Clinical Stars Lead a Successful Professional Practice Program: The UEXCEL Program Has Improved Patient Outcomes While Developing Nurse Leadership and Autonomy

By Krugman, Mary; Rudolph, Michelle et al. | American Nurse Today, September 2013 | Go to article overview

Clinical Stars Lead a Successful Professional Practice Program: The UEXCEL Program Has Improved Patient Outcomes While Developing Nurse Leadership and Autonomy


Krugman, Mary, Rudolph, Michelle, Nenaber, Amanda, Dietrich, Carolyn, American Nurse Today


Professional practice programs are essential for strengthening nursing professionalism and enhancing job satisfaction. Increasingly, structures to support nurse empowerment in controlling their practice and experiencing a positive work environment are linked to high-quality patient outcomes and achievement of ANCC Magnet Recognition[R].

The University of Colorado Hospital (UCH), a three-time Magnet[R]-designated hospital, developed a practice program called UEXCEL in the late 1980s, which has been in continuous operation for more than 22 years. It has proven to be a significant force in developing professional nurse leadership, autonomy, and empowerment and in improving patient outcomes. UEXCEL stands for the University of Colorado Hospital's Excellence in Clinical Practice, Education, Evidence-based Practice, and Leadership. This nurse-led program promotes a highly educated nursing workforce (84.5% of our nurses have bachelor of science in nursing degrees); 44% are certified in their specialty. Half of our 1,500 clinical nurses are graduates of our national UHC/American Association of Critical-Care Nurses Post-Baccalaureate Nurse Residency Program. UEXCEL also drives succession planning; 53% of current nurse leaders at UCH are former UEXCEL participants who've advanced to higher practice levels.

The foundation for UEXCEL was adapted from Patricia Benner's novice-to-expert framework for the stages of clinical competence and is based on principles of the Magnet Recognition Program. (See UEXCEL governance.)

Practice program structure

Regardless of service, specialty, or practice location, every clinical nurse who practices at the point of care across our hospital is a UEXCEL member. This program isn't based on a point system; nor does it include advanced practice nurses or those holding specialty roles (such as case manager). Every clinical registered nurse (RN) has a job description, job code, and classification as a level I advanced beginner, level II competent nurse, level III proficient advanced professional nurse, or level IV expert professional nurse.

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UEXCEL grants credentials to nurses to practice, provides a framework for performance evaluation based on the American Nurses Association's (ANA) Standards of Clinical Nurse Practice, and supports clinical nurse career goal development through promotional advancement. Four categories of practice exist, with titles aligned to match the Magnet[R] Model components (reprinted here with permission):

* exemplary professional practice

* transformational leadership

* structural empowerment

* new knowledge, innovations, and improvements.

Key program elements

UEXCEL reinforces exemplary practice by using ANA standards, evidence in practice, and key program components. For example, UCH values reflect practice as a method for developing and enhancing critical thinking. Clinical narratives are required at all levels of practice.

* Level I nurse residents complete narratives throughout the program, reflecting on the complex issues facing newly licensed nurses.

* Clinical nurses who've chosen to advance from level II to III or from level III to IV must include a written narrative in their portfolio application that articulates a philosophy of practice and describes a clinical example of patient care reflecting skill acquisition at a higher level of practice.

* At the time of performance appraisal, clinical nurses at levels II, III, and IV come prepared to verbally reflect on practice using examples of care that highlight excellence at their practice level.

Research shows the most important issue for clinical nurses is working with competent peers. Reflective practice and peer review are two program components that leverage the expectation for clinical competency and patient safety.

Mentorship is another essential element of UEXCEL. …

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