Clinical Nurse Leader: University of South Alabama, College of NursingUniversity of South Alabama Me

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Clinical Nurse Leader University of South
Alabama, College of Nursing/University of South
Alabama Medical Center

• Ann Brown, RN, MSN
• Stephanie Brown, RN, MSN
• Rebecca Pomrenke, RN, MSN, CCNL
• Linda Roussel, RN, DSN

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Questions?

• Please email any questions during or after the
  presentation to jstanley_at_aacn.nche.edu

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Why a CNL?

• Get better patient outcomes with the scarce
  resources available
• Get better outcomes with fewer
• Better utilize nurses to the full scope of their
  knowledge and skills
• Retain nurses in the profession
• Recruit highly qualified candidates to the
  profession

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USA CNL Program

• Two Tracks Advanced Generalist (MSN)
• Accelerated Blended courses
• Traditional RN BSN
• RN to MSN

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USA CNL Program

• CNL White Paper Guided Program Development
• http//www.aacn.nche.edu/CNL/CNLpubs.htm
• AACN End of Program Competencies
• http//www.aacn.nche.edu/CNL/pdf/EndCompsgrid.pdf
• Funded grants
• Consultation

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USA CNL Program

• Course Content Concepts
• Complex adaptive systems
• Change
• Microsystems
• Relationship-based care
• Patient-centered care
• Collaboration

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USA CNL Program

• Course Content Concepts (Cont.)
• Theory-based (CAS, Queing, Change,
  Relationship-centered care)
• Evidence-based Practice
• Quality Improvement
• Care Provider
• Leadership
• Communication
• Lateral Integrator

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USA CNL Program

• Course Work
• CNL Curriculum Framework
• Pathology
• Pharmacology
• Health Assessment
• AACN Guideline Recommendations
• http//www.aacn.nche.edu/CNL/pdf/curricfrmwrk.pdf

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USA CNL Program

• Clinical Immersion Experience
• Two clinical courses
• 300 (out of 400-500 hours)
• Immersed in the CNL Role
• Precepted experience with cadre of mentors
  including Nurse manager, nurse educator, QI, PI
• Preparation for CNL Certification

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USA CNL Program

• Clinical Immersion Experience 2 semesters
• Learning Experiences (Sample Assignments)
• Needs Assessment (Models, Theories guide
  assessment)
• Workflow Analysis
• Gap Analysis
• Interviews with stakeholders and strategic
  partners

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USA CNL Program

• Clinical Immersion Experience 2 semesters
  (Cont.)
• Data driven
• Readiness for change
• Evidence-based practice guidelines
• Test of change (Proposed change)
• Process and outcome measurement
• Evaluation of change (metrics, quality
  indicators)

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USA CNL Program

• Clinical Immersion Experience
• Setting up contracts with preceptor(s)
• Reviewing course and clinical objectives
• Working with system at microsystem level
• Meeting with preceptor(s) on regularly, scheduled
  basis
• Sharing findings, possible project plans
• Meeting with stakeholders to present plan
• Implementation of plan

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USA CNL Program

• CNL Students Experiences
• Successes
• Lessons Learned
• Future Plans
• CNL job description
• http//www.aacn.nche.edu/CNL/pdf/examplejobdescrip
  tion.pdf
• Next Steps

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CNL Experience

• Prior to starting CNL track worked in the Burn
  ICU for 10 years
• Had worked with Stephanie and Ann on various
  committees and projects
• Had achieved the highest level of the hospital
  clinical ladder program
• When not staffing was always getting involved in
  issues to improve patient care

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CNL Experience

• When CNL program was introduced to me it was an
  extension of the work I was already doing
• I had been pulled to staff on the 6th floor many
  times and respected the work the nurses did there
• I also empathized with the issues they were
  having related to staffing, stress levels, and
  patient acuity

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CNL Experience

• When I started the immersion project I identified
  many issues but with the time I had I focused on
  4 issues
• Location of supplies and linens
• Care delivery system
• Difficulty reaching physicians, time spent
  getting to the phone
• Documentation issues, shift summary and change in
  status

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CNL Experience

• The goal of addressing these issues was to
  increase
• Safety
• Accountability
• Visibility
• Efficiency

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CNL Experience

• Safety
• Put medical-surgical nurse back at the bedside
• Patient centered
• RN responsible for
• Medication
• Treatments
• Education

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CNL Experience

• Accountability
• Improving nurse-to-nurse communication
• Involve patient and family in care
• Involve RN, patient, and family in discharge
  planning

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CNL Experience

• Visibility
• Improve communication with patient and family
• Improve healthcare team communication
• Increase patient safety

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CNL Experience

• Efficiency
• Give nurses more time with the patient and family
• Improve documentation

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CNL Experience

• A lot of the research and best practice evidence
  was based on the work of Transforming Care at the
  Bedside (TCAB)
• After implementing the changes on the 6th floor
  the opportunity to participate in the National
  TCAB Project became available
• Applying for the grant was an easy decision for
  the Medical Center
• It was the perfect way to assist us in our quest
  for excellence

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CNL Experience

• Since we were excepted to participate in TCAB I
  am the project coordinator
• I also am responsible for all of the data
  collection required and working with both the
  TCAB floor and the control group
• I work in conjunction with Stephanie, the Unit
  Educator and administration

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CNL Experience

• I am also working with staff development and the
  College of Nursing in training our Nurse Response
  Teams on the patient simulator
• Through a TCAB initiative I have also identified
  the need for better pain control protocols for
  our surgical patients
• I am currently tracking the pain call light data
  and finding evidenced based practices to work
  with the physicians on pain control

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CNL Experience

• I sat for the certification exam in August of
  2007
• I passed the exam! I am currently certified as a
  CNL
• The exam scenarios were easier for me related to
  my prior work experience, it allowed my to really
  dive into the problem
• The multiple choice section was more difficult
  related to my tendency to over analyze things
  (good for CNL role)

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CNL Experience

• I started in the CNL role full-time in September
• The job description and pay scale had to be
  written and approved for this new role
• The White Paper was the guide for the job
  description as well as the vision the Medical
  Center had for the evolution of the role

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Questions
Please email your questions to jstanley_at_aacn.nche.
edu