CNL Wall of Fame Welcome to the CNL Wall of Fame! The CNL Wall of Fame is designed to showcase career achievements of CNLs, CNL education programs, and CNL clinical partners. To be featured on the CNL Wall of Fame, e-mail the Commission on Nurse Certification (CNC) a description of your achievement (750 word count maximum) along with a photograph (jpeg format) and release form;  send to CNC’s Director, Tracy Lofty, at tlofty@aacn.nche.edu. Clinical Nurse Leaders · Clinical Partners · Points of Pride ____________________________________________________________________________ CLINICAL NURSE LEADERS 100 Percent Pass Rate for Certification of Michigan’s First Cohort of Clinical Nurse Leaders In January of 2008, Saint Mary’s Health Care in Grand Rapids, Michigan, a ministry organization of Trinity Health, in partnership with the University of Detroit Mercy (UDM), began an initiative to improve patient care delivery. This initiative provided an opportunity for registered nurses to participate in the Clinical Nurse Leader (CNL) master’s degree program. Following an application and interview process, Trinity Health provided full scholarships for 17 students to complete the CNL program. These students had varied nursing experience from bedside nurse to physician consultative services. Through a joint venture between Saint Mary’s Health Care and UDM, the students were provided with education and preparation in care coordination, quality improvement, patient safety, leadership development, and patient outcomes. During the final semester of education, the students were required to complete 300-400 hours in a clinical immersion. Each student was paired with a Masters prepared nurse as their preceptor.  Students learned to facilitate interdisciplinary care within their microsystem. In addition, they worked alongside each discipline to coordinate efficient care delivery. Upon completion of the CNL program in April 2010, all 17 students took the CNL certification exam.  On May 11, 2010, all 17 students successfully passed the exam and are now nationally certified as Clinical Nurse Leaders. This cohort of students represents the first graduating class of Clinical Nurse Leaders within the state of Michigan. After thoughtful consideration by the senior nursing leadership team at Saint Mary’s Health Care, each CNL was assigned to a microsystem. Microsystems represented within the hospital include all inpatient units, the emergency department, the diabetes center, the pain and palliative care service, the psychiatric care unit, and ambulatory clinics. On May 17, 2010, two inpatient units participated in the start of a demonstration project to standardize the model of care delivery with the CNL. Four CNLs have been assigned to these inpatient units to assist the organization in effectively actualizing the CNL role. By July 2010, all CNLs will be practicing within the organization. Cohort Picture: Back (left to right): Mary Harnish, Susan Koons, Carey Johnson, AnneMarie Richmond, Dawn Borreson, Laurie Sayer, Laurie Schwartz, Roberta Wilkes, Kevin Hengeveld, Kristin Van Zweden, Lauran Stuive Bittinger Front (left to right): Becky Parker, Rebecca Valko, Beth Van Dam, Beth Triezenberg, Bridget Graham, Rose Rice   Kathy Faber, MSN, RN, CNL St. Joseph’s Children’s Hospital Neonatal Intensive Care Paterson, NJ Kathy Faber has been a neonatal intensive care nurse at St. Joseph’s Children’s Hospital’s Neonatal Intensive Care Nursery in Paterson New Jersey for twenty-nine years. Her dedication and commitment to the extremely low birth weight infant and their families is one to be admired and aspire to. Her focus is on family-centered care and the premature infant’s journey from our home to theirs, through compassionate quality nursing care; focusing on patient outcomes, patient satisfaction and parents as partners. She has developed many collaborative initiatives that revolve around the family and the vulnerable population she cares for incorporating the core values of excellence, dignity, charity and justice that are within the foundation of St. Joseph’s Regional Healthcare System of which she has had her career. She has her masters’ degree in Nursing from the University of Medicine and Dentistry of New Jersey and is a certified Clinical Nurse Leader.  Kathy, through her own self governance and nursing excellence has created an atmosphere of quality improvement and heighten inquiry that sustains the professionalism within nursing at the point of care, at the bedside. Some of her initiatives include: The Maternal Child Division Thermoregulation Collaborative, Plans of Care by Gestational Age, the Tiny Baby, the Discharge Process of the Neonate, Parents as Partners, and Evidence-Based Plans of Care. These projects encompass the parents, the nursing staff, administration and other ancillary staff that should and could have an impact on patient care. Kathy does this in collaboration not competition formulating strong bonds within the healthcare family improving communication, commitment and outcomes. In fact Kathy received the Aspiring Nursing Leadership Award from the ONE of New Jersey in 2008, as a result of her leadership skills for improving the discharge process of the premature infant within the NICU. A discharge checklist successfully assisted the registered nurses in transitioning the family and premature infant to home resulting in increased patient satisfaction and a decrease in lengths of stay in the NICU by 2.18 days, and in 2009 she received the Academy of Neonatal Nursing in Practice Award as a result of her many Family Centered Care Initiatives.             