Leading Initiatives

CNL Wall of Fame

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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 Coordinator, Dana Reid, at dreid@aacn.nche.edu.

Clinical Nurse Leaders · Clinical Partners · Points of Pride

 

2014 CNL Vanguard and Visionary Leader Award Recipients

AACN is pleased to announce that two national nursing leaders – Dr. James Harris and Dr. Geraldine (Polly) Bednash, Chief Operating Officer (CEO) of AACN – are the recipients of the 2014 CNL Visionary Leader Award. The highest honor presented by AACN to practice leaders making significant contributions to advancing the Clinical Nurse Leader (CNL) initiative, these awards were presented at the CNL Summit and Research Symposium held in Anaheim, CA this January. The CNL Vanguard Award, which recognizes the innovative work of a CNL-certified nurse, was also presented at the Summit in conjunction with the Commission on Nurse Certification (CNC) to Sonja Orff for her exemplary work as a true champion for patient safety. This year, there were a number of outstanding nominations. For that reason, Kimberly Kirkpatrick was selected for an honorable mention. For more information, visit http://www.aacn.nche.edu/publications/March-April.pdf.
 

Clinical Nurse Leaders

Gordana Dermody, MSN, RN, CNL
Saint Anthony Medical Center/College of Nursing

Gordana Dermody, Special Projects Coordinator/Instructor for OSF Saint Anthony Medical Center/College of Nursing, used her expertise as a registered nurse and Clinical Nurse Leader to educate nurses at a Catholic, mission-based hospital in Uganda. Ms. Dermody took part in a two week humanitarian trip along with another nurse, trauma counselors, librarians, and a group of physicians. She qualified for a vocational training grant through the Rockford Rotary Club that allowed her to take part in this important work with the prime minister and other local government officials and community leaders. Click here to read OSF Saint Anthony Nurse Travels to Uganda by WIFR Newsroom (posted on March 20, 2014) in its entirety.


2012 - 2013 Chair of the CNC Board of Commissioner’s View of the CNL and Its Future
By Enna Edouard Trevathan, DNP, MSN, MBA, RN, CNL

Nursing in general, comprises the largest segment of the healthcare interdisciplinary team. Competent nurses are most associated with improved patient outcomes. Furthermore, competent care rendered by theses nurses arises from the knowledge applicable to practice. The American Association of Colleges (AACN) White Paper (2007) outlines many roles that describe, the Clinical Nurse Leader (CNL). In my past and current involvement with the CNL role, some of the roles in the end of program competencies have resonated more with my students and colleagues.


The role of the CNL in many endeavors is to utilize and to apply the AACN program competencies. As a nursing professional, the CNL is responsible for leading at the highest level of clinical care at the microsystem. Nursing leadership, one of the program competency trains the CNL to discover, disseminate, and apply evidence for improving nursing practice. A CNL, in this role is well suited to participate and drive the development of policy and procedures within a healthcare organization. Furthermore, a CNL can communicate and navigate skillfully in a milieu where conflicts may exist among nurses and other healthcare professionals. The CNL, in many instances is the liaison to help coordinate the care being provided to the same clients by the various healthcare professionals. The CNL can expertly accomplish this task by analyzing interdisciplinary patterns of communication and chain of command existing at the internal and external unit levels that affect patient care.
 
The CNL as an educator and an information manager can provide knowledge at the point of care and help nurses to improve healthcare outcomes of the patients. As an educator, the CNL (“…uses appropriate teaching principles and strategies as well as current information, materials and technologies to teach health care professionals under their supervision.” (AACN White Paper, 2007)

The CNL as a System Analyst can analyze care delivery process of the unit. The CNL uses several methods such as observation, informal interviews, chart audits, needs assessment, Ishikawa diagram, failure mode evaluation analysis (FMEA), root cause analysis (RCA), strengths, weaknesses, opportunities and threats (SWOT) analysis, and cost analysis, to name a few. The CNL’s formal training provide this clinician with multiple tools in his/her toolbox to help identify gaps in the microsystem unit levels endangering the safety, the quality, and driving up the cost of care being provided.

As a clinical Outcomes Manager, the CNL is in a unique position to identify key issues and research new ways to implement a practice change. In this role, the CNL can evaluate alternative processes based on current evidence based practice to achieve optimal outcome. Evidence-driven practice starts with nurses possessing the knowledge and skills to provide competent patient care.

