Virtual Reality: The Student Perspective on the Clinical Nurse Leader

1. Virtual Reality: The Student Perspective on the Clinical Nurse Leader CNL Network Teleconference July 19, 2006 Tamela Garcia, RN, MSN Nancy Adams, RN, MSN

2. Questions? Please email any questions to Joan Stanley at jstanley@aacn.nche.edu before, during, or after the presentation. Thank you!

3. Speaker Introduction • Nancy Adams Graduated with MSN from University of South Florida in the first CNL program in May of 2006. Employed at Morton Plant Mease Clearwater Hospital, FL. She has been an oncology nurse on an oncology unit with medical/surgical overflow for 19 years. • Tamela Garcia Graduated with MSN from University of South Florida in the first CNL program in May of 2006. Employed at Morton Plant Mease Countryside Hospital, Safety Harbor, FL. She has been a telemetry nurse for 5 years and works on a medical/surgical remote telemetry unit.

4. The USF CNL Program • 33 credit hours • 300 hours of clinical residency • CNL seminar each semester to prepare us for the role • For more information: http://hsc.usf.edu/nocms/nursing/Programs_of_Study/cnl.html

5. Why our CNL Program/Seminars are Successful • Strong quality and safety culture • Dynamic Clinical Nurse Educator—Sue Hartranft • Supportive organization and management • Seminars designed/taught by a leader from each practice partnership • Utilized the same clinical objectives/outcome indicators for all practice partners

6. Why our CNL Program/Seminars are Successful • The CNL preceptor was the same person who designed/taught the seminars • A Morton Plant Mease (MPM) Foundation grant supported a work-study program that paid the MPM students a full time salary while they were in school • Full-time versus part-time residency • Residency was on the unit that the CNL was hired on after graduation

7. The CNL Role Today • Twelve/Fifteen patients • 24 Hour Accountability • Monday-Friday 0800-1630 workday • Work with two RNS/PCTS with six/seven patients each

8. A Day in the Life of a CNL • Greet staff • Obtain staff assignment and patient information • Obtain patient report/plan of care from staff nurses • Meet with Social worker for planned discharges • Review all labs/radiology reports (address abnormals) • Review telemetry strips • Round on all patients • Round with MDs • Complete all indicators and chart reviews

9. The CNL Role Continues • Major resource for the nurses • Design plan of care for the patient with collaboration from MD/Nurse/Patient and other interdisciplinary services • Cover staff as needed (meds, ADLs, cover pts for breaks)

10. Indicators/Outcomes • Discharge by 1100 or within one hour of written discharge if patient is going home • Discharge planning begins at time of admission • RN/Patient goals for the day is discussed and written on the whiteboard • Patient satisfaction with pain management • All patient education is completed • Fall assessment/prevention • Skin assessment/prevention

11. Indicators/Outcomes Other areas we look at are: • Central line dressing changes • Medication reconciliation forms • Advanced Directives • Discharge patient survey • Increased nursing satisfaction

12. Barriers of New Role • Uniform In order for us and others to view us in our new role we wore lab coats, student badge, and professional street clothes • Experience nurses felt threatened Was able to gain their acceptance by communicating and demonstrating leadership in the role • Non core staff Working with travelers and float nurses to elicit team spirit and providing quality care

13. Successes • Found diabetic supply resource for a patient • Prevented alcoholic patient from leaving without proper discharge instructions • Assessed/evaluated care of patients which identified educational opportunity due to unsafe nursing practices • Moved terminally ill patient to lower level of care and honored patient and family wishes

14. Successes • Identified patient no longer receiving HHC supplies and was able to provide supplies from new HHC agency • Reroute readmissions of oncology patients to CNL unit for continued continuity of care • Call received from spouse after patient died to commend CNL on care provided • Discussions with patients/families on various religious and end of life issues

15. Future Plans/Ideas • Implement EBP to bedside • Post-discharge phone calls • Develop patient educational tools and standards • Precept new CNLs • Continually be JCAHO compliant and Magnet accredited • Actively involved in professional organizations • Quantified data/research

16. The END Questions? Please email them to Joan Stanley at jstanley@aacn.nche.edu Thank you!