In a post-pandemic world, the need for strong nursing professional development (NPD) practitioners and leaders is greater than ever. Health systems, and nurses specifically, find ourselves facing challenges in staffing, a widening theory-practice gap, supply chain interruption, and cost constraints that impede our ability to provide optimal patient care (Smiley, et al., 2021). Taking it one step further, as NPD practitioners and NPD leaders, we are faced with the challenge of providing more with less, and seemingly having to fight for every resource we need to do our work.
My title is the executive director of the Office of Professional Practice for University of Louisville (UofL) Health, a small regional academic health system in the Louisville, Kentucky area. But my title only gives a peek into my role and how I support and drive change, quality improvement, and nursing practice across the system and within the state of Kentucky. To promote integration, at my health system, the nursing research, nursing excellence, and a portion of the workforce development teams, as well as the Resuscitation Institute, report up through me. I report to the system’s chief nursing officer (CNO), and lead a team of 60+ NPDs in a variety of settings and roles, which include 13 in NPD, resuscitation, and research at the system level. UofL Health employs over 12,000 staff including 3,500 nurses and is comprised of a wide range of facilities, hospitals, and freestanding medical centers.
Why does this matter? As the NPD leader responsible for the cohesion of NPD and nursing care across the system, my hat is constantly changing. Over my years in this role, I have gained perspective on a few key considerations for NPD leadership across sites, which I will share throughout this article.
1. Stay up to speed on key initiatives and challenges across facilities.
In alignment with Harper and Maloney’s (2022b) finding regarding the required competencies of a multisite NPD leader, my role requires me to be up to speed on key initiatives and challenges at each facility. This means I have to be embedded within leadership in order to exert influence on decisions while also keeping a finger on the pulse of nursing across the city and state to stay ahead of trends. Constant environmental scanning is required, and the ability not only to identify the needs, but develop and implement strategies and programs to address the needs proactively. All of this is primarily done to support the health system, but I always also must be mindful of demonstrating and communicating the worth of the NPD practitioners, nurse researchers, and staff who work within the Office of Professional Practice (Harper, 2022; Harper & Bindon, 2020; Harper & Maloney, 2022a; Harper & Maloney, 2022b; Harper, et al., 2022).
2. Build relationships internally.
The role of relationship building cannot be overstated in relation to the success of any NPD, but especially a multisite leader. I am blessed to have worked with or for the system CNO for 10 years in a variety of NPD roles. The trust she has in me to accomplish what is asked is paramount to the overall success of the department. When the system formed at the end of 2019, establishing a similar working relationship with the CNOs and nursing directors at each facility was my top priority. I structure my time to ensure I get face time with each of them at least monthly, either one-on-one or in a group setting. I provide monthly reports and data that is used at various senior leader and board meetings that highlight the ability of the team to drive the bottom line for the organization. I also ensure each facility NPD leader and team get similar face time, with all of us delivering a similar message of support for key initiatives and metrics within the facility and across the organization. This collaboration ensures that when the NPD department is in need, we get the attention and support required to be successful.
3. Build relationships externally.
Relationship building with external stakeholders is paramount to the success of the organization. The pandemic put the need to develop internal and external talent pipelines into overdrive (Smiley, et al., 2021), which means fostering relationships with both community and academic partners (AACN, 2021; AONL, 2012). I sit on several deans’ advisory boards and assisted our affiliated school of nursing with their most recent accreditation document writing and site visit. The dean of the UofL School of Nursing and I communicate and collaborate frequently, establishing processes to funnel our nursing staff to their RN to BSN and graduate programs and for dual credit for our associate degree (ADN) prepared nurse residents to obtain credits towards their BSN upon successful completion of nurse residency. We recently partnered on a $3.5 million HRSA grant, in collaboration with the local community college nursing program, to pave a path for health system employed students to the community college for their LPN and RN (ADN) and then on to the university’s BSN program, while providing funds for social support in addition to salary and tuition. My proposal to create a nursing specific workforce development team was approved, and I hired a manager in spring 2023. From that work, our relationship with over 15 local high schools was formalized, and internship and other pipeline programs are proliferating.
4. Leverage relationships to build influence.
Expanding on relationship building, I served on the Kentucky Board of Nursing for four years, the Kentucky Organization of Nurse Leaders for five, and am active in the Kentucky Nurses’ Association. Add to that my time on the ANPD Board of Directors, and I have been able to establish a network of NPDs and nurse leaders across the city, state, and country that I can leverage to create coalitions, collaborate on processes, and just bounce ideas off of. This has been invaluable to the success of not only me, but the NPDs who report to me, who have gotten opportunities others may not, to UofL Health as a whole, and to the patient’s and family's lives we impact.