Family strengthens family and Kathy’s belief in this allows her expertise, knowledge and creativity to facilitate the family unit from admission to discharge, to the community. She focused on family centered care that includes the parents from day one in the understanding, caring and decisions surrounding their infant’s growth and development. She participates in daily medical rounds where a plan of care is discussed and collaborated with the bedside nurse, the care managers, the social worker, physical therapy, respiratory, and the parents in order to help the parents obtain ownership for their infant’s medical condition. This encourages bonding which will enhance a life long support system for the growing premature infant. She also has developed a bedside roadmap of procedures, tests and exams for parents to use for journaling their infant’s progression while in the hospital, allowing for a written document of their infant’s medical status. She organized weekly parent meetings with all NICU parents to formally meet the members of the NICU team and have their concerns and/or questions reviewed assuring communication and trust of the parents toward their infant’s plan of care. Kathy has embarked on another aspect of family-centered care by holding weekly scrapbooking sessions with the NICU families. This actually acts as a form of support group for the parents. It has proved to be a huge success in providing constructive time for our parents to secure memories, while formulating relationships within the group. Kathy along with the social worker run the sessions and has secured funding by collaborating with the Child Life Services Department of the hospital. As a professional nurse, Kathy is an excellent nursing role model for her peers. Her dedication to the profession is equally matched with her compassion and insight for mentoring her colleagues. As a senior resource nurse she supports the education of the bedside nurse through collaboration with the nurse manager and clinical educator. As the CNL she formulates the educational needs of the nursing staff in collaboration with the specialty unit’s competencies and nursing department; coordinating current standards of care as set by regulating organizations. She encourages professional growth within the maternal child division by offering her time and energy, mentoring setting the culture for change. She has developed a monthly journal club, reviewing current literature on both shifts, providing evidence-based nursing practice at the bedside, and now has worked with library services.   Christine Hamill, MSN, RN, CNL, CLNC Director of Outpatients Services and Magnet Coordinator  Wentworth-Douglass Hospital Dover, NH Christine R. Hamill, RN, MSN, CNL, CLNC received the 2009 New Hampshire Organization of Nurse Leaders for Excellence in Nursing Leadership.  The purpose of this award is to recognize an individual who demonstrates outstanding achievement in a nursing leadership position.  Recipients of this award must be a member of the New Hampshire Organization of Nurse Leaders (NHONL) for a minimum of two years, participate in meetings and functions of the NHONL, be currently employed in a nursing leadership role in the State of New Hampshire, have five years experience as a nursing leader, the most recent two years in New Hampshire, and demonstrate excellence in the specialty of nursing leadership through advocacy, innovation, and practice.  Ms. Hamill was nominated by one of her direct reports for her experience and expertise as a nurse, a leader, a mentor and a professional.  ____________________________________________________________________________ CLINICAL PARTNERS Deb Smith, MS, MBA, RN, NEA-BC, FAEN Vice President, CNO OSF St. Joseph Medical Center Bloomington, IL  Participation as a clinical partner with Illinois State University College of Nursing since 2004 – attending meetings with AACN and other clinical partners. Publication of an article in the Journal of Nursing Administration, April 2007, Transforming the Care Delivery Model in Preparation for the Clinical Nurse Leader Presentation at the National Magnet Conference, Louisville, KY October 2009, Small Focus Gets Big Results.  The use of the CNL and Patient Care Facilitator to positively impact patient outcomes on a microsystem level. Sponsoring site visits for other organizations considering changing their care delivery model – one from Central Illinois, one from Wisconsin. Multiple phone calls regarding the care delivery model utilizing the CNL. Calls with CNL graduate students relative to the institution’s model and the role of the CNL. - - - - - - - - - - - - - - - - - University of Tennessee Health Science Center and Methodist LeBonheur Healthcare Open Four Dedicated Education Units for Clinical Nurse Leader Teaching and Practice The University of Tennessee Health Science Center (UTHSC) College of Nursing in partnership with Methodist Le Bonheur Healthcare (MLH) in Memphis, Tennessee has opened four Dedicated Education Units (DEU) serving as exemplary teaching and learning environments for Clinical Nurse Leader (CNL) education and practice. The MSN-CNL program at UTHSC is a Model C master’s entry program; annual enrollment is approximately 70 2nd degree students. A DEU is recognized nationally as an innovative model of clinical education. The UTHSC-MLH DEUs provide