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

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


1
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

2
Questions?
  • Please email any questions during or after the
    presentation to jstanley_at_aacn.nche.edu

3
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

4
USA CNL Program
  • Two Tracks Advanced Generalist (MSN)
  • Accelerated Blended courses
  • Traditional RN BSN
  • RN to MSN

5
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

6
USA CNL Program
  • Course Content Concepts
  • Complex adaptive systems
  • Change
  • Microsystems
  • Relationship-based care
  • Patient-centered care
  • Collaboration

7
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

8
USA CNL Program
  • Course Work
  • CNL Curriculum Framework
  • Pathology
  • Pharmacology
  • Health Assessment
  • AACN Guideline Recommendations
  • http//www.aacn.nche.edu/CNL/pdf/curricfrmwrk.pdf

9
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

10
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

11
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)

12
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

13
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

14
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

15
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

16
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

17
CNL Experience
  • The goal of addressing these issues was to
    increase
  • Safety
  • Accountability
  • Visibility
  • Efficiency

18
CNL Experience
  • Safety
  • Put medical-surgical nurse back at the bedside
  • Patient centered
  • RN responsible for
  • Medication
  • Treatments
  • Education

19
CNL Experience
  • Accountability
  • Improving nurse-to-nurse communication
  • Involve patient and family in care
  • Involve RN, patient, and family in discharge
    planning

20
CNL Experience
  • Visibility
  • Improve communication with patient and family
  • Improve healthcare team communication
  • Increase patient safety

21
CNL Experience
  • Efficiency
  • Give nurses more time with the patient and family
  • Improve documentation

22
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

23
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

24
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

25
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)

26
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

27
Questions
Please email your questions to jstanley_at_aacn.nche.
edu
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