Building a CNS Reserve: The Impact of a CNS Fellowship Program on Unit-Acquired Pressure Ulcers and Nurse Satisfaction

Purpose:
To impact nursing satisfaction and nurse-sensitive outcomes by increasing the number of clinical nurse specialists (CNS) through the design and implementation of a CNS Fellowship program.

Significance:
The CNS is seen as the standard bearer for professional nursing practice and is vital to its advancement (Harrell & McCulloch, 1986). Highly complex patients in task-saturated environments demand CNS interventions to orchestrate care and achieve excellence in nurse-sensitive outcomes.

Strategy and Implementation:
To design and test a CNS Fellowship program, human and financial resources were required. The CNO valued the impact of CNS practice on nurse-sensitive outcomes. An institutional philanthropic grant supported the program. This was an opportunity for existing CNS staff to mentor CNS students in their professional development. Nurses in an accredited program interviewed for fellowship positions on units with open CNS positions. Our “grow your own” program included tuition, paid time off for class and clinical rotations, and the mentorship and coaching of the CNS team. Developmental opportunities included an informal practice curriculum that complemented the formal CNS program. This included book studies, exploring leadership style, and side-by-side practice with CNSs. Theory learned in school and applied on the unit supported nursing practice and outcomes. Graduates of our program have a two-year work commitment.

Evaluation:
Evaluation included orientation, RN satisfaction, and outcomes. Orientation was eliminated. On one unit, nurses' intent to remain the next year rose 13% and job enjoyment T-score rose from 49.68 to 55.98. Quality perception went up from 3.09 to 3.35. Mean unit-acquired pressure ulcers fell 1.41%.

Implications for Practice:
Building competent CNS resources with a fellowship program requires the support of the CNO and the dedication of the existing CNS pool for the side-by-side mentoring and coaching of students. Continued success of the program will focus on the development of competency based-evaluation tools.