In 2008 Amanda L. Stefancyk, MSN, MBA, RN, began a yearlong fellowship program with the American Organization of Nurse Executives (AONE). Stefancyk was one of 30 nurse managers or directors chosen to participate in the inaugural year of the fellowship. The fellows attended meetings throughout the year and kept in touch through e-mail and phone calls. Stefancyk says the fellowship enabled her to network with gifted managers and directors, some of whom had different experiences and faced different challenges. It was a supportive group, and they contributed to each other's learning.

As a separate initiative, the AONE is leading the current expansion phase of Transforming Care at the Bedside (TCAB), which involves 67 hospitals. Another AONE fellow, Amy Lussier, BSN, RN, of San Jacinto Methodist Hospital in Baytown, Texas, also is involved in the TCAB initiative.

Stefancyk feels that she has grown as a leader through both the AONE fellowship and her involvement with TCAB. The TCAB initiative is much bigger than anything she had done before. She's gained confidence that she can manage a project of this scope.

The underlying concept of TCAB is for front-line staff and unit-based leaders to become engaged in generating ideas for change and in making the change happen. The TCAB process isn't just about a single change. It's about the process of change, the journey. TCAB is about empowering staff; Stefancyk has seen how her staff has become more confident as they have engaged in the TCAB process.

Many of the nurses on Stefancyk's unit have become champions for the TCAB initiative and have attended national conferences where they demonstrated their new skills. For example, a staff nurse went with Stefancyk to a national AONE meeting and made a storyboard presentation about how they moved supplies to the bedside. She explained the problem they were trying to address, how the change was made, and their evaluation of it. It was the first time this staff nurse had made such an important presentation, and Stefancyk says she was excellent.

A medical-surgical unit historically is thought of as a stepping-stone, a place to start before moving to a specialty. Stefancyk and her team are trying to emphasize that medical-surgical nursing is a specialty in itself, so that nurses see the unit as a place that can be continually challenging. Nurses on this unit are the experts who are going to be teaching other nurses in the hospital about TCAB.

Laurie Lewis

freelance medical writer, New York City