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Clinical Nurse Leader

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Clinical Nurse Leader. Hartford Hospital/Sacred ... of new RN, Clinical Leader Role (RN ... New hires to RN, clinical leader role are oriented through core ... – PowerPoint PPT presentation

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Title: Clinical Nurse Leader


1
Clinical Nurse Leader
Preparation A Practice Partner Perspective
  • Hartford Hospital/Sacred Heart University Connecti
    cut Practice Partners, 2006
  • Laura Caramanica, RN, PhD Vice President,
    Nursing
  • Joanne Roy, RN, PhD Nurse Educator
  • Hartford Hospital, Hartford, CT

2
Reminder
  • Please send all questions via email to Joan
    Stanley at jstanley_at_aacn.nche.edu

3
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
  • Outline
  • Overview of the Hartford Hospital Patient Care
    Delivery System
  • RN, Clinical leader role at Hartford Hospital
  • CNL initiative
  • Hartford Hospital/Sacred Heart University
    collaborative
  • Sacred Heart University curriculum/class profile
  • Preparation for the transition of CNL role
    accountabilities in practice

4
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
  • Hartford Hospital Patient Care Delivery System
  • 2001-2003 Hartford Hospitals Patient Care
    Delivery Redesign
  • Development of new RN, Clinical Leader Role (RN
    CL)
  • Recognized need for staff nurse leaders to
    collaboratively manage care across the continuum
    on the unit level
  • Need for staff nurse leaders to advance
    evidence-based practice, increase use of
    data/technology, provide clinical leadership at
    the unit level and increase performance
    improvement activities (change agent)

5
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
  • Hartford Hospital Patient Care Delivery System
  • Implementation of the new role as part of
    redesign of patient care system FY2001 3
  • BSN required for advancement to this new role
    accountability (and full time status)
  • Budgeted for 4 RN CL per patient care unit
    (though most units had 2 such roles for the first
    18 months of implementation
  • Required standardization of this new role across
    all specialties
  • New role accountability, competency tool and
    orientation developed

6
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
  • RN, Clinical Leaders identified in practice
  • Every nursing unit was able to identify at least
    one nurse (and in many instances more than one),
    who were influential leaders to their peers.
  • These qualities often surfaced based on personal
    characteristics, circumstances and years of
    experience.
  • As we began to roll out the RN, Clinical Leader
    role, we recognized the need to promote and
    enhance the opportunity for RN, CL to demonstrate
    these leadership qualities in more consistent
    manner. Also prompted opportunity to recognize
    leadership potential early in ones nursing
    career.

7
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
  • Hartford Hospital RN, Clinical Leader Role
    Development and Implementation
  • Dr. Joanne Roy assumes responsibility to develop
    RN, Clinical Leaders including core
    competencies, orientation and ongoing quarterly
    meetings
  • RN, Clinical Leaders continue their development
    and application of their new accountabilities
  • Qualified RNs continue to apply for open (or new)
    positions as they are posted.
  • New hires to RN, clinical leader role are
    oriented through core curriculum which is offered
    annually.

8
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
  • Hartford Hospital - RN, Clinical Leader Role
  • Three basic premises combined to generate the
    development/educational needs of the RN, Clinical
    leader role
  • Leadership is influence (John C. Maxwell)
  • The most influential people, in terms of
    improving direct care provision, are those that
    directly deliver nursing care (Cook, 2001)
  • Nursing leadership has been defined by action.
    This action manifests in the behavior of one who
    is directly involved in providing clinical care,
    continuously improves care and influences others
    (Cook, 2001)
  • Cook, M (2001). The attributes of effective
    clinical nurse leaders. Nursing Standard,
    15(35), 33-36.

9
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
  • RN, Clinical Leader Education
  • Through use of
  • RN, Clinical leader role description
  • RN, Clinical leader role competency
  • Formal education program was developed in the
    form of Introductory Modules.

