I would need to complete an immersion experience as part of Ferris State University’s MSN program outcomes. The CVCPC meets once a month to plan for a yearly conference that is held to educate staff on emerging cardiac and vascular topics. Through this conference attendees are able to earn continuing education units (CEUs). The CVCPC decides on a spending budget, location for the conference, speakers, meal planning, and vendors. Each member was assigned a specific role. For the previous conference held in February I was in charge of the creation of CEUs. Prior to this I had no experience in writing CEUs and to overcome this I worked closely with a committee member who has experience in writing CEUs in order to complete this portion of the planning process. The work completed by the CVCPC allowed attendees to earn eight CEUs at the two day 2019 Cardio-vascular Conference and will hopefully be reflected in the next GLINT survey. Appendix E details a copy of the brochure that the CVCPC and I created. My involvement within the committee continues as it has been a great learning opportunity. We are beginning the planning process for the 2020 Cardio-vascular Conference. The third project I completed was a series of activities to increase my understanding of organizational finances. The first of these activities was to review a program that Spectrum Health utilizes for financial planning named “StrataJazz”. My preceptor and I reviewed equipment requests for each of her areas and then submitted these requests along with justification for purchase. These requests then went to a review panel and were approved based on a weighted scale. To further my knowledge of organizational finances I also attended an educational meeting to learn about a new program that the organization is beginning to implement named “ActionOI”. This program allows similar areas within different organizations to compare many different aspects of how each area functions. One example of this is the comparison of how the area in which I work performs to other organizations in relation to meeting budgeted hours per patient day (HPPD). The goal of the implementation of this program is to provide a tool in which an organization can improve upon lean methodologies. The final activity I participated in was a conference to learn about changes to my organization’s fiscal year and budgeting methods. Currently the organization’s fiscal year begins July 1st but will be changing to January 1st. Current budgeting standards are to create a budget based on yearly forecasting, this creates the need to adjust the budget throughout the year. The purpose of this conference was to educate leaders on a change in organization strategy to a monthly budgeting process. This will allow the organization to practice lean methodologies. Due to the fiscal year change the organization needs to create a “stub” budget from July 1st through December 31st and requires leaders to prepare their areas for this budget. Overcoming Issues, Concerns, and Challenges In each project I encountered issues, concerns, and challenges. Research and consultation were the primary tools I used to overcome these barriers to success. The creation and implementation of a swim lane was a challenge due to lack of experience prior to beginning the immersion practicum. In order to overcome this challenge I gained knowledge of the purpose and practice of the utilization of a swim lane to meet organizational objectives. Jun, Ward, Morris, & Clarkson (2009) describe that a swim lane is an activity diagram “designed to show a sequence of activities with a clear role definition by arranging activities according to responsibilities” (p. 220). While this process was effective in disseminating results from leading and lagging metrics to staff, staff buy-in was a significant barrier to overcome. I utilized consultation with my preceptor, transformational leadership methods, and understanding of the change process as described by Roy’s (1970) adaptation model to overcome this issue. Prior to implementation I gained insight from my preceptor on what she expected to be barriers to success as well as strategies to overcome these barriers. An education PowerPoint as shown in appendix B was developed as a transformational leadership tool as it allowed me to be “proactive and convince followers to strive for higher performance”, provided a framework to influence those around me, and to round with purpose (Merrill, 2015, p. 319, Burns, 1978, & Sherrod, Brown, Vroom, & Sullivan, 2012). The education PowerPoint also fostered open communication horizontally and vertically, provided inspiration, and enthusiasm amongst staff for the implementation of this change (ANA, 2009). Transformational leaders monitor and ensure compliance with changes in the workplace by utilizing the six principles of a lean culture; these principles are creating an attitude of continuous improvement, value-creating, unity of purpose, respect for the people who do the work, creating visual tools, and a flexible regimen (Huntington & Goodyear, 2018). These principles were reflected in my practicum through daily rounding and audits, in the moment reinforcement of expectations, and facilitation of Managing for Daily Improvement (MDI) meetings to create end-user ownership of outcomes by involving bedside staff as reflected in appendix C. As a member of the CVCPC I also encountered issues, problems, and challenges. A unique challenge for this year’s conference was