Clinical Nurse Leader

1
Clinical Nurse Leader
Preparation A Practice Partner Perspective

• Hartford Hospital/Sacred Heart UniversityConnecti
  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

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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut 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

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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut 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)

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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut 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

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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut 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.

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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut 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.

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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut 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.

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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut 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.

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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut 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)

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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut 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
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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut Practice Partners,
2006

• Drs Laura Caramanica and Joanne Roy publish
  article (2004)
• Leadership The Clinical Nurse Leader
• One Hospitals Experience

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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut 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

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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut 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.

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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut 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

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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut 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

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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut Practice Partners,
2006

• Shared Governance

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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut Practice Partners,
2006
Computer Skills (Communication)
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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut Practice Partners,
2006
Role-Modeling Collaboration
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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut Practice Partners,
2006
Role-Modeling Critical thinking
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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut Practice Partners,
2006
Evidence-Based Practice
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Growth and Development of Self/Others
Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut Practice Partners,
2006
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Managing Quality Improvement Data
Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut Practice Partners,
2006
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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut 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

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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut 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.

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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut 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.

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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut 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

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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut 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

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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut 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 LeaderHartford HospitalSacred
Heart UniversityConnecticut 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

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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut 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.

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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut Practice Partners,
2006

• Master of Science in NursingClinical 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
  leaderto promote safe, high quality, and cost
  effective care in any healthcare setting.

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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut 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

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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut 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

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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut 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 LeaderHartford HospitalSacred
Heart UniversityConnecticut 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

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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut 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

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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut 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

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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut 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)

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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut 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.

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Clinical Nurse LeaderHartford HospitalSacred
Heart UniversityConnecticut 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 LeaderHartford HospitalSacred
Heart UniversityConnecticut 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.

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Questions?

• Please email Joan Stanley at jstanley_at_aacn.nche.ed
  u