10
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
  • RN, Clinical Leader Education Modules
  • Core Curriculum Content
  • Clinical leadership
  • Quality care and improvement
  • Mentoring
  • Evidence-based Practice
  • Core Curriculum Process
  • Theoretical session (knowing)
  • Practice session (implementing)

11
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
  • Sample of Current Model of Service Based Nursing
    Leadership including RN, Clinical leaders

Director - Nursing
Nurse Educator
Case Coordinator
APRNs-CNS
Nurse Manager Unit 1
Nurse Manager Ambulatory
Nurse Manager Unit 2
Nurse Manager Unit 3
Outpatient Setting
1 RN Clinical Leader
2 RN Clinical Leaders
2-3 RN Clinical Leaders
3 RN Clinical Leaders
4 RN Clinical Leaders
of staff of patients
of staff of patients
of staff of patients
of staff of patients
of staff of patients
12
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
  • Drs Laura Caramanica and Joanne Roy publish
    article (2004)
  • Leadership The Clinical Nurse Leader
  • One Hospitals Experience

13
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
  • Leadership The Clinical Nurse Leader, One
    Hospitals Experience
  • Description of the Role as it was created out of
    Hartford Hospitals Patient Centered Care
    Redesign (2001 -3)
  • Identification of the need for this new role
  • Description of the educational program provided
    for nurses assuming this new role accountability
  • How this role advancement was not a new clinical
    ladder program
  • Key responsibilities of the RN CL
  • Enhancing opportunities for clinical leadership
    among nurses at the point of service (patient
    care unit)
  • Plans to evaluate role and implementation

14
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
  • Evaluation of the RN Clinical Leader Role (2004)
  • Purpose To determine to what extent this role
    has been implemented and to measure
  • To what extent do the RN CL engage in new role
    activities
  • Compare this to how much they performed these
    activities prior to the implementation of their
    new role
  • Describe to what extent they made advances or
    improvements in clinical practice on their unit.

15
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
  • RN Clinical Leader Survey Items
  • Behaviors under each category derived from
  • RN Clinical Leader Role Description
  • RN Clinical Leader Competency
  • RN Clinical Leader Peer Review tool
  • RN Clinical leader discussions

16
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
  • Summary of findings
  • Seven Categories of Role Accountability
  • Shared Governance
  • Proficiency in computer skills (communication)
  • Role-modeling collaboration
  • Role-modeling critical thinking
  • Evidence based practice
  • Growth and development of self and others
  • Managing data and information for Quality
    Improvement

17
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
  • Shared Governance

18
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
Computer Skills (Communication)
19
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
Role-Modeling Collaboration
20
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
Role-Modeling Critical thinking
21
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
Evidence-Based Practice
22
Growth and Development of Self/Others
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
23
Managing Quality Improvement Data
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
24
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
  • Significant change in most accountabilities
  • Theme unit based initiatives incorporated into
    daily practice
  • Examples
  • Acting as chair person of unit based council
  • Collaborating with nursing peers across patient
    care specialty services
  • Promoting use of critical thinking
  • Raising Evidence-based inquiries in daily
    practice
  • Mentoring staff
  • Conducting QI audits and leading unit based QI
    projects

25
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
  • No Significant changes noted.
  • Theme High level of participation pre-role
  • (unit-based)
  • Precepting new staff
  • Theme Low level of participation pre-post role
    (off-sight activities)
  • Sponsoring clinical topic for HH roundtable
  • Presenting at yearly at a research conference.

26
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
  • Next Steps to the Evaluation of RN, Clinical
    Leader role
  • Evaluate accountabilities in terms of impact to
    determine those which should be
    maintained/eliminated/altered.
  • Establish need for new role accountabilities
    based on qualitative data including Focus groups
  • Use this data to guide the development and the
    transition to the Clinical Nurse Leader as
    defined AACN proposal.