CNL students with the opportunity to learn directly from bedside leaders in clinical practice to achieve competencies in exemplary nursing care, patient care coordination, and quality and safety. In January 2009, the first two DEUs opened at Methodist University Hospital (MUH); one is a 22-bed adult neuroscience unit certified by The Joint as a Primary Stroke Center and the other is a 22-bed adult orthopedic and medical-surgical unit. Eight experienced staff nurses who were trained by UTHSC CON serve as clinical teachers and a clinical educator who recently was awarded Clinical Educator of the year from the American Association of Neuroscience Nurses provides consultation. Following the successful pilot of the UTHSC-MUH DEUs, two more DEUs were opened at the Le Bonheur Children’s Medical Center on the neurosurgical and orthopedic units.  Twelve nurses from the UTHSC-LeBonheur DEUs serve as clinical teachers for all students enrolled in Pediatric Nursing and for Leadership students interested in a pediatric nursing career. One of the UTHSC-LeBonheur DEUs is led by a certified Clinical Nurse Leader, the only CNL in the MLH system. All UTHSC CNL students have an opportunity to learn on a DEU. Formative and summative evaluation of the DEU experience is systematically captured from the perspective of the students, clinical teachers, CON faculty, and MLH leaders; DEU microsystem outcomes are also tracked for evidence of improvement. External funding for the evaluation is supported by grants from HRSA, awarded to UTHSC CON for the Master’s-entry CNL program and from the Methodist University Hospital Foundation. Both grants build upon pilot results from the 2006 MSN CNL program and a previously awarded grant from the Quality and Safety Education for Nurses funded through the Robert Wood Johnson Foundation.   __________________________________________________________________ POINTS OF PRIDE Linda Andreoli Receives National Student Nurse of the Year Award Linda Andreoli, a second-year CNL student at the University of Toledo, has been selected as the “Nation’s Most Outstanding Student” for the 2009/2010 academic year.  As the recipient of the National Student Nurse of the Year award by StuNurse.com, an arm of Publishing Concepts, Inc., Linda received a $1000 scholarship, a plaque highlighting her achievements, and feature cover on the magazine.  Nominated by a group of peers, faculty, and Timothy Gasper, PhD, RN, Dean and Professor at the University of Toledo School of Nursing,  Andreoli was chosen as the most outstanding among the many entries from across the nation.  According to Dr. Gasper, “She raises the expectations for all of us in the College of Nursing and demonstrates the best in the college, her student peers, and herself.” A full copy of StuNurse.com is available online at http://www.stunurse.com/; click on the magazine icon located in the upper left corner of the web page (just below the HOME button).  Linda is on the front page, pages 3, 10-11, 13 (UT congratulatory page) and page 16 (congratulating her as a US Navy Reserve member).   Mary E. Mather, MSN, RN, CNL South Texas Veterans Healthcare System San Antonio, TX Presenting abstracts, posters, and podium presentations provides opportunities to speak about the Clinical Nurse Leader role and how it impacts care. Clinical Nurse Leader Role Impacts Geriatric Needs in an Outpatient Clinic This presentation was co-authored with Kim Hall MSN, RN, CNL and presented at the National Gerontological Nursing Association with an abstract, poster, and podium presentations for innovation in practice. The purpose was to impact care delivery in the Geriatric Evaluation and Management (GEM) Clinic through the use of the Clinical Nurse Leader (CNL). Research has shown that care is complex and often mis-coordinated whereby information is often not available to those who need it, when they need it. Evidence Based Practice (EBP) integrates best available evidence, clinical expertise, and patient values within a care delivery model influenced by a role such as that of a CNL. A Microsystems review of the GEM clinic recognized fragmentations in care delivery. Several areas of care delivery were reviewed: the daily clinic flow, unscheduled daily concerns that interrupted that flow, and patient satisfaction with care. The vulnerable elder, whose reality includes polypharmacy, requires process analysis and eventually transformation of care to improve quality of care; this process is known as medication reconciliation. The GEM Clinic averages 25 phone calls per day from patients regarding medication issues.Collaboration with an interdisciplinary team formulated a plan to improve quality of care at the point of care. Medication Reconciliation was discussed and planned using the Plan Do Study Act cycle. The completed Clinical Microsystems Assessment Tool (MAT) revealed a need for creation of an exit interview. In addition, the GEM team created a nurse telephone log to identify trends and track the phone calls. The results indicated greater medication adherence by the patients, reduced number of phone calls regarding medication needs, increased customer satisfaction with services provided. Rollout of the Rapid Response Team This project began as a capstone project that I followed through the development of the entire program, and I continue to participate in weekly review meetings. It was a poster and abstract presentation for the 2009 Summer Institute on Evidenced Based Practice and was co-authored by Kim Hall, MSN, RN , CNL and Marthe Moseley, RN.             