Development, implementation, and evaluation of a train-the-trainer program for emerging nurse leaders in China: a 12-year longitudinal study

TL;DR

A 12-year study in China shows that a train-the-trainer program effectively builds nurse leadership skills and has long-term positive impacts on healthcare systems.

Contribution

This study presents a 12-year evaluation of a scalable train-the-trainer model for nurse leadership in China.

Findings

Participants showed significant and sustained improvements in knowledge, attitudes, and practices over 12 years.

The program had a cascading effect, with participants training over 25,000 healthcare professionals.

The model is scalable and sustainable for strengthening nurse leadership and health systems in China.

Abstract

Despite being the largest group of health care professionals, nurses represent a neglected human resource in China, especially in leadership, education, and public health. The aim of this study was to develop and evaluate a Train-the-Trainer (TTT) model to build leadership capacity among emerging nurse leaders in South China, using a comprehensive assessment and evaluation immediately after, at 6-month, and 12-year post-TTT.

A mixed-methods approach was employed starting with a needs assessment to guide the development and implementation of the curriculum in the TTT programs. Three tailored courses were developed. Outcomes were assessed using pre- and post-training surveys on participants’ knowledge, attitudes, practices (KAP), along with self-reported capability improvements. Multivariate analysis of variance (MANOVA) and paired t-tests were employed to assess the TTT impact. Cascading effects were assessed through reports of TTT activities and institutional changes. A p-value < 0.05 was considered as statistically significant.

A total of 180 emerging nurse leaders (middle career) from 136 institutions in Guangdong (GD) Province participated in the TTT program, with support from the Guangdong Province Department of Health. The course participants showed significant short-term improvement in KAP and self-reported competencies in the three courses, with sustained gains observed at 6 months and 12 years post-training (all p < 0.05). The cascading effect of the program was substantial at both 6-month and 12-year post-TTT, with 180 participants disseminating knowledge and delivering further training to about 25,000 healthcare professionals in the Province.

The TTT program proved to be a scalable, sustainable model for developing nurse leadership and strengthening system capacity in China. In the global shortage of nurses, more than ever, we need to prepare emerging leaders to advance nursing practice and build a quality nursing workforce contributing to China’s national health reform.

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