The national post-baccalaureate graduate nurse residency program: a model for excellence in transition to practice.

The Chief Nursing Officers (CNOs) of the University HealthSystems Consortium (UHC) of Academic Hospitals desired to increase the numbers of baccalaureate graduate nurses hired by their facilities and provide a more consistent, uniform transition into practice for these graduate nurses. A partnership between the UHC CNOs and the American Association of Colleges of Nursing (AACN) led to establishing a National Post-Baccalaureate Graduate Nurse Residency Program. The structure, curriculum, and outcomes measures were developed and the program was implemented, with growth from six original pilot sites to 34 academic hospitals. Outcomes from the first year of program operation at these six sites show a high rate of retention, decreased stress by graduate nurses over time, improved organization and prioritization of care, and increased satisfaction in the first year of practice.     

Transforming mediocrity to excellence: a challenge for nurse leaders.

A grounded theory study of nursing leadership in Western Australia was undertaken to shed light on complex contextual and individual variables associated with nursing leadership. By applying the constant comparative method of data analysis, the core problem facing nurse leaders was identified as overcoming and compensating for disadvantage related to a repressing context which impeded the movement of nursing from retardation and mediocrity, through turbulence and toward excellence. Following a long period of stagnation (reflecting mediocrity in the nursing system) and a shorter evolutionary phase, revolutionary changes were being implemented, creating an extremely turbulent environment. Findings revealed that nurse leaders used a core process labelled optimising to deal with the core problem and to achieve influence and advancement. This process had progressive phases identified as surviving, investing, and transforming. Failure to optimise led to floundering. Transforming reflected exceptional performance or excellence and involved using the optimising strategies of reversing negative situations and creating additional resources to achieve influence and significant advancement or change in the nursing system. This study has implications for leadership practice, for the development of future leaders and for future research and theory development.     

Achieving excellence in practice: a model for continuing education for nurse practitioners

PURPOSE: To provide a continuing education (CE) model that will meet varied needs of nurse practitioners by incorporating the variable of years of experience in practice setting. DATA SOURCES: An empirical study conducted over a period of approximately 10 months, from Fall 2002 to Spring 2003 in one of the southeastern states. CONCLUSIONS: A model has been developed to plan and deliver CE education programs based on the changing CE needs of NPs as they gain experience and expertise. IMPLICATIONS FOR PRACTICE: Results of this study may be used to guide providers to develop and offer CE programs based on the CE needs of NPs related to length of time in clinical practice, general issues of practice, and specialty practice area needs.     

The clinical specialist-staff nurse research team: a model for clinical research

Increasing sophistication in nursing research has created a demand for preliminary work before the completion of a design for a major research project. This report presents a method which meets this need and provides research experience to nurses working on the clinical units. The role of the doctorally prepared clinical nurse specialist (CNS) in promoting collaborative research is presented. For the staff nurse the purpose of this collaboration was to facilitate an introduction of nursing research during the completion of her BSN. A secondary purpose was to provide the doctorally prepared CNS with preliminary data on the effects of nursing care on preterm infants with bronchopulmonary dysplasia. Through collaborative effort, a research protocol was developed and implemented with four preterm infants. The successful completion of this project provided the CNS with preliminary data and the staff nurse with a better understanding of the complexities as well as the rewards of clinical nursing research.     

The synergy model and the role of clinical nurse specialists in a multihospital system.

The role of clinical nurse specialists was formalized in the 1950s; the goal was to prepare inpatient, bedside nurses who would serve acutely ill patients via consultation and direct care. Clinical nurse specialists were to be expert clinicians, consultants, educators, and researchers. In the early stages of practice development, the focus was the specific needs of the assigned unit or floor. Organizational restructuring led to the elimination of many positions for clinical nurse specialists, with a shift of some of the nurses' responsibilities to others (ie, managers) or the abandonment of some of the traditional roles. Recently, a reversal occurred in this trend, evidenced by a steady growth in the demand for these advanced practice nurses by organizations seeking to improve patients' outcomes while remaining fiscally responsible. This demand led to changes in role expectations and expanded the responsibilities of clinical nurse specialists to a system-wide or organization-wide level. Contemporary practice of clinical nurse specialists is not well reflected in traditional role definitions or commonly accepted practice models. The Synergy Model, developed by the AACN Certification Corporation, was introduced as a way of linking certified practice to patients' outcomes. The model describes 8 nurse characteristics and 3 spheres of influence. This article describes how a group of clinical nurse specialists applied the model to successfully change from a unit-based to a multisystem practice.     

