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Shadow nurse executive

Job shadowing is where an individual from one area of the organisation has
the opportunity to work alongside and gain experience of the role of another
individual, and gain an insight into that particular work area. It can also be used to
provide an individual within a department the opportunity to work alongside more
experienced colleagues. So they can learn and develop within their current role. Job
Shadowing is an activity which allows a student to spend time in the workplace with a
person who has a job that is of interest to the student. Job shadowing is designed to
provide with the opportunity to spend time with a health care professional and
participate in an interactive learning experience.

What is Shadow nurse manager?

Shadow nurse manager refers to the process whereby a person shadows or
follows head nurse/ nursing director in their work role for a period of time, for the
purpose of enhancing their own performance and that of the person they shadow.
Shadowing programs needs the hospital and accepts that staff can benefit from a wellmanaged shadowing scheme where there are clear expectations on the shadow and the
sponsor. Shadow is a person who is not employed by the institution or any
employer and usually a school or college student, who attends and observes the work
role. Sponsor is the member of Trust staff whose role will be observed by the
shadow. The job shadow will be able to observe the work environment, duties, and
activities of nurse manager etc. that come with the job, but will have no direct patient
contact. A job shadow can be considered an interview that helps with future health
education and career exploration for the individual.

The shadowing experience provides valuable information about a nurses

communication style, ability to interact with staff, patients, and families, and level of
interest in available positions. Shadowing also allows staff nurses to provide valuable
input that in some cases validates what the nurse manager has observed. In addition,
the program benefits the applicants because it allows them to make more informed
decisions. By shadowing a nurse in a unit, participants are able to gather information
about what its like to care for a particular units population and observe how the
nursing team interacts.

Purpose of Job Shadowing:

1. To develops leadership skill and supervisory skill.
2. To improve communication different culture and encourage continuous
3. To provides realistic insight into working in healthcare. Experiencing day-today operations in a hospital or other healthcare environment can dispel false or
glamorized notions that it might have about the profession.
4. The aim of the systematic plan is to enable both shadows and sponsors to
reflect and learn from the experience, and should be developmental for both
5. Work shadowing should be considered as part of normal staff development. It
provides opportunities for sharing best practice and self/professional reflection
and development
6. Job Shadowing provides a realistic experience in the work day of their career

Job shadowing is an opportunity to expand their knowledge about their career

8. Job shadowing provides more information about their career choice.

Principles of job Shadowing:


Job shadowing will be confined to observation only. Under no circumstances will

students be permitted to take an active part in any situation relating to patient care.
2. When the shadow placement involves observation of a situation in which a patient
is involved this is only permissible where the patient has given their full explicit
and informed consent to the presence of the shadow.
3. When the shadow placement involves contact with members of the public consent
for the shadowing to take place must be sought and obtained prior to the
shadowing taking place.
4. During the shadow placement, the shadow will be supervised at all times, and
must not seek to influence the work of the presenter. Shadows must not be given
unsupervised access to patients medical records; normal access must be
supervised and for illustrative purposes only.
5. The role of the Shadow should be made clear to anyone with whom they interact
during the shadow placement. It must be made clear that the student is not a
medical or other clinical student attached to the hospital.
6. Information which is considered confidential by the institution must be treated as
such by the Shadow.
7. All placements are unpaid and institution will not meet any costs of travel,
subsistence or accommodation or any other costs incurred by the shadow.
8. Both parties who are involved in the plan can terminate the shadowing placement
at any stage.
9. The shadowing area of the presenter must normally be relevant to the objective,
and may be development of their career succession plans of both parties.
10. Both parties in the scheme have responsibility for their own learning - the shadow
placement is a two-way process.
11. The plan will support the organisations Health and Safety Policy and any other
health and safety procedures.
12. The plan will support the organisations Equality and Diversity Policy and must
be compatible with the Equality Impact Assessment.
13. The plan is goal-oriented

Benefits to job Shadowing:

1. Observing the challenges faced by staff in a hospital environment.
2. Developing an enhanced understanding of professional practice in an

organizational context
Further developing communication and networking skills.
Enhancing their professional development plan.