To top it all, nursing requires a combination of the highest understanding of the science of health and a caring bedside manner befitting only those who seek a position with such a personal involvement in the patient’s well-being. The CNL exhibits an extraordinary amount of empathy and caring, in combination with a passion for science and health that makes the role, a perfect match for those who decide to pursue this career. The CNL is a team player and recognizes the power of synergy and collaboration within a nursing and a medical team. The CNL is intellectually capable to learn and apply all the competencies of an exemplary nurse clinician. The CNL has the willingness, drive, and the caring attitude that go with developing into an outstanding interdisciplinary team member.

As the outgoing chair of the Commission on Nurse Certification (CNC) Board of Commissioners, I was reflecting on the role of the CNL and what does it mean to me, my students and my colleagues. As I was pondering about the future of the CNL, a conversation with a colleague painted the picture very vividly for me. In the future, I see the CNL professional role as a sharer of knowledge and an active participant in the journey of providing exceptional care with peers.

To exemplify, I would like to highlight one particular CNL, Catherine (Cathy) Coleman. Cathy as she is known, after finishing her MSN/CNL at The University of San Francisco, School of Nursing and Health Profession (USF SONHP) and passing the certification examination in summer 2010, wanted to continue to support the CNL role by teaching in the program at USF. Through the program, she became a staunch advocate for CNLs and still believes that the most important change agents in health care remain the interdisciplinary teams in any patient-centered microsystem. Her faculty advisor encouraged enrollment in the Doctor of Nursing Practice (DNP) program and in fall 2010, she began that journey. In the spring of 2011, she started teaching part-time in the graduate program. The DNP program offers her a perfect opportunity to blend her CNL skills and focus on the microsystem with her passion and life-long commitment to breast cancer care and breast center development at the meso and macro system levels. Her MSN/CNL internship included a comprehensive literature review and multiple microsystem analyses related to breast cancer care in a medium size community hospital in Northern California. Currently, she continues to build upon that project in every DNP class and assignment. As a result of her pursuit as a life-long learner and a patient advocate, she has written a manuscript to be published in July, 2013 in the Oncology Nursing Forum. Cathy states: “It was important for me to introduce this role to colleagues in the Oncology Nursing Society that share the CNL mission of becoming change agents through advocacy and interdisciplinary health care. As I pursue my final DNP project in another breast center setting, I will continue to expand upon the lateral integration of care delivery by probing gaps in quality of care that affect patient outcomes and interprofessional staff satisfaction.”

In every institution, there is a Cathy who is ready to be discovered or is forging ahead applying the CNL core competencies and anchoring the role within every fabric of the healthcare institutions. I challenge us to continue to support the role and create opportunities to apply the role in clinical areas never before considered. As noted above, the CNL is committed to academic excellence and is inspired to be a life-long learner to embrace current and future healthcare challenges by providing care to a diverse patient population.

Information on Cathy

“I am a faculty member at USF and have been involved in the CNL effort nationally since the beginning in 2004.  The CNL role is the most important contribution to improving health care I have experienced in my 40 plus years of nursing.  My goal is to support that role to encourage graduates and institutions to use the CNL role to improve patient safety and satisfaction, staff satisfaction which all contribute to enormous cost savings.  The literature supports amazing CNL successes, such as decreasing falls, pressure ulcers, reducing staff turnover, increasing patient satisfaction scores and saving money by making small changes at the point of care – the microsystem where patients and processes come together.

2013 CNL Vanguard and Visionary Leader Awards

AACN is pleased to announce that two national nursing leaders – Dr. Joan Shinkus Clark from Texas Health Resources and Dr. Marjorie Wiggins from Maine Medical Center – are the recipients of the 2013 CNL Visionary Leader Award. The highest honor presented by AACN to practice leaders making significant contributions to advancing the Clinical Nurse Leader (CNL) initiative, these awards were presented at the CNL Summit held in New Orleans last month. The CNL Vanguard Award, which recognizes the innovative work of a CNL-certified nurse, was also presented at the Summit in conjunction with the Commission on Nurse Certification (CNC) to Barbara Edwards from St. Lucie Medical Center for her exemplary work as a true champion for patient safety. To view press release, click here.


