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  1. Nix, Maria MSN, BSN, RN

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As nurses transition from undergraduate programs into clinical practice or from graduate programs into leadership roles, they face a steep learning curve. Research demonstrates that healthcare fellowships encourage professional development, benefit participants, and add value to organizations.1 A survey by the American College of Healthcare Executives found that fellowship participants report increased overall professional confidence, career satisfaction, and professional development.1 In 2012, the American Association of Colleges of Nursing (AACN) established priorities to support nursing education in response to the Institute of Medicine (IOM) Future of Nursing report, which offered recommendations to strengthen the nursing profession.2,3

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Recognizing the need to support nurses in career transitions and fill the gap in professional development opportunities for nurse executives, our organization developed a nursing administrative fellowship, aligned with the IOM recommendations and the AACN priorities.2-4 The fellowship exposes nurses to hospital administrative personnel and processes under the guidance of preceptors, which gives them a safe place to learn, and aims to provide participants with targeted education designed to prepare them for future leadership roles within healthcare organizations.


Fellowship program design

Our organization, a nonprofit academic healthcare system, has offered healthcare administrative fellowships, specifically for in-house operations, since the 1970s. In recent years, additional concentrations have been added, including finance, supply chain, human resources, and revenue cycle. In 2015, we recognized the need for nurse executive professional development and succession planning, and developed the nursing administrative fellowship.


During the 1-year fellowship, participants rotate through the health system's hospital campuses, clinics, corporate offices, and other areas they're interested in experiencing. The program combines one-on-one mentoring; executive shadowing experiences; and participation in projects, such as the development of a 3-year strategic plan, participation in The Joint Commission auditing, and staff education.


The American Organization of Nurse Executives (AONE) nurse executive competencies provide the foundation for the fellowship.5 The AONE competencies define expected behaviors for nurse leaders and include communication and relationship building, knowledge of the healthcare environment, leadership, professionalism, and business skills.5 Throughout the fellowship, experienced nurse executives model the nurse executive competencies as they mentor nurse fellows in specific organizational functions. Nurse fellows shadow nurse leaders from specialties such as hospital operations, nursing research, nursing labor workforce management, service-line leadership, nursing professional development, and the division of financial management.


The CNO and vice president of quality at our organization serves as the program administrator and as a preceptor to the nurse fellows. The nursing administrative fellowship is integrated with fellowships from other concentrations, offering nurse fellows the opportunity to participate in collaborative learning experiences throughout the program. Fellows complete quality improvement projects and participate in a monthly journal club, which allows current and past fellows to exchange ideas about industry trends and issues, and provides an opportunity to build presentation skills. Fellows attend a monthly lecture series delivered by leaders from across the healthcare system on a variety of topics, such as information technology, budgeting, and the patient experience.


Each year, one or two fellows are selected for the nursing administrative fellowship. Required qualifications are a BSN degree, current state licensure, basic life support certification, and a minimum GPA of 3.0. Additionally, candidates must hold or be in the process of completing an MSN, master of healthcare administration or health services administration, master of business administration, or master of public health degree.


Throughout the program, the executive preceptor provides nurse fellows with evaluation and feedback on their progress with the nurse executive competencies. Additionally, nurse fellows complete simulation training modules on human resources-related topics, such as interviewing, conducting evaluations, and having difficult conversations. During the training, actors challenge fellows with various scenarios and the session is video recorded. The preceptor reviews the recorded sessions with each fellow to provide personalized feedback.


The added value

In an interview with our organization's first nursing administrative fellow, we asked her to describe the value of the program. (See An interview with a nursing administrative fellow.) She responded, "I would describe myself as a 'fixer.' I'm a problem solver. Working as a clinician, I identified operational issues that I wanted to work on but didn't have the capacity. My clinical training focused on just that, clinical training. As I acclimated to the world of healthcare, I realized that there were many aspects, behind the scenes, that I wanted to fix. The nursing administrative fellowship allowed me to transition from a strictly clinical role into a role where I've been able to learn about the other side of our healthcare system and to explore if this is a future professional interest of mine. At the beginning of the fellowship, one of my definitions of success was to be able to identify my passions and my goals for role progression in healthcare by the time I finished the program. I can confidently say that the nursing administrative fellowship has allowed me to do just that."


The fellowship program has been in existence for 2 years. After completing the program, the first fellowship graduate has subsequently been hired to a combined administrative and practice role. The second year of the fellowship is currently in progress.


Future implications

Nursing executive fellowship programs offer education targeted to meet the learning needs of future nurse leaders. A nursing fellowship, concentrated in nursing administration, offers participants the opportunity to develop leadership skills and gain perspectives from experienced nurse executives, preparing them to serve in leadership roles. As healthcare organizations, nursing organizations, and nurse leaders aim to support nurses in career transitions, reflection on the experiences of nurse fellows can provide insight and direction to enhance professional development programs for nurse executives.


An interview with a nursing administrative fellow

Question 1: What's one skill you developed during the fellowship?


Answer: The experience helped me develop my presentation skills and public-speaking skills. I gained perspective as I shadowed and worked alongside executives, and I learned by presenting regularly to different audiences and listening to experienced speakers. I was like a sponge absorbing knowledge and alternative viewpoints from many disciplines of healthcare, both on the front lines and behind the scenes.


Question 2: What aspects of nursing administration did you learn about?


Answer: I learned about billing and reimbursement, supply chain operations related to nursing, strategic planning, infection control, the challenges and opportunities in large-scale staffing, business skills, professional relationship skills, time management skills, and much more. I learned project leadership skills and how leaders deal with difficult situations when things go wrong. Shadowing experienced executives, I also picked up valuable career-life skills, such as balancing my work and home life.




1. American College of Healthcare Executives. Administrative residencies and postgraduate fellowships in healthcare administration: summary report. https://http://www.ache.org/postgrad/SummaryReport.pdf. [Context Link]


2. American Association of Colleges of Nursing. AACN response to the IOM's future of nursing report. http://www.aacn.nche.edu/media-relations/AACN-Response-to-IOM-Update.pdf. [Context Link]


3. Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: National Academies Press; 2010. [Context Link]


4. Cosme S. Residency and fellowship programs for RNs and advanced practice RNs. J Nurs Adm. 2015;45(9):416-417. [Context Link]


5. American Organization of Nurse Executives. AONE nurse executive competencies. http://www.aone.org/resources/nec.pdf. [Context Link]