Leadership Experiences in the Community for Nursing Students: Redesigning Education for the 21st Century

Article excerpt

To respond to massive changes in health care delivery, nursing curriculum redesign requires that we return to our roots in the community and the visionary leadership of Lillian Wald, whose Henry Street Settlement (1,2) remains a model for community-based leadership. Wald's mission--to serve those in need, wherever they may be found--remains our legacy. But while the challenge of preparing students to function within a multitude of settings is not new, the changes now confronting faculty, students, and the entire health care system are taking place at a startling pace.

To respond to these rapid changes, nurses must be able to think critically, plan strategically for continual change, function in health care teams, and work with diverse groups of people. Curriculum redesign must address trends toward interdisciplinary teamwork, collaboration across disciplines, and community partnerships (3,4). In the words of the Pew Commission Report of 1993, nursing "will face these challenges from a position of strength, since nursing's skills of collaboration, effective communication, and teamwork will be needed to support and practice in a changed system" (5, p. 30).

Leadership and management experiences for nursing students have traditionally taken place in the structured environment of acute care facilities, neglecting opportunities in the community. This article describes a capstone leadership course designed for students working toward their Bachelor of Science in Nursing degree. It took place in a nontraditional community-based setting, an alternative high school for pregnant and parenting teenagers. After evaluation of a small pilot program for eight students, a second pilot was attempted in which increased emphasis was placed on integration with the course on community health nursing.

This project was our faculty's first step in nursing education redesign. It is well in keeping with the mission of our university, which emphasizes service to those who are disadvantaged within a community context. The project is part of a proactive, strategic plan to expand leadership experiences into the community. Our goal is to integrate traditional community health nursing with leadership in a streamlined curricular model to foster the development of community-based competencies for the future.

Implementation of the First Phase The setting for the pilot project was an alternative high school in the inner city. Approximately 400 young women attended classes daily, and 200 of their children used day care services. The school, which employed two full-time school nurses, offered a weekly midwifery clinic and social, legal, and psychological services.

Most of the eight nursing students had been at this clinical site for community health nursing. Their familiarity with the teen students, teachers, and administrative staff was identified as a major strength in the development of the curricular model. The administrative staff was receptive to the pilot program and participated in putting forth recommendations for projects that would directly benefit the school and the community.

Some of the students reported that they did not feel comfortable or competent with the change in focus. They realized that independence and creativity would be required for community-based leadership and understood that there would be no protocols to follow. In addition, they had had few opportunities to delegate tasks to others and were apprehensive about doing so with peers and school personnel. Clearly, new modes of leadership delivery were needed beyond those learned and practiced in a traditional acute care facility. A greater emphasis on relationship and partnership skills and creativity would be required for success.

In anticipation of the pilot project, students met in bimonthly seminars with the leadership clinical faculty to formulate their clinical goals. Ways to operationalize and practice leadership skills in a community setting were a major focus of the seminars. …