Laura Caramanica - American Association of Colleges of Nursing

1/16/2015
Clinical Nurse Leader
Laura Caramanica RN PhD CENP FACHE FAAN
Vice President/Chief Nursing Officer
Wellstar Kennestone Hospital
Clinical Nurse Leader
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In 2007, ANCC Board of Directors approved a white paper on “The
Education and Role of the Clinical Nurse Leader “
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Shortly after, a demonstration project across the nation was convened
whereby through a strong academic & service partnership the development
and implementation of the CNL role would take hold in the field
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While this unfolded with professional debate and no clear road map on how
to do this; approximately 50 A&P partnerships in many states across the
nation came together as a collaborative to create this new role in nursing
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Connecticut’s Hartford Hospital and Sacred Heart University teamed up to
produce the 1st CNL in that state
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Today, the need for the CNL role is even more obvious given the growing
and changing complexity of health care delivery
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While the initial competencies of this new nursing role were well identified,
these have been revised and updated
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WellStar Health System is a not-for-profit system recognized as a national leader in
comprehensive care. Staying ahead of the curve in technology has enabled WellStar to be
leaders in both the diagnosis and treatment of an extensive array of health conditions.
Serving a population of more than one million residents of NW metropolitan Atlanta,
WellStar consistently looks at total patient wellness and works to ensure that all systems
support that focus.
Specialists and primary care providers work in a multi-disciplinary environment with more
than 12,000 diverse team members throughout our five hospitals and physician offices. By
working through a patient-centered model of care, WellStar places enormous value on
quality and safety with many accolades to support our work.
Each year, more than 600,000 of our neighbors receive world-class service at a WellStar
facility.
WellStar’s Vision:
To deliver world-class healthcare.
WellStar’s Mission:
To create and deliver high quality hospital, physician and other healthcare related services that improve the
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health and well-being of the individuals and communities we serve.
Clinical Nurse Leader
WellStar
Kennestone
Regional
Medical
Center
• 633 licensed beds
• 66 bed Emergency Department (ED) with more than 120,000 visits a year
• 35 ambulatory sites
• Level III neonatal intensive care unit
• Level II trauma center
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1/16/2015
Clinical Nurse Leader
• MSN program is 100%
asynchronous on line program
• The program tracks are
Nursing education and health
systems leadership which
includes nursing leadership
and Clinical Nurse Leader
roles.
The University of West Georgia Tanner
Health System School of Nursing
• Post masters certification In
CNL role is also offered
• Approximately 100 MSN
students and 1/3 CNL
Students
Clinical Nurse Leader
• Partnership between WellStar Health Care System &
University of Western Georgia (Began in 2011)
• To fully implement WellStar Nursing’s 5 Star Professional
Practice Model thereby enabling clinical nurses to think
critically & to ground their practice in evidence along with the
adoption of all forms of technology
• Provide leadership for the transformation of the delivery of
care at the micro system level through strong
interprofessional teamwork and collaboration
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1/16/2015
Clinical Nurse Leader
Clinical Nurse Leader
• Over three (3) years, 30 CNLs and student CNLs are in 4 of
WellStar Health System (WHS) hospitals
• First two (2) CNL cohorts had education fully funded by
WHS
• Third (3rd) cohort currently orienting / immersion with CNL
mentors in 3 WHS hospitals
• Introduction and the “why” to implement the CNL has been
explained at unit, medical & department meetings as well as
local and now national presentations
• Interest has been generally about “How are you measuring
their impact / what outcomes can you attribute to this new role
in nursing at WellStar?”
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1/16/2015
Clinical Nurse Leader
Core Competencies
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Critical thinker
Generalist & manager of
clinical care
Coordinator of care & care
transition
Leads & advocates for
patient care
Translates evidence into
practice
Leverages technology to
support clinical care &
patient care outcomes
Role model & mentor for the
nursing profession
Active member of profession
& continuous learner
Clinical Nurse Leader
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Positioning CNL s for
Success
Develop a strong
Academic /Service
partnership
Obtain leadership support
on both campuses
Communicate what this
new role can do for the
health setting & establish
measures of success
Appoint executive
sponsors on both
campuses and enroll
strong candidates for this
role
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1/16/2015
Clinical Nurse Leader
1st Cohort
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Benefited from the foundation that was developed in the field by early
adopters
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Planning sessions held to finalize the curriculum and to enroll the first
cohort of student CNLs
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Information sessions jointly to inform prospective students about this
new masters prepared nursing role
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Regular steering meetings held to enable faculty and hospital nursing
leaders to synchronize the launch of this new initiative
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Ongoing feedback from CNL students were solicited in class and
during the clinical practice immersions to enable their success
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Continuous means for feedback including this past fall conducted a
“retreat” to assess implementation/outcomes – bought together
faculty and service leaders with all 3 cohorts of CNLs
Clinical Nurse Leader
Subsequent CNL Cohorts
• Benefited as well from the learnings from the field and from
our 1st cohort’s experience
• CNL students now able to be mentored by CNL graduates
during their immersion
• CNL graduates however remain in various stages of
establishing their own new role identity & implementation
• One of the foundational steps CNLs must do is develop a
strong partnership model with their Nurse Managers &
establish their clinical leadership role within their specialty
interprofessional health care team
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Clinical Nurse Leader
CNL as Student
• Model A (BSN to enroll) and a model E ( Post
masters certificate )
• The full program is 36 credits, full time is 4
semesters, part time is 6 semesters.