27
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
  • American Association Colleges of Nursing
  • Announces for public feedback white paper on
  • New Clinical Nurse Leader Role (May 2003,
    Revised June 2004)
  • Drs. Caramanica and Roy review the Similarities
    and Differences of AACN/CNL and the newly created
    HH/RN CL in their Hospital-wide Redesign

28
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
  • AACN Clinical Nurse Leader/HH RN, Clinical leader
  • Similarities
  • S Functions within clinical microsystems
    (nursing units)
  • S Coordination of care across continuum
  • S Evidence Based Practice
  • S Process Improvement
  • S Communication, Collaboration, Negotiation,
    Relationships
  • S Information technology
  • S Quality of patient care
  • S Clinical nurse leader competencies
  • S Change management
  • S Mentoring and supporting staff in patient
    care
  • S Professional advancement of nurses

29
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
  • AACN Clinical Nurse Leader/HH RN, Clinical Leader
  • Differences
  • D Different education requirement (HH/BSN
    AACN/Masters)
  • D Title (HH/RN CL AACN/CNL)
  • D Clinical expertise in specialty population
    followed by Generalist education (HH/RN CL)
    Generalist education applied to cohort of patient
    (AACN/CNL)
  • D Initially envisioned to be a strong
    partnership between the Nurse Manager and this
    new role to meet unit staff (and patient) needs
    from a clinical perspective
  • D Counted in numbers for providing patient care
    (HH/RN CL)

30
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
  • Hartford Hospital/Sacred Heart University
    Partnership
  • Hartford Hospital and Sacred Heart University
    agree to consider partnership on the development
    of the new Clinical Nurse Leader Role (2004) and
    attend AACN offering on the same days
  • Initially 3 other partner Hospitals and
    Universities in the state explored this
    opportunity attending the offering together and
    meeting later to form a team to develop a CT
    Partnership for purposes of developing and
    standardizing the project in CT
  • Personnel changes in these Hospitals and
    Universities narrowed the team to two remaining
    partnerships

31
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
  • Hartford Hospital/Sacred Heart University
    Partnership
  • Hartford Hospital and Sacred Heart University
    team continued to track nation-wide project
    attending other conferences and audio sessions
    describing the project evolution
  • Sacred Heart University Faculty and Hartford
    Hospital Leaders work together to prepared
    educational requirements and to plan for the
    clinical rotation at Hartford Hospital for
    application of new knowledge and role acquisition
  • Spring 2005 Partners began dissemination of
    information on this new role to perspective
    students. Enrolled first students Fall 2005.

32
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
  • Master of Science in Nursing Clinical Nurse
    Leader Track
  • The Clinical Nurse Leader (CNL) is designed to
    prepare RNs with a Bachelors degree for the
    newly designed and evolving role of CNL. The CNL
    is a generalist prepared at the Masters level
    with advanced clinical skills who will be
    responsible for a group of patients in a specific
    patient unit or healthcare setting. The major
    roles of the CNL are expected to be clinical care
    coordinator, outcomes manager, patient advocate,
    educator, information manager, and care team
    leader…to promote safe, high quality, and cost
    effective care in any healthcare setting.

33
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
  • Sacred Heart University
  • MSN CNL Track Plan of Study
  • 12 credits of graduate core courses including
    Health Care Policy and Ethics, Theory and
    Professional Roles, Research, and Evidence-Based
    Practice
  • 9 credits of clinically focused courses including
    Family and Community Context for Health Care,
    Advanced Health Assessment, and Advanced
    Pathophysiology
  • 9 credits of track focused courses including
    Health Management Information Systems, Care
    Management and Resources Across the Continuum,
    Disease Management and Outcomes Assessment
  • 6 credit CNL Role Immersion Practicum
  • CNL TRACK 36 CREDITS
  • A Nursing Administration course and Advanced
    Pharmacology are recommended however, aspects of
    pharmacology are incorporated into various CNL
    courses as well

34
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
MSN CNL Track Current Status and Enrollment
  • Interest in the program has been very high from
    Hartford Hospital and other area institutions
  • The first students were admitted during the
    2005-2006 academic year
  • Details regarding the role immersion course are
    being finalized with Hartford Hospital