5. Reflecting on their goals and objectives.

6. Experiencing the diverse culture within a hospital environment.
7. Enhancing their understanding of issues within a hospital environment in
providing national health system services.
8. Observes a professional in a perspective field of study
9. Helps determine if the job shadow wants to continue in his or her path of study
10. Explore health care career choices

Questions of job shadowing:

1. What are the supervisory techniques of nurse manager?
2. What are the benefits of supervision?
3. During supervision, what things will supervisor consider?
4. How will you provide ward round?
5. How will you manage critical situation in your ward round?
6. Why we performed ward round?
7. What are the advantages of ward round?
8. If nurse shortage in your ward, how will you manage it?
9. What strategies will you provide to develop your staffs?
10. How will you communicate other departments?

Job shadowing in real pace:

My practicing area is OPD of Burapha University hospital. My respected
Ajarn selected the hospital, date, time. I observed as a shadow nurse manager in the
hospital for 2 days. The 1st date was 23/ 08 /2013 and time was 8am. I presented the
hospital at 7.45 am and Ajarn come hospital at 8am. I went to nurse director office
with Ajarn and gave me some document. Assistant Nurse Director and Ajarn selected
my shadowing placement area was OPD and introduced me assistant head nurse of
OPD named Mrs. Ta. Mrs. Ta rounded every department of OPD with me and I
introduced all OPD departments such as screening point, antenatal, and medicine
patients referring centre. She understood me the process why patient visit the doctor.
At last, Mr. Ta introduced me head nurse of OPD in hospital. Under supervision of

head nurse has OPD of ENT, mental, AIDS, skin, and cardiology. She has 2 assistant
head nurse, 4 registered nurses, 10 aid nurses.
Shadowing point:
I knew and observed how to manage registered nurse, practicum nurse, and
aid nurse, how to communicate with them, how to negotiate other department.
According to direction of head nurse, aid nurse decorated every OPD. Head nurse
manages all stationary, instruments, medicine. I observe how to find out medicine and
send recognition to the store of medicine department via computer. Head nurse told
me if any unexpected situation occur or incidence happen how to manage it and take
decision to prevent further same incidence. I joined fire fight seminar and observed
how to practically manage situation. At the end of the week, she arranged internal
discussion about their work- where lack, gap or others and participated all nurse. I
took part their internal discussion. She took decision according to conclusion of
It was the 2nd day of observing shadowing activities of assistant nursing
director. I went to hospital at 8 am and met with Assistant nurse director. Burapha
university hospital is a public hospital and contains 141 beds. I knew structure of
nursing department such as Nursing director---> Assistant Nursing Director ---> Head
nurse -----> Assistant head nurse ------> Registered nurse -----> Practicum nurse---->
Aid nurse.
Assistant nurse director taught me supervisory technique, ward round, and
communicate other departments. Assistant nurse manager supervised to special ward
and Operation Theater. I observed her supervisory technique.
Special ward: Special ward (private room) is in 5th floor and bed is 17. At first,
assistant nurse director introduced us with head nurse, registered nurse. I observed
total manpower head nurse- 01, registered nurse-03. Practicum nurse-01 and aid
nurse -03. Then I saw display board which focuses on patients statement- total
patient, diseases, condition, medicine store room, medicine distribution room. Every
patient has individual pot for medicine. Assistant nurse director wanted to know any
problem or any incident occurs or not and overall condition of the ward.
Operation Theater: Then we went to operation theater (4th floor).We met head nurse of
Operation Theater and Assistant nurse director introduced us and described our view

to go there. At first took information about nursing manpower, and then we saw
display board. Display board gave information about total operation, type of
operation, anesthesia, and surgeon. We met surgeon, she gave information about
Operation Theater. Then we met anesthesia nurse. She prepared patient for anesthesia.
1. Supervision mode: Peer, group, self assessment, and tiered systems.
2. Supervision tools: Checklists.
3. Supervision focus: Implementing their objective and focusing on problem solving
(at supervisor, staffs or patients).
4. Supervisory techniques:
a. Coaching: Coaching is a collaborative relationship undertaken between a coach
and a willing individual the staffs. The coach uses a variety of communication skills
including questioning, listening, observing and giving feedback. The coach can also
assist with an action plan and with learning by encouraging the client to develop a
coaching action plan. Coaching, whether provided in person, by phone or the Internet,
has traditionally been seen as a one-on-one activity. Health coaching can be a useful
strategy for nurses who want to help patients achieve their goals.
b. Observation: The three domains of observation are language, moods and
emotions, and

the body. Observe shifted staff nurse, find out nurses problem,

incident case, admission-discharge patients, seriously ill patients, etc.

