Advanced Clinical Practice Fellowships

Building Leadership at the point of care to develop a healthy working environment


The organization, Geraldton District Hospital, is a rural hospital consisting of 20 inpatient Acute Care beds, 26 Long-Term Care beds and a 9 bed Emergency department that provides chemotherapy services. Although the organization is small the services provided are vast, including cardiac, mental health, obstetrics, pediatric, geriatric, post operative, general medicine, palliative, and critical care. 

Due to the small size of the hospital and its rural location Geraldton District Hospital experiences its own realm of challenges in health care due to its small community and restricted resources. Throughout my 8 years working at the hospital based on my own personal experiences, experiences of my coworkers and demonstrated by staff survey results a theme had been developed established a need to improve the culture and working environment between staff throughout the hospital. The fellowship program involved all staff including all nursing, allied health professionals and support services from the Acute Care, Long-Term Care, Emergency, and outpatient departments in enhancing leadership qualities and techniques to improve the working environment and reduce violence, harassment, and bullying in the workplace through educational sessions and developed resources. Management was also involved in educational sessions due to the nature of their leadership roles and for learning to be indirectly disseminated throughout the organization as the new expectation of the working environment.  To create change within the working environment throughout the hospital, change needs to occur within each department as each department is interdependent. Background knowledge was gained to thoroughly understand concepts of leadership, bullying violence and harassment and conflict management as well as the importance of compassion in health care. An in-depth staff survey was conducted throughout the organization to determine specific areas of need of the organization that required development or improvement. Educational and development sessions were held for all staff to work on the specific areas of need based on the survey results to create change for improvement in these areas and work toward a healthy, positive working culture throughout the organization. The fellowship was a hospital wide project to create a healthy working environment and reduce incidents of workplace bullying harassment and violence.

The fellowship provided a great opportunity which allowed me to gain a broad range of skills, knowledge and expertise related to many aspects of leadership, workplace environment and bullying, harassment, and violence.  When developing the learning plan and applying for the fellowship the big question I wanted to solve or understand better was “How leadership at the point of care effects workplace culture and atmosphere and does it contribute towards bullying, harassment, and violence?” In order to answer this question, I had to fully understand each of these concepts. A thorough level of knowledge was gained regarding leadership and the impact a transformational leadership style within work environments. Knowledge was also gained, bullying, harassment, and violence as well as conflict management. Skills for identifying bullying, harassment, and violence as well as effective strategies and conflict mitigation techniques for implementation within the organization were also developed throughout the fellowship.  A substantial amount of knowledge was gained on the importance and profound impact compassion has within healthcare including its benefits for patients, healthcare workers and the health system. The fellowship advanced my skills and attributes within my nursing practice by learning to facilitating change and develop successful strategies for motivating and sustaining change within the organization. Leadership skill development occurred as I determined how to feedback difficult information to the organization in order to create forward momentum and motivate all staff towards achieving the goal of a positive working environment. Learning to effectively disseminate learned knowledge through the creation of engaging activities for staff learning and development towards leading and sustaining the desired change. Throughout this process gaining confidence in knowledge sharing and coaching and mentoring point of care leadership skill development with my fellow staff. Presentation and public speaking skills were developed through leading educational sessions with staff which further developed confidence and positioning myself as a leader, resource and mentor relating to leadership, bullying violence and harassment and conflict management.


There are many benefits developing a healthy work environment and reducing bullying, violence and harassment within a health care organization can have on its patient and client population. Due to the nature of the fellowship some beneficial outcomes for the patient population are delayed as creating change in a workplace environment develops over time. Immediate changes that occurred after educational sessions with staff were seen in focused areas of communication, which translated into improved care for patients. When communication was improved between departments, patients were provided clear and correct instructions from regarding the department’s services provided a smooth transition of care for patients accessing outpatient services. With time for allow change to occur and continued work on improving the working environment within the organization their will be an increase in positive outcomes for patients. Increased compassion between health workers translates into increased compassion for patients improving levels of patient centered care and reducing errors and adverse events. This will result in higher client satisfaction scores on client surveys and an improved community view of the organization. Again, this type of change takes time but at this point we are starting to see small improvements in important areas like communication which is leading towards efficient patient care and will contribute towards creating greater patient outcomes in the future.

The fellowship was highly focused on the interactions between staff throughout the organization therefore there were great outcomes experienced among colleagues because of the fellowship. Staff were able to see results of the survey which pinpointed key areas of need for development and gaining a greater understanding of these areas for improvement and what underlying factors may be causing them. Staff were able to voice their experiences and concerns and be reassured that the organization is working towards improving the desired needs to create a healthy working environment for all. Staff from each department throughout the organization participated in activities to develop and encourage a change in culture, develop leadership at the point of care, build relationships and trust and determine appropriate meaningful means of recognition. Overall staff were highly participative and engaged when completing the survey and in workshop sessions as they felt this work was meaningful to them as a member of the organization. Workshop session evaluations on multiple occurrences had comments such as “This is exactly what this organization needs”. Current outcomes for staff include increased positive communication between colleagues, problem solving by means of discussion and increased teamwork. All areas of which in time with continued use will contribute towards a positive culture and healthy working environment as the norm within the organization. Specific staff members have taken a leadership approach by showing their interest in being park of a working group to continue to work towards creating and sustaining a healthy working environment.  All staff were given guidance on how to continue to improve and sustain a newly developed healthy working environment in the future. In addition, there is a plan in place to continue the work and goals of the fellowship by having additional workshops working on further areas of need including communication, conflict management and teamwork. With the work that has been completed during the fellowship and the plan to continue this work in the future I am confident in the development and sustainability of a positive working culture within the organization which will be demonstrated by staff recruitment and retention.

Overall experience

The Advanced Clinical Practice Fellowship provided an amazing experience rich in opportunities for learning and development. I am more than grateful to have had this experience and the amount of personal growth and development it has provided me. The fellowship allowed me to stretch my knowledge and skills as a Registered Nurse working in patient care areas towards an avenue of research and project development and implementation.  I have gained a greater understanding of the challenges of project development and of creating sustainable change within an organization. With the support of my mentors to develop and position myself as a leader and role model within the organization and creating impactful change for all staff. My favourite moment within the fellowship was being able to connect with my fellow colleagues on a meaningful level, to show them they are not alone in the challenges they may be facing and give them a voice for change. During workshops watching staff make the connection with the information I was sharing and how it affects them and instantly having them become engaged and participate in discussions and activities for growth and development was the upmost best part. Seeing the positive change in my staff through their motivation and active participation encourages and motivates me to continue this work within the organization as change takes time, and the need remains. Overall, it was a beautiful experience to have a vision, set out a goal, demonstrate a need and have others believe in and work towards achieving the same goal towards creating positive change within the organization. I said multiple times throughout the fellowship process “This is the hardest thing I have ever done”, but this experience provided the most growth, learning and has been extremely rewarding on both personal and professional levels. I am dedicated to continuing this effort to sustain positive change for my fellow staff as I continue to develop myself as a leader and as a Registered Nurse for my team, my patients, and my community.