35
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
  • Challenges and Benefits unique to HH situation.
  • Challenges
  • Redefining existing RN, clinical leader role
    description to incorporate use of added
    competencies.
  • Address differences in the RN, clinical leader
    role and AACN CNL (particularly those associated
    with patient care assignments) in light of expert
    care givers (budgetary).
  • Address transition/non-transition of present RN,
    Clinical leaders to CNL role and effective use of
    competencies associated with both roles.
  • Address utilization of CNL to full extend of
    their education

36
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
  • Our unique situation Challenges and Benefits.
  • Benefits
  • Many competencies associated with the CNL role
    are being actualized in practice by RN, clinical
    leaders
  • Nurses and staff at HH are familiar with the
    concept of leadership outside the management
    role.
  • Many key players (multidisciplinary) are familiar
    with unit-based clinical nursing leadership role.
  • Components to enhance current role are in place
    through groundwork set by current RN, Clinical
    leader role
  • RN, Clinical leader website for dissemination of
    information
  • RN, Clinical leader established cohorts
    hospital-wide
  • RN, Clinical leader links with outside
    microsystems

37
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
  • Our unique situation Challenges and Benefits.
  • Benefits
  • Core Education for RN, CL new to role
  • On-going orientation modules offered yearly for
    NEW RN, clinical leaders
  • Quarterly meetings for RN, CL engaged in role
  • Examples of topics selected and presented by
    Service Clinical leaders
  • Pain management
  • Diabetes management
  • Stroke management
  • Methods to promote critical thinking among staff
  • Chronic kidney disease
  • Methods to promote patient satisfaction (FISH
    philosophy)
  • Use of information technology

38
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
  • Our unique situation Challenges and Benefits.
  • Benefits
  • Address leadership skills that are portable and
    universal and result in improved patient care
    and health outcomes. These include the ability
    to
  • Research for best practice
  • Bring about a culture change
  • Communication and collaborate in partnership
    approach
  • Motivate and lead in a variety of situations

39
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
  • Benefit Transition Opportunity
  • Nursing as a Profession
  • In order to promote the professional advancement
    and visibility of HH RN, Clinical leaders
    throughout the institution, we are engaging them
    in a new team (and associated subteams) that will
    address the advancement of the nursing profession
    at Hartford Hospital. Subteams include
  • Strategic Planning
  • Corporate Compliance
  • Magnet Standards
  • Evidence Based Practice
  • Recruitment and Retention
  • Information Technology
  • RN, Clinical Leader Role Development (NEW)

40
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
  • Nursing as a Profession
  • RN Clinical Leaders will influence the
    professional practice of nursing at Hartford
    Hospital through these teams.
  • Emerging plans, projects and deliverables will be
    set by teams. There are designated RN, Clinical
    Leaders within each team.
  • Implementation of plans will proceed throughout
    institution. RN, clinical leaders will champion
    unit-based change in patient care and
    professional nursing.
  • Anticipate RN, Clinical Leader Role Development
    team will address the challenges noted earlier.

41
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
  • Evaluation of the CNL Initiative
  • Aware of the recommendations of AACN
  • 1. Costs/financial data
  • 2. Customer satisfaction
  • 3. Quality/internal processes
  • 4. Unique successes
  • Awaiting additional national project
    recommendations prior to addressing evaluation of
    our local partnership efforts.

42
Clinical Nurse Leader Hartford Hospital Sacred
Heart University Connecticut Practice Partners,
2006
  • Next steps for HH/SH partners
  • Proceed with RN, Clinical Leader Development team
    within Practice setting
  • Address recommendations set forth in this
    presentation
  • Attend June 15/16 conference with Academic
    partner
  • Define the details of CNL track coursework
  • Explore potential associated with CNL immersion
    experience from academic and practice
    perspective.

43
Questions?
  • Please email Joan Stanley at jstanley_at_aacn.nche.ed
    u
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