 

Claire Gangware, MSN, RN, CNL
Jesse Brown VA Medical Center
Chicago, IL

Claire has been instrumental in implementing and sustaining Unit Based Safety Huddles on her medical-surgical unit.  The entire nursing team, including the Unit Manager, Nurses, and Nursing Assistants, gather each day at 10:00 am to participate in a quick 10 minute communication huddle which allows caregivers to share important information pertinent to patient care on the unit.

Claire states: “The main reason we began (doing daily safety huddles) is because (Nurse- to-Nurse) walking rounds at the patient’s bedside did not allow a chance (for all care givers) to hear about all patients on our unit.  (During the huddles) we discuss fall risk, planned discharges, DNR status, isolation, wander guards, continued need for close observation, as well as who needs assistance with ambulation, toileting, feeding.   It gives the charge nurse a heads up about patients on O2, foleys (for auditing), PICCs, Ports, who’s on chemo, who’s going for procedures.

One nice outcome is the improved communication, i.e. new products on the supply carts, scheduled unit in-services, and any issues with equipment or staffing.  It’s like a mini staff meeting daily that IMPROVES TEAMWORK.

What I like is it has been adopted by the staff as a daily practice.   Nurses initiate it on their own even if management is not available; therefore the unit nurses feel it is worthwhile.”

One measurable outcome on Claire’s Unit has been a 55% drop in the fall rate since the Daily Safety Huddles have been adopted as practice.   

Ask a CNL about quality and safety!  Good work, Claire!


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Pictures: (left to right): Alise Farrell (Clinical Faculty) and students Lauren Taylor, Amber Tarvin, Candice Mathews, Lakisha Washington, Dynisha Lee, Teresa Britt (Clinical Faculty), and students Crystal Martin, Pamela Llana, Alam Sharifi, Mang Ensell, Kathryn Fairley, Nancy Ray, Brandi Soule, Ronisha Turner, and Dr. Leslie McKeon (Associate Professor)

 

The University of Tennessee Health Science Center Clinical Nurse Leader Inaugural Graduating Class Receives Academic Recognition from the Governor

On April 12, 2011 the University of Tennessee Health Science Center College of Nursing Clinical Nurse Leader (CNL) students attended the Tennessee Nursing Association (TNA) Legislative Day in Nashville and met with House Representative and Senators for the West Tennessee District.   Students spoke with Rep. John J. DeBerry, Jr. (D-Memphis) about the new Master’s Entry CNL program and explained that their class would be the first class to graduate. He sponsored an academic achievement resolution in the House on May 4th regarding the new program and distinguished members of the inaugural graduating class; on May 24, 2011 it was signed by Governor Haslam.  Dean Donna Hathaway shared Resolution HJR0390 with graduates and their families at the College Nursing 2011 Dean’s Convocation. To read the resolution click here.


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100% 2011 Sonoma State Graduates Pass the CNL Exam

Sonoma State University has announced a 100% pass rate of their 2011 graduates sitting for the CNL Certification Exam during the summer testing period. The Sonoma State University CNL education program for students entering nursing with a degree in another field provides a curriculum of 67 credits in five continuous semesters.  This intensive program layers foundation courses with graduate courses in each semester. The CNL language, terms and concepts from the End of Program Competencies are imbedded in every course.    Lisa Fredrickson, a 2011 CNL graduate attributed the success to early association with the CNL role.  “We were engaged in microsystems analysis from day one - which meant leaving comfort zones to engage with agents at all levels of care – and this helped us inhabit & understand the role of the CNL.”


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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


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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.


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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

The University of Virginia’s (U.Va.) Clinical Nurse Leader education program began in August 2005 and is a full-time, 24-month accelerated master’s program for students who have a bachelor’s degree in a field other than nursing. Unlike other degree programs, Clinical Nurse Leader clinical training uses an apprenticeship model for the 1,000 clinical hours of the program. Instead of receiving training in groups, each student is mentored one-to-one by a clinical preceptor at the U.Va. Medical Center and a host of other clinical sites. U.Va. is the only master’s-entry CNL program in Virginia and Washington, D.C., and admission to the program is quite competitive; for fall 2012, the program received more than five applicants for each of the 24 spaces in the entering CNL class.
 
Below are recent articles (accomplishments) regarding the U.Va. program:


Deb Smith, MS, MBA, RN, NEA-BC, FAEN
Vice President, CNO
OSF St. Joseph Medical Center
Bloomington, IL 

1.  Participation as a clinical partner with Illinois State University College of Nursing since 2004 – attending meetings with AACN and other clinical partners.