c. Trace: Nurse Manager goes to ward and interview and find by investigation.
Specially nurse manager tracer diseases and procedures, medical record, and audit.
d. Conference: Conference/ clinical conference provide the fundamental tools for
new nurse manager. Nurse leader supports, guides, and interviewing his staff to
confronting workplace conflict. By providing conference, nurse leader justify the
staff, equipment, and supplies that need to keep the department providing quality care.
Nurse leader understand the situation of workplace. Nursing Conference uses current

evidence to help nurses, administrators, and managers gain insight and knowledge
related to work behaviors and relationships with each other.
e. Mentoring: By uses of mentoring, nurses become more motivated and productive
through mentoring, communication and collaboration between staff members is
improved, employee commitment is increased through participation in mentoring.
Mentoring gain a better understanding of how the general practice operates develop
interpersonal skills, gain knowledge about the practice nurse role and it provides
opportunities to widen professional networks and reduce professional isolation.
f. Receive consult: Consultation between nurse manager and staffs by verbally,
telephone, or other massages to solve problems or others. It provides evidence-based
approaches to common problems and risks of long-term care patients. It improves
coordination among key professional disciplines and reducing fragmented and
incompatible initiatives and approaches. It clarifies accountability for the standard of
care as established by law and regulation and promotes more effective root cause
analysis of commonly identified issues that affect long-term care performance and
g. Interrelationship: The professional relationship between nurse manager and their
staffs is the prediction of quality service, and job satisfaction. It is good decision
making process to consult with them and easy to solve any problem.
h. Negotiation and communication: Negotiation is a process where two parties
between nurse manager and staffs with differences which they need to resolve are
trying to reach agreement through exploring for options and exchanging offers and
an agreement. To communicate with the objective of reaching an agreement by
means, where appropriate, of compromise. It is useful when the requirement is
difficult to specify and relatively inexpensive to undertake. It is flexible and not
prescriptive and should be confidential.
Benefit of supervision:
1. Supervision improves client outcomes
2. It develops advancement of nurses specialized knowledge, skill, attitude and


It helps to learning and professional development.

It helps to teaching, coaching and empowering
It develops teamwork, collaboration and partnerships
It enhances professional autonomy and accountability
It improves assessment and monitoring, interviewing, formulation and

8. It helps to regulate, guide and direct nursing practice
9. It facilitates evaluation of nursing practice
10. It increases self-awareness, critical awareness, self-evaluation
5. Nursing rounds in ward:
1st day head nurse of OPD and 2nd day assistant nursing director shared about
idea, practical knowledge and skill of ward round. Nursing rounds are a means of
proving contact between the nurse director/nurse manager and each individual in
nursing service. Nursing rounds involve the observation and often interview of
nursing staff about clinical setting, clinical experiences, problem, problem solving
process and trace. It demonstrates symptoms important in nursing care and illustrates
the skillful nursing care. It promotes staffs development about characteristics of
common health problems, team work and increases the learning ability about critical
thinking of the individual staffs. It increases interest to share idea and knowledge with
others and relationship between nurses and patients. There are three types of
nursing rounds such as -a) Information giving rounds: It is used
to acquaint the staff with all patients on the ward or division. b)
Instructional rounds: Here the nurse is expected to read the
charts and come to rounds with basic information in mind. c)
Problem solving rounds: This is to help the nursing staff learn to
conduct initial interviews make an assessment of patients needs
and identify nursing care problems .
i. Why does need word round:
1. To demonstrate symptoms important in nursing care.
2. To compare the patients reaction to disease and study
the disease conditions.

3. To demonstrate the effects of drugs i.e. indication,

actions and reactions of drugs.
4. To illustrate the skillful nursing care.
5. To compare methods of meeting nursing needs and to
have a better understanding and to give more purposeful care to
6. To illustrate successful improvisation and to give
opportunity for the use of different applications.
ii. Advantage of ward round:
1. It Promotes staffs and student learning about
characteristics of common health problems, team work.
2. It identifies staffs and patients problems and issues in a
clinical situation
3. It evaluate the effectiveness of nursing in interventions
4. Share clinical knowledge, idea with peers and identify
gaps in their own understanding
5. Develop new perspectives about the patient' care
6. It increases the learning ability about critical, thinking of
the individual students
7. It increases the relationship between nurses and patients
to feel comfort and natural.

