Role of the Clinical Nurse Leader

1
UPMC HEALTH SYSTEM

• Role of the Clinical Nurse Leader
• Experience from the field

2
University of Pittsburgh Health System

• Integrated health care delivery system
• 20 hospitals ranging from an academic medical
  center to small rural hospitals
• 35,000 employees
• 6000 nurses

3
A Case for Change Major Driving Forces

• Patient demand exceeding nursing supply
• More complex, high risk patients who require
  exquisite nursing expertise
• Need for improved continuity across the continuum
  of care
• Numerous broken systems that require clinical
  leadership and intervention
• Competency levels of new graduates

4
Emergence of the PNCC role

• Based on our Professional Practice Model
  (Transformational Model)
• BSN or above required
• 3-5 years experience
• Demonstrated competency as an expert clinician
• Demonstrated leadership skills

Manager
PNCC
Staff
5
Requisite behavioral skills

• Ability to plan and organize
• Ability to mentor and develop others
• Adaptability
• Good analytical skills
• Good interpersonal skills
• Good communication skills
• Initiative
• Strong customer service orientation
• Tolerance for stress
• Conflict management skills

6
Role of the PNCC

• Manages a case load of 15-20 patients
• Facilitates the assessment, planning,
  interventions and evaluation of patient care
• Facilitates the smooth coordination of care
  across the continuum
• Ensures that clinical resources are utilized in
  the most effective manner
• Evaluates issues, trends, etc. within the patient
  population
• Serves as an expert clinical resource to members
  of the health care team

7
Outcomes

• Less fragmentation of patient care
• Significant decrease in length of stay
• Improved patient satisfaction
• Improved physician satisfaction
• Nurses enjoy the role minimal turnover or
  vacancies

8
Educational Development

• Basic leadership skills
• Planning and decision making
• Communication skills
• Improving staff performance
• Coaching staff
• Conflict resolution
• Delegation
• Creating a service culture
• Innovation and change
• Time management
• Basic healthcare economics

9
Next stepsEvolution of the Role

• In smaller community hospitals, Advanced Practice
  Nurses have been utilized in this role and also
  serve as physician extenders
• Recently pilot tested merging the PNCC role and
  the Case Manager role into a Primary Care
  Coordinator role with good results.
• Plans to implement the role in home care and long
  term care facilities

10
Lessons learned

• Can work in all different types of organizations,
  but looks a little different in each
• Flexibility is key
• People revert to what they know (e.g. charge
  nurse)
• This is a different role that must be constantly
  reinforced
• The organizational sell is both clinical and
  financial
• Partnering with the medical staff
• Budgeting at least some non-direct time

11
CNL Issues to be addressed

• What level of preparation will be required?
• How do we develop this level of expertise
  without actual clinical experience beyond a
  student experience?
• How can we merge academics and the real world
  that this role will encounter?
• How can we integrate our advanced nurses and
  faculty? Can we learn from the medical model?
• What can we eliminate from the curriculum in
  order to add the requisite leadership skills
  necessary for this role?