Internally, I am able to leverage what I have learned and the relationships I have grown to exert influence in nursing across the system. In collaboration with the system and facility CNOs, I maintain the system’s nursing strategic plan, which allows me to embed the work of the NPD into the action planning to meet strategic initiatives (Harper, 2022; Harper & Bindon, 2020; Harper & Maloney, 2022a; Harper & Maloney, 2022b; Harper, et al., 2022). I was able to ensure it was written into the strategic plan how NPD contributes to driving the outcomes of the organization. When necessary, I am also able to advocate and build in needed NPD resources to support the strategic plan that then feed into the budget planning process. I am able to align our NPD programs and initiatives in such a way that they are built into the success of the organization.
For example, in 2022 the Joint Commission released new standards for both resuscitation and workplace violence prevention. Recognizing a gap in the organization’s processes, I was able to advocate for a workplace violence prevention coordinator and finally get the system to approach workplace violence prevention, de-escalation, and safe physical management in a standardized approach. A gap analysis in our resuscitation review and education processes allowed me to establish a Resuscitation Institute, which now holds a resuscitation program manager, NPD practitioner, and three data abstractors to drive resuscitation outcomes across the system in a consistent manner.
5. Develop nursing staff through evidence-based practice.
Having the nursing research department also report up through me has allowed for the development of leaders and staff in competency-related, evidence-based practice (EBP) and research, but approached from an NPD framework. The researcher and EBP coordinator come from an academic and NPD background and are systematically building a body of research and EBP projects to improve the care environment and address the unique needs of the organization, while promoting the nursing profession as a whole (Harper, 2022; Harper & Bindon, 2020; Harper & Maloney, 2022a; Harper & Maloney, 2022b; Harper, et al., 2022).
Layered over all of this is the alignment of nursing as a whole in the nursing excellence framework. The system is dedicated to supporting both Magnet® and Pathways to Excellence®, which has allowed me to obtain resources to drive shared decision-making, leadership development and quality improvement.
6. Use what you learn to advocate for resourcing the NPD team.
The expansion of our NPD team, as well as varying levels of NPD practice prior to the formation of the health system, also necessitated putting resources behind the development of our NPD team. The system NPD team created NPD Bootcamp, a four-part course that is phased over the NPD’s first year of practice. Parts one and two include online modules for the new NPD practitioner, followed by a review of the ANPD Scope and Standards, professional practice model and core curriculums (Harper, 2023; Harper & Maloney, 2022a). Part three is focused on technology for the NPD, building online content and simulation. Part four is advanced topics in NPD including project management, EBP and organizational value and return on investment. Existing NPDs also attended parts two through four. Building up the NPD team across the system has created a data-driven team able to articulate and demonstrate the value of their role within the organization at all levels. Everything I have outlined would not be possible without a strong team of NPDs carrying out the work, and exemplifying all the roles, inputs, throughputs, and outputs of the NPD in our professional practice model (Harper & Maloney, 2022a).
As an NPD multisite leader, I always seem to find additional work that must be done. There is always more coming down the line, but I have been able to leverage relationships and influence to establish NPD as an integral part of the operations within UofL Health. I and/or my team sit at the table for most decisions and are consulted prior to implementation of key initiatives. We are able to mold and craft the organization as a whole while having little direct authority over decisions and processes. I have found this to be the key to the department’s continued growth and success.
American Association of Colleges of Nursing (2021). Academic-Practice partnership resources.
American Organization for Nursing Leadership (2012). AACN-AONL task force on academic-practice
partnerships: guiding principles.
Harper, M.G. (Ed.). (2022). Leadership in nursing professional development: An organizational
and system focus (2nd ed.). Association for Nursing Professional Development.
Harper, M.G. (Ed.). (2023). Core curriculum for nursing professional development (6th Ed.).
Association for Nursing Professional Development.
Harper, M.G. & Bindon, S.L. (2020). Envisioning the future of nursing professional development.
Journal for Nurses in Professional Development, 36(1), 39-40. DOI:
Harper, M.G., & Maloney, P. (Eds.). (2022a). Nursing professional development: Scope
and standards of practice. (4th ed.). Association for Nursing Professional Development.
Harper, M.G. & Maloney, P. (2022b). The multisite nursing professional development leader
competency determination study. Journal for Nurses in Professional Development,
38(4), 185-195. DOI: 10.1097/NND.00000000000000836.
Harper, M.G., Maloney, P., Aucoin, J., MacDonald, R. (2022). Findings from the 2021 study:
Organizational value of nursing professional development practice.
Smiley, R.A., Ruttinger, C., Oliveira, C.M., Hudson, L.R., Allgeyer, R., Reneau, K.A., Silvestre,
J.H., Alexander, M. (2021). The 2021 national nursing workforce survey. Journal of
Nursing Regulation, 12, S1-S96.