Aims To improve the orientation and mentorship of Hospice Community Nurse Specialists.

To accelerate skills development and delivery of quality specialist palliative care.

Background Rosser et al (2004) describe role transition from Generalist to Specialist Nurse as complex and stressful. McCreaddie (2001) using grounded theory approach showed that orientation and mentorship are helpful when adopting the Nurse Specialist role.

Methods

1. Literature review

2. Focus group. CNSs made suggestions for future orientation and mentorship programs

3. Audit. 18 CNSs reviewed the current Hospice CNS orientation and mentorship program

4. Formative evaluation through semi informal interviews and summative evaluation by questionnaire at 6/12 post recruitment, after changes to program.

Results The audit findings were categorised according to % of positive statements:

• ▶ ≥75% supernumerary period and available learning resources

• ▶ 40–75% clinical visits and personal objectives

• ▶ ≤ 40% formal mentorship and role expectations.

The suggestions from the focus group and research evidence were concordant with the audit findings and were used as evidence for change.

Implementation of a competency-based orientation and mentorship guide.

The guide includes competences reflecting National Occupational Standards for end of life care. It includes self and peer assessment, caseload management, guidance for mentors and local information. The guide serves as a teaching tool and benchmark for standards of practice.

Ongoing evaluation In the summative evaluation post the change, CNSs positively rate mentorship and are clear about their role. The formative evaluation shows they feel supported and are more confident in their role.

Conclusion Changes to the program are dynamic in response to ongoing evaluation and change which will be followed by re-audit in the future. In time, it is hoped that a well prepared work force will promote innovation in specialist palliative care.