• 100 % online.
• University of Western Georgia is recognized by
US News and World Reports as one of the top
100 on line nursing programs
Clinical Nurse Leader
Transition from CNL Student to CNL Graduate
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1/16/2015
Clinical Nurse Leader
Introduction into Practice
• Provided formal and
informal discussions on
what is a CNL and
summary of their role &
responsibilities
• Attended monthly CNL &
NM Dyad partnership
meetings at each facility
and at the system level to
vision role & develop role
responsibilities
Clinical Nurse Leader
Introduction into Practice cont.
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Participated in the revision of
their proposed job description
Enhanced their role
accountabilities
Aligned their contribution in
conjunction with WellStar’s 5
Star Professional Practice
Model
Identified their role’s outcome
measures for success
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1/16/2015
Clinical Nurse Leader
Day in the Life
Attendance at
Hospital-wide
Safety Huddle
Clinical Nurse Leader
Day in the Life cont.
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Exempt employee / 5 days a week -key role in assuring continuity of
care
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Mornings begin with a review of progress notes, making rounds
speaking with the staff, patients, and the unit’s hospitalist
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Prepare clinical nurses for collaborative bedside rounds (CBRs)
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In collaboration with the Hospitalist, assemble the IHCT to develop
patient’s plan of care with the patient; review the patient’s progress;
solidify goals & treatments; and facilitate the patient’s transition to
another level of care or discharge
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Provide for coordination of care across the continuum
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Role model professional nursing practice
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Lead PI projects & serve as mentors for staff seeking clinical
advancement or for new grads engaged in their EB Projects.
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1/16/2015
Clinical Nurse Leader
Day in Life cont.
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Ensure core measures and other value based purchasing
requirements are tracking as required using sophisticated electronic
dashboards
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Participate on hospital-wide committees and taskforces to develop
and improve clinical processes of care
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Credentialed in yellow and green belts six sigma and lean
methodology, lead interprofessional Kazan initiatives with black belt
professionals
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While they do not carry a direct patient care assignment, provide
highly visible clinical leadership supporting clinical nurses and other
members of the health care team in partnership with the NM (no
office but designated work space & computer)
Clinical Nurse Leader
Monthly CNL/NM Dyad Meetings
• Attendees include CNL/NM Dyads; Director of
Quality; PI Specialists; CNO; & selected guests
• Overview of focus topic of the month
• CNL/NM Dyad reports (rotation of group reports)
• Standardized reports submitted ahead of
committee meeting/facilitated by CNO
• Tracking outcome measures/sharing best
practices
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1/16/2015
Clinical Nurse Leader
Team: __________ & ____________
INTRODUCTION
AREA OF PROFESSIONAL PRACTICE:)
DESCRIPTION OF THE INITIATIVE as listed
above.
RESULTS/ OUTCOMES
Clinical Nurse Leader - Dashboard
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1/16/2015
Clinical Nurse Leader
Monthly System-wide CNL Meetings
• Attendance of CNLs (and student CNLs) across
the system
• Facilitated by designated experience CNL
• Deliberation on the role & impact of the CNL role
• Developing a repository of CNL initiatives and
tracking quality & financial measures of success
Clinical Nurse Leader
CNL Retreat
(Day of Dialogue)
• Review of history of CNL role at WellStar
• Results of pre CNL & NM Survey on how the implementation
is going & sharing of early success stories
• Identification of barriers that still need addressing
• Deliberation on how to reduce variance of the role across the
system
• Further need to advocate for the role and its expansion
• CNL need for further skill in managing a change process
• Desire to standardization of dashboard and measures of
success
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1/16/2015
Clinical Nurse Leader
Early Measures of Success
Professional Practice Model
• Strengthen unit-based shared governance
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• Enhancing the clinical nurse’s role and contribution to Clinical
Bedside Rounds & Bedside Shift Report & Hourly Rounding
• Mentoring nurse for Clinical Advancement and new grads with
their EB Projects
• Contributing to increasing the number of nurses who are
certified; publishing; participating in returning to school for
advanced degrees; use of evidence base practice and the
adoption of technology at the unit level
• Promotion of Interdisciplinary Collaboration at the unit-level
Clinical Nurse Leader
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Improvement in HCAHPs Scores
Reduction of Cautis
Reduction of CLASBIs and other HAIs
Improved documentation of VTE
Served as “cyberstars” for our EPIC build, rollout and
enhanced documentation
Improvement in 2 pm Discharges and decrease in readmission
rates
Improved Central Line Insertion & Care
Reduction in Hypoglycemic Events
Reduction in Door to Balloon time
Leadership for Kazan and other PI Initiatives
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1/16/2015
References
• American Association of Colleges of Nursing. (2007). White paper on
the Clinical Nurse Leader role. Retrieved January 12, 2012 from
www.aacn.nche.edu/CNL/
• CNL Webinar: Clinical Nurse Leaders' association: Susan Ottenfeld,
Jesse Brown VA Medical Center, Chicago, Illinois, September 24,
2010
• Tornabeni , M & Miller, J. (2008, July). The power of partnership to
shape the future of nursing: the evolution of the clinical nurse leader.
Journal of Nursing Management, 16 (5), 608-613. doi: 10.1111/j.13652834.2008.00902.x
• James L. Harris & Linda Roussel. Initiating and Sustaining the
Clinical Nurse Leader Role, A Practical Guide. (2010) Jones and
Bartlett Publishing, Sudbury, Massachusetts.
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