2.  Publication of an article in the Journal of Nursing Administration, April 2007, Transforming the Care Delivery Model in Preparation for the Clinical Nurse Leader

3.  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.

4.  Sponsoring site visits for other organizations considering changing their care delivery model – one from Central Illinois, one from Wisconsin.

5.  Multiple phone calls regarding the care delivery model utilizing the CNL.

6.  Calls with CNL graduate students relative to the institution’s model and the role of the CNL

Points of Pride

Marissa Elliott-Vizcarrondo, MSN, RN, CNL
John Muir Behavioral Health Center
Concord, CA

I have the privilege of being a Clinical Nurse Leader and using the skills I acquired in school in my current position as a Nurse Manager. I was recently hired into this position after only being a nurse for two and half years due to the education I received in implementing change and transforming patient care. I am proud to call myself a Clinical Nurse Leader and I am looking forward to the positive changes I will make for both my staff and my patients.

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Patricia Baker, MSN, RN-BC, CNL
Methodist Healthcare System and
South Texas Veterans Healthcare System
San Antonio, TX

A CNL’s Perspective: Tale of “Clinical Microsystems”

As a novice Clinical Nurse Leader (CNL), in a new role, there’s a feeling of gratitude and privilege of being a pioneer. With knowledge, skill, and ability (KSA) to enter practice as an advance generalist at the point-of-care, also, known as the clinical microsystem where patients/clients /families and care teams meet (Nelson et al, 2008),  it became clear early on that the focus of the role is to integrate the unique domains of the CNL’s professional practice (nursing leadership, clinical outcomes management, and care of environment management), to continuously assess, diagnose, plan, implement, and evaluate the microsystem.  An asset of the CNL’s professional expertise is the ability to practice on various microsystems. With practicing on three Clinical Microsystems, there was an urgent need to formulate standardized work processes: 1) Perform a comprehensive 5Ps microsystem assessment; 2) Collect and analyze data on specific unit-based Core Measures; 3) Assess linked Microsystem’s processes; 4) Assess the microsystem alignment with its macrosystem; 5) Evaluate Evidence-Based Practice (EBP) processes for alignment with facility’s policy and procedures; and 6) Utilize continuous quality improvement monitoring tools.  Amazingly, either it was the 45-bed medicine telemetry, 60-bed telemetry, or the emergency department, there was a heightened perspective that all three microsystems had similar needs to improve patient safety, improve patient and staff satisfaction; strategically enhance and align quality processes, and bridge the gap between best practices and actual practice in an effective, efficient, and timely manner.  The CNL works collaboratively with the unit nurse manager and other interdisciplinary team members, such as Clinical Nurse Specialists (CNS), nursing staff, physicians, dietitians, case managers, quality/risk managers, infection control, housekeeping, physical therapy, occupational therapy, social service, pastoral service, clerical staff, information technology, radiology, laboratory, pharmacy, nurse educators, and data support systems, to enhance lateral integrated care. The CNL ensures that the multitude of diverse cohorts of patients/families receive care based on the best available evidence. Promising signs of positive impacts of the CNL role are decrease in patient fall and fall injury rates, improved patient satisfaction scores, decrease in blood culture contamination rates, improved staff handoff communication, improved results of core measure data, and everyday staff gratitude of the CNL presence.  

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Linda Rusch, MS, APN-C
AACN CNL Resource Coach

". . . I have experienced first hand how seven CNLs can collectively make a difference.  By reducing falls, central line infections, pressure ulcers, etc. is not only cost avoidance but tells its community, come to this hospital where we collectively will provide the safest quality care you as a patient deserves.  Still not sure?  Experiment with one unit and a CNL and see the difference they make." 

"The CNL as lateral integrator and safety nurse provides a safety net to patients and a reminder to busy nurses of the importance of follow-through and checking. The CNL has expertise in Microsystems and has the ability to make complex systems more efficient and streamlined. Their unique position as clinical leader has resulted in numerous positive outcomes for our patients. A number of examples are as follows: a 16 % reduction in one unit's yearly NIM rate producing a savings of over $ 240,000, 20 % reduction in falls, 22 months of being VAP free, 28 months of being Central Line Infection free and 11% increase in foley removal. These all can be quantified as cost avoidance and a huge savings for any healthcare organization. But for a patient not receiving an infection etc., it is priceless."

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).
 

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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.

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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.

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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