Current state of supervision:

Supervision was originally conceived as a management process to oversee a
check on a persons work; however, supportive supervision is now recognized as best
practice. When done well supportive supervision defines objectives and expectations,
monitors performance, helps interpret data, provides focused education, helps with
planning and problem solving and enhances community participation. In practice
supervision is still often administrative, top-down, irregular and of poor quality. Poor
supervision has various causes which can be structural (e.g. lack of financial or
human resources), functional (e.g. inadequate tools or training) and cultural (e.g. a


traditionally hierarchical system). Understanding these problems is key in designing

effective and feasible supervision approaches.

Theory congruent of shadowing area:

Cognitive therapy model of supervision:
Supervision, which is provided using the cognitive therapy model, is similar
to the therapy process in that aims to be focused, structured, educational and
collaborative. It is also acknowledged that the practice of supervisor and supervisee
(within and between supervision) will be influenced by their own core beliefs,
underlying assumptions and automatic thoughts. Supervision sessions are structured
by an agenda and in the same way that cognitive therapy aims to make links across
sessions. Cognitive therapy supervision aims to summarize previous session content
and review any learning which has occurred between sessions. The clinical supervisor
aims to help supervisees apply cognitive therapy to a high standard, develop their
assessment, conceptualization and treatment skills and, as advocated by explore their
own reactions to the therapeutic process. Padesky (1996) also highlighted the parallel
between treatment and supervision processes. She highlighted the outline of
differences between supervision modes and foci. A supervision mode is the means by
which supervisee learning and discovery occurs.
The focus of supervision can be the mastering of new skills, conceptualizing
clinical problems or progressing the therapists understanding of the client-therapist
relationship. Many cognitive therapy educationalists and clinicians now highlight the
potential benefits of acknowledging our own cognitions, emotions and behavior in the
methods and processes, and can also help to conceptualize treatment plans for clients.
During the supervisory process it will sometimes become apparent to a supervisor that
a supervisee may have an underlying assumption about a client, the therapy process or
the supervisor which is compromising his or her application of cognitive therapy,
compromising his or her self-care and/or influencing the process of therapeutic
change in a contradictory way. The structure and process of this supervisory model
might be of value to nurses working within different specialties where the concepts of


supervisory foci and modes of delivery are equally applicable and where the
supervisee seeks an educational focus. The exploration aims to increase awareness of
how our own cognitions can influence the therapeutic endeavour and how we can use
this to understand the issues which can arise during the process of cognitive therapy.
These types of issue are not confined to counseling, psychotherapy or mental health
nursing they are relevant to all nursing contexts.

The nature of the healthcare centre/ hospital has privacy laws require all
employees, volunteers, students, and even those completing job shadows. It should
maintain a high level of confidentiality. This confidentiality is in respect to all
information of a medical that concerns patients, visitors, residents, doctors, or
employees. Under no circumstances should such information be discussed with any
unauthorized persons(s) either outside or inside the facility. To engage in such
discussions is not only a breach of confidence, but demonstrates a lack of concern for
others. Breaching confidentiality could lead to involvement in legal proceedings
should an individual report a violation of their rights.

Job shadowing provides the individual with a unique opportunity to find out
how other staff work and their roles involve. It develops a deeper knowledge and
understanding of other roles and functions within the hospital. Shadowing has the
potential to develop an enhanced understanding of professional practice in an
organizational context. Job shadowing focuses on valuable information about a nurse
managers communication style, supervisory style, ability to interact with staff,
patients, and others. Shadowing provides realistic insight into working in healthcare.
Shadow nurse follows supervisory technique of nurse manager. If future leader get
opportunity to shadow nurse leader or others then he/she identify suitable profession.
I gathered nurse manager leadership activity, supervisory activity, practical experience


which I apply in our country if I get opportunity. So every future nurse leader should
to enhance critical thinking, decision making, and practical experience by shadowing
nurse leadership activity, supervisory activity.

This process benefits new hires,
Sloan G, Watson H (2002) Clinical supervision models for nursing: structure,
research and

1. 2. Sloan G.& Watson H(2002), Clinical supervision models for nursing :

structure , research and limitations