decreased staff awareness. The Cardio-vascular conference had not been held for the previous two years because of the implementation of a new electronic health record within the organization. This was compounded by staff turnover and lack of awareness of previous conferences. To create awareness the CVCPC created a brochure, shown in appendix E. I also created awareness by promoting the conference at MDI meetings. This behavior reflects transformational leadership as it created opportunity for staff to further educational growth. The creation of CEUs was also a challenge for me as I had no prior experience. To achieve this goal I partnered with an experienced CVCPC member to gather conference speakers’ topics, goals, and objectives and from these create a document for submission to the Wisconsin Nurses Association Continuing Education Approval Program Committee for CEU approval. My preceptor and I identified organizational finances as an area of opportunity when developing my immersion practicum. This issue was discovered when discussing the use of a capital request tool named StrataJazz and patient care areas HPPD’s. Balancing patient care and fiscal responsibility as described by Muller (2015) is a critical competency that nurse leaders must possess as well as practice nursing-sensitive value-based purchasing to promote optimal staffing and a safe practice environment (Kavanagh, Cimiotti, Abusalem, & Coty, 2012). To achieve these competencies I participated in an educational opportunity to learn about IBM’s Action OI program. This program allows for comparison of financial and operational data from more than 750 organizations, identifies expense improvement opportunities, and assists in making changes that impact financial planning (IBM ActionOI, 2019). Another opportunity I sought to increase my understanding of the organization’s financial planning was to attend a conference about the change of the organization’s fiscal year and budgeting practices. The implementation of the ActionOI program continues to be refined and developed as the organization works to understand the opportunities it presents. The change in the budgeting process and stub budget has not been completed and requires further dissemination of knowledge. As a leader within the organization I look forward to expanding my knowledge of these processes. These experiences have allowed me to have a better understanding of how the organization functions financially. Another challenge that I encountered during this practicum was my preceptor requiring surgery in which recovery would cover an extended portion of the semester. Effective communication and planning early in the semester allowed me to continue my projects with two of her co-workers, Amy Fox and Krissy Hoosen. This was a valuable experience as both of these leaders also exhibit transformational qualities and allowed me to experience more of the organization that I would otherwise not had exposure to. Evaluation A formative evaluation was completed mid-semester to assess the progress of achieving practicum goals and identify areas of opportunity to ensure a successful immersion experience. The evaluation process allowed for assessment of areas which could be objectively reviewed and expanded on by my preceptor and self-reflection. The formative evaluation tool also provided a comment section to document descriptive feedback and individualized planning. After completion of the practicum, a summative evaluation was performed. The summative evaluation allowed for review of results of the immersion practicum as well as my overall performance in meeting objectives. The summative evaluation also included a section for individualization of feedback from my preceptor and self-reflection of my performance. The evaluation process allows for continued growth beyond the completion of the immersion practicum. The forms can be found in Appendix F and G. The development of these evaluation forms was based on a Likert-scale style questionnaire and was used as a guide throughout the role immersion learning experience. Likert (1932) describes that Likert-scale questionnaires fall into four categories a) yes-no, b) multiple choice, c) propositions responded to by degrees of approval, and d) newspaper narratives. Propositions responded to by degrees of approval, as shown in appendices F and G, were used in the creation of the formative and summative evaluations. Nemoto & Beglar (2014) support the use of the Likert-scale to measure a person’s affect or cognition on a continuum. Norman (2010) also supports the use of the Likert-scale as data retrieved via this method can be statistically significant and provides qualitative data to support evaluation of my role immersion. The self-identified ANA (2009) standards structured the evaluation forms and were developed in combination with Roy’s adaptation model and the theory of Transformational leadership (Roy, 1970 & Burns, 1978). Conclusion The immersion practicum overview describes the activities I completed to satisfy role immersion goals and objectives. Issues, concerns, and challenges were overcome through transformational leadership and nursing theory. These methods and allowed for my professional growth as a nursing leader. The completion of this role immersion practicum has allowed me to meet Ferris State University’s MSN program objectives and has provided me with valuable experiences that will influence my leadership style throughout my professional career.