Thriving, Not Just Surviving: Implementing a Transition to Practice Fellowship for New Case Managers 

By Katie Rismiller MSN, RN, CPN 

Most experienced nurses could transition from bedside nursing to case management, but for those nurses to thrive in their new role, they need more than just a few weeks of onboarding. According to Knighten (2022), "structured orientation, preceptorship, mentoring, and particularly residency programs can reduce turnover, bridge the academic-practice gap, and support the transition of new graduate RNs to professional nursing practice" (p.186). Much of the literature related to residency correlates to fellowships. The ANCC defines residency as a program for nurses with less than 12 months of experience, and a fellowship is a program for nurses with at least six months of relevant experience (ANCC, 2020). A fellowship provides a platform to continue to grow in competence, professionalism, and emotional well-being. You might say, "That sounds like a lot of work!" There is reliable information available on this topic, and it's not as hard as you might think to bring this benefit to your new case managers. 

The steps I took to develop a transition to practice fellowship at my organization were: 

1. Review evidence 
2. Assess resources and risks 
3. Identify focus areas and develop goals 
4. Create a monitoring and evaluation framework 
5. Content creation 
6. Implementation 

Review Evidence | Doing your homework is The first step in implementing a successful fellowship program. Luckily, there are several resources to help you do this. Most institutions allow access to an online database of articles. Work with a reference librarian to create meaningful search criteria. Consider using the Johns Hopkins Resource (2023) or a resource from Pare and Kitsiou (2017) titled Write a Literature Review or Chapter 9 Methods for Literature Reviews from Handbook of eHealth Evaluation: An Evidence-based Approach to evaluate the articles you find. 

Assess resources and risks | As with any project planning, assessing available resources and risks is vital. When considering resources, think of money, time, and people. As I developed our fellowship, I utilized one RN staff member as a facilitator. The time commitment for the RN facilitator was 4-5 hours per month. A budget request for $100 per fellow was submitted but denied. However, a celebratory lunch was approved after the fellowship. Possible risks during the development stage are:

• The need for clear objectives.
• Having low performers in charge of the project.
• Overestimating resources.   

Identify focus areas and develop goals | Clear objectives must be established before developing content. I created overarching, broad goals for the fellowship and monthly, specific goals. Doing this allowed me to keep the focus on achieving the overarching goals. The overarching goals I developed, based on my literature review, were: 

1. Provide a pathway for experienced nurses to master a new setting. 
2. Establish habits for maintaining emotional well-being. 
3. Identify strategies to improve work efficiency. 
4. Demonstrate professional growth within the area of Case Management. 
5. Increase patient and nurse satisfaction. 

Additionally, I identified focus areas for the fellowship, which were topics repeated in the literature. The focus areas for my fellowship were emotional well-being, efficiency and effectiveness, professionalism, and patient-centered care. 

Create monitoring and evaluation framework | To monitor progress toward goals and evaluate the fellowship's overall effectiveness, I gathered qualitative and quantitative data throughout the fellowship. Before the fellowship started, fellows completed a survey with some original questions and questions from the Casey-Fink Graduate Nurse Experience Survey©, with permission (Casey and Fink, 2023). This same survey was given at 3, 6, 9, 12, and 15 months from the start of the fellowship. Patient satisfaction results were also reviewed. Quantitative data included chart audit scores, completed professional development hours, case closure – goals met percentages, and retention rate. The data collected from the fellows was compared to staff with similar tenure who did not participate in the fellowship. 

Content Creation | Creating content for the fellowship was pretty simple once monthly objectives were identified. The content was taken from various sources and organized using the Articulate e-learning platform. Headers organized each month's content: 

1. Objectives 
2. Coaching/Mentoring Session 
3. One Team 
4. In-Person Session 
5. Self-Reflection 
6. Online Modules 

Implementation | When it came time for implementation, we identified nurses who had been hired 5-7 months before the start of the fellowship. This decision was based on an adaptation of Hopson, Adams, and Scally's Applications for Career Education work (1976, 1981) by Williams (1999), which identifies a significant decision point around six months after a change – in this case, a new job. We identified 3 participants for the pilot fellowship. Coaches/mentors were selected based on four criteria:

• Holding an active case management certification.
• Being a registered nurse.
• Having tenure in the department.
• Being willing to mentor new staff. 

Start developing a fellowship for your new case managers now, and in a few months, you will witness a change in confidence, emotional well-being, efficiency, and satisfaction! 

References 

American Nurses Credentialing Center. (2020). ANCC Practice Transition Accreditation Program (PTAP)  

  Application manual. 

Casey, K., Fink, R., Krugman, M., & Propst, J. (2004). The graduate nurse experience. Journal of Nursing  

  Administration, 34(6), 303-311 

Knighten, M. (2022). New nurse residency programs: Benefits and return on investment. Nursing  

  Administration Quarterly, 46 (2), p.185-190. 

Williams, D. (2008, January 14). Life events and career change: Transition psychology in practice. The Eos  

  Life-Work resource centre. https://www.eoslifework.co.uk/transprac.htm 

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Bio: Katie is a nurse educator with diverse professional experience.  She has worked in healthcare for over 20 years including roles such as candy striper, nurse’s aide, staff nurse, patient navigator, nursing faculty, and education specialist.  She has practiced in various specialties including adult, pediatric, outpatient, inpatient, medical/surgical, oncology, informatics, academia, and simulation.  Regardless of the role or specialty, Katie’s goal has remained the same – challenge herself and others to always ask, “Why?” in order to continually move towards best and evidence-based practice.