Abstract

With funding from the Ontario Ministry of Health and Long-Term Care, the Registered Nurses' Association of Ontario (RNAO) established the Advanced Clinical Practice Fellowship (ACPF) program in 2000 to improve patient care and outcomes through advanced nursing knowledge and skills.

This paper describes the perceptions of ACPF fellows regarding their influence on quality of care and patient outcomes, specifically, the types of practice change activities initiated, successful implementation and influence on outcomes, barriers encountered and strategies used to address them and influence change.

Methods: Thirty telephone interviews were conducted with ACPF fellows after completing their fellowship. Interviews were analyzed using descriptive content analysis.

Results: Fifty-one practice change activities were identified. Ratings for successful implementation (1 = not successful, 10 = extremely successful) were 7.2/10; ratings for successful influence on outcomes were 7.4/10. Barriers identified were (a) resistant attitudes, (b) time and workload, (c) lack of administrative support and (d) lack of mentor's involvement. Strategies proposed were (a) building a knowledge base, (b) negotiation and dialogue and (c) self-reliance and persistence.

Implications: The ACPF program is an innovative and highly utilized initiative. While this program supports strategic directions of government and nursing professional groups, further research will validate and expand on the specific ways in which the initiative influences professional development, healthcare delivery and patient outcomes.