The Rapid Response Team (RRT) was an initiative to enhance safety and patient outcomes for those exhibiting clinical deterioration. Rollout included timelines, team composition, clinical call parameters, education, documentation, pilot initiation, and outcome monitoring. The team included: nursing, medicine, surgery, intensive care, respiratory therapy, psychiatry, spinal cord, and administration. Situation, Background, Assessment, and Recommendation (SBAR), and the Huddle are communication formats adopted from TeamSTEPPS. Also included were patient and family education strategies that complemented the comprehensive effort.                  Noteworthy multi-service improvements were realized in several crucial patient outcome measures before and after the activation of the RRT: a reduced number of cardiac arrests, medical emergencies, and deaths from cardiac arrest outside of the ICU. Weekly huddles have drastically improved communication.             On-going evaluations of the team processes are continuing to support the sustainability of this system improvement. Team composition, micro-system re-education, and effective communication skills have continued to prepare patients to RRT arrival where the teams function effectively to improve patient outcomes.   Kim Hall MSN, RN, CNL South Texas Veterans Health Care System San Antonio, Texas  Pioneering the Clinical Nurse Leader Role: A Personal Journey “What is a Clinical Nurse Leader?” I remember thinking this as a nurse mentor suggested that I look into this new role as I prepared to start graduate studies.  Excitement, fear, and questions abounded in my brain as I read the white paper on the role of the Clinical Nurse Leader. Fear would win if I did not try, my questions would remain unanswered if I did not try and I craved to infuse my professional growth with excitement.  Pioneering a new role is a historical event! Wow, I am part of creating history in my profession. The encouragement from mentors, faculty, and colleagues helped me to deal with fear. I began with integration of new knowledge and skills acquired from school into the work setting to lay a foundation for my new role. I did a pilot study during a research course; the instructor met with me during her personal time to help me prepare an abstract for submission. My mentor was just as excited when my first abstract on self diabetes management was accepted for an international conference on evidence based practice. In the midst of school and work, nurse’s week is a great time to celebrate an opportunity to share. I made a poster about the clinical nurse leader role, and the difference the role was making in my clinic setting.  Within the course objectives for another class on aggregate studies I integrated the “huddle” concept for interprofessional team growth. Huddling is a communication strategy to improve access to care for patients and enhance daily situation awareness among healthcare team members. The impact of the intervention strategy using the “huddle” technique was that clinic patients made decreased emergency room visits. The dissemination of the impact of this project was shared at a national CNL summit as both a podium and a poster presentation. Then in one of the last classes on my journey to become a CNL, was the capstone project! Our group focused on rolling out one of the national patient safety goals, a rapid response team, at a system wide level. The recommended reading list kept me busy studying for the CNL certification exam. I can’t believe how much technology has advanced and I find practice simulation tests to be quite challenging. However, I did not give up until I could obtain a perfect score, and then call my schoolmate late in the evening, laughing and cheering together!  The final day arrived. As I took the CNL certification exam, I burst out laughing the first time the response on the simulation section read that the answer is not appropriate, for this is the exact wording I have said to my children. The outcomes however, are excellent and I received congratulatory notices from faculty, CNC, organizational leaders and peers – these have me soaring. Colleagues encourage my continual growth by encouraging me to disseminate what I have learned. Professional organizations such as ANA, Sigma Theta Tau, and the National Gerontological Nursing Association are platforms for my professional growth as I educate others about the CNL role. The more I do, the more I learn - the last abstract that I had submitted was nominated as finalist for a clinical innovation award. The clinical nurse leader of today is a pioneer, a catalyst for change in healthcare microsystems, and we have only just begun.     Sharon Kimball, MS, RN, CNL, CRRN Providence Portland Medical Center "I believe that as we are on  the vanguard of the CNL movement, we need to be open to any position that will put our CNL skills to best use....just ensure that you are true to the white paper (The Education and Role of the Clinical Nurse Leader). I find that I am particularly focused on helping the nurses to evaluate processes and improve outcomes, as well as implementing best practice."   Interview with Jeri Milstead the First Chair of the Commission on Nurse Certification (CNC) Board of Commissioners Top | Certification | About CNC | CNL | AACN Home Copyright © 2009 by the American Association of Colleges of Nursing. All rights reserved.