RESUMO
New graduate clinical nurse specialists (CNSs) face many challenges when starting their new role. To address this, a CNS fellowship program was developed to mentor new CNSs during their first year of practice. This CNS fellowship program would provide opportunities to increase skills related to each of the CNS spheres of influence, including nursing practice, patient care, and systems and organization. Experienced CNSs mentored CNS fellows and identified learning opportunities. The fellows completed an online self-assessment based on the National Association of Clinical Nurse Specialists CNS Competency Checklist during week one of orientation and again at months 3, 6, 9, and 12. The CNS fellows completed and presented three projects designed to explore the spheres of the CNS role, along with a formal onboarding. The results of the fellowship depicted significant competency development within all three CNS spheres at program completion. The CNS fellowship program provided structure and guidance to the newly graduated CNSs and clearly transitioned staff nurses to advanced practice nurses. The fellowship has demonstrated a positive effect on both the new CNSs and the organization in which it was developed.
RESUMO
PURPOSE/OBJECTIVES: In 2010, our comprehensive cancer center developed a professional practice model where the clinical nurse specialist role was transformed to proactively plan and facilitate evidence-based best practices in collaboration with a transdisciplinary, population-focused team that manages the patient across the cancer care continuum. BACKGROUND: Prior to this transition, practice was unit based, focused on nursing staff education, skills, and competencies, and practice varied widely based on the needs of the unit. This lack of role consistency resulted in decreased autonomy and collaboration and frustration with not consistently impacting positive outcomes. DESCRIPTION: Nursing leadership worked with the clinical nurse specialists to develop and transition to a population-focused model. Some responsibilities in the unit-based model were retained, whereas others were transitioned to different roles. The reporting structure was centralized, and the role was realigned to focus on a specific patient population encompassing care from diagnosis throughout survivorship. OUTCOME: Baseline job satisfaction data were collected prior to the transition and repeated at 6 and 12 months, then 2, 3, and 4 years after implementation. Over time, there was significant improvement in participation in decision making, support of leadership, and positive contributions to patients and staff, resulting in improved nursing-sensitive patient outcomes, an increase in evidence-based practice initiatives and nursing research projects, and substantial professional growth of clinical staff. CONCLUSION: With this practice model, clinical nurse specialists consistently and proactively plan and facilitate evidence-based best practice in collaboration with a transdisciplinary team that manages the patient from diagnosis through the cancer trajectory. Results of outcome measurement report job satisfaction at an all-time high. Significant impact is demonstrated for patients and families, the nursing staff, and the organization. IMPLICATIONS: Healthcare organizations should evaluate current roles and practice models for opportunities to incorporate innovations that will result in improved patient care and satisfaction.