The Pathways to Nursing Care Excellence Fellowship

Purpose:
To help us exceed desired care outcomes, we created a one-year fellowship for nurses to address two challenging nurse-sensitive indicators. Our purpose was to provide nurse fellows with quality improvement strategies and opportunities to lead new approaches and to evaluate outcomes.

Significance:
Clinical nurses must become the face of quality improvement and drivers of change and sustainability. To achieve this, clinical nurses need to assume accountability for care outcomes by creating processes that ensure improvement interventions are in place and outcomes are reliably measured.

Strategy and Implementation:
A yearlong fellowship was developed to support clinical nurses to identify, plan, implement, and sustain care improvements in their work settings. Applicants were selected based on a personal statement outlining an interest in one of two targeted NDNQI clinical indicators and a statement of support from their manager. Interactive teaching strategies, protected work time and input from faculty advisors, unit leaders, unit-based shared nursing leadership councils and fellow colleagues facilitated ten fellows' development, implementation and evaluation of their projects. Teaching strategies included monthly didactic presentations, group work focused on concept application, time on the units collaborating with unit leadership, faculty mentorship and follow up reflection of their work. Dynamic program planning facilitated the faculty's ability to target needed education as fellows developed and implemented their projects.

Evaluation:
Evaluation methods included fellow satisfaction ratings completed at each training day, mid-year survey, and measurement of proximal (evidence of practice change) and distal (impact on patient outcomes) project outcomes. All fellows have successfully implemented and evaluated a quality approach.

Implications for Practice:
The Pathways to Nursing Care Excellence fellowship demonstrates a feasible and efficacious hospital-based nursing quality education program that delivers targeted curriculum to support nurses' efforts to improve their clinical practice and deliver higher quality and safe care.