The use of teaching portfolios to promote excellence and scholarship in nurse education

Achieving excellence in nurse education and demonstrating scholarship in teaching is a challenge for nurse educators who find themselves torn between maintaining high standards in nurse education and their own need for recognition and promotion in an environment that primarily favours research and publications over excellence in teaching. The use of a teaching portfolio is a way to display excellence in nurse education and to provide a public display of teaching scholarship. While not a new concept in nursing education, it has some originality in its application to practising nurse educators. However, the requirement for and guidelines on the development of a portfolio for nurse educators (other than those undertaking educational training) has been little explored. The aim of this paper is to explore the concept of a teaching portfolio as a vehicle to demonstrate excellence and scholarship among seasoned nurse educators. The process of developing a teaching portfolio at one university setting is outlined, so that other teachers are enlightened to the potential benefits of this activity.     

Unit-based research forums: a model for the clinical nurse specialist to promote clinical research

Although nurse researchers have generated research findings, practitioners in clinical practice have not consistently utilized them. Evaluation and modification of clinical practice through research is a key component of the role of the clinical nurse specialist (CNS). In this paper, an innovative model is described in which the Clinical Nurse Specialist coordinates specialty-based clinical research through the use of unit-based research forums, an outgrowth of unit-based quality assurance. Such a model allows staff at the unit level to engage in problem-solving dialogues, resulting in increased use of research findings and generation of original research.     

The clinical nurse leader: a response from practice.

In October 2003, over 200 nurse leaders from education and practice met at the invitation of the American Association of Colleges of Nursing. A newly released white paper, describing the role of the clinical nurse leader, was discussed at the conference. This article outlines a response to that white paper from one practice setting. The article shares information about another role, that of team coordinator, that is similar to clinical nurse leader and has been implemented at an integrated not-for-profit health care system in 5 hospitals. The comparison of the team coordinator role to the clinical nurse leader role might assist in visualizing such a role in practice. Although the roles are not identical, many of the driving forces for change were similar; these included the need to meet the changing demands for improved patient outcomes and nurse retention. The team coordinator role has 4 domains of practice that are crosswalked against the clinical nurse leader 15 core competencies. An evaluation of the team coordinator role showed changes that need to be made, such as placing more emphasis on clinical progression of patients. Lessons learned are shared, including keeping the scope of the role manageable, providing documentation standards for new roles, and the leadership required of the nursing executive to implement change.     

The clinical nurse specialist--a personal perspective.

The post of clinical nurse specialist (CNS) is relatively new in the United Kingdom, and research so far suggests that the intensive care unit is an appropriate area for the further development of the role (Thompson et al, 1986). The purpose of this paper is to examine the function of a clinical nurse specialist within an intensive care unit, and to discuss the various aspects that constitute the role, within the fields of clinical practice, education, research and management. Nursing practice is developing--the aim being truly individualised patient care. A clinical nurse specialist should be in an ideal position to innovate, lead and evaluate change.     

The role of the clinical nurse specialist/neonatal nurse practitioner in a breastfeeding clinic: a model of advanced practice

A commitment to quality health care requires the development of innovative models of care. An example of such a model is the Clinical Nurse Specialist/Neonatal Nurse Practitioner in the role as consultant to Lactation Consultants in a large breastfeeding clinic. The role of the Clinical Nurse Specialist/Neonatal Nurse Practitioner in this ambulatory setting encompasses all the dimensions of the advanced practice model including research, leadership, education, and clinical practice. The evolution of this model of care is described. A conceptual framework of this advanced practice model is presented, supported by examples of the role in the clinic.