This DNP project is about change and, ultimately, about changing the culture of
organizational complex adaptive systems. It is also about addressing the very serious health care systems issues regarding quality improvement and safe patient care at the clinical micro system level. Itis an expectation at this level for the DNP candidate to have developed systems thinking abilities. As a systems thinker, the candidate focuses on the quality and nature of the
relationships among the various parts of the systems to bring about significant change that can positively alter our healthcare systems. The transformation of these two systems into a new innovative program was supported by nontraditional thinking, planning and execution.
Summary of Process
The DNP candidate effectively brought together the CNL task force members from both the university and the medical center to plan and implement this innovative onsite CNL
education program. Together, they learned that a concerted effort was necessary in order to lead systemically. Itis clear from the results of this process that these two large adaptive systems that could have collided were able to work through the complex issues and evolved as partners. The program emerged from the chaotic developmental process of recognizing and identifying
occurred by the deconstruction of traditional academic and service thinking. The culmination of the partnership is the creation of the new CNL delivery system, a hybrid modality (one week in class and one week online), at the workplace allowing for two classes to be taught
simultaneously.
Lessons Learned
There were several lessons learned from the collaborative processes. First, the mission and vision of the innovation have provided direction for the transition and implementation of this project. The mission and vision are powerful tools providing directions and a sense of purpose for all past, current and future efforts. Second, the importance of participative relationships cannot be underestimated in the development of an innovative partnership between service and education. The institution as well as the students must be educated in the CNL role. The best way to accomplish this goal is to collaborate with the institutional leadership to create an onsite program with course sequences and assignments directly linked to institutional goals (see Appendix C).
Itis also critically important to develop a business case filled with key strategic plans to guide the concept and identify any gaps in the implementation plan (Harris&Ott, 2008). Open and frequent communications between the task force members from service and academia can prevent major delays in the implementation plan. Interestingly, the marketing plan, a sub-
category of the strategic plan, yielded the greatest results by word of mouth. The expected results from the mass media were mildly effective. Employees stated that they saw the postings and/or read their emails, but they could not believe that it was true. Once surveys indicating interest in the program were returned, an information session was held at the VA Palo Alto. The response from the information session (which was also teleconferenced to remote sites) was encouraging.
Employees were also motivated to inquire about the program after hearing about it from a co- worker.
Additionally, there are formal inquiries and documentations that should be undertaken. The development of a memorandum of understanding (MOD) defining the specific
responsibilities of each partner is crucial. Italso identifies the individuals in the respective institutions who can legally design and sign the MOD. This important document confirms and seals the partnership. Simultaneously, the inquiry of any reporting requirements by external accreditation agencies (i.e. the Western Association of Schools &Colleges [WASC] and the Commission on Collegiate Nursing Education [CCNE]) must be completed in a timely manner. Lastly, the support and buy-in from top leadership members on both sides of the partnership are vital to the success of the implementation plan. Flexibility, tenacity and creativity are required characteristics to nurture the development of the project from inception to implementation. The enhancement of our healthcare delivery system is the ultimate winner of the development of these new partnership efforts. These efforts have service and academia engaged in creating new models for nursing education delivery.
Dissemination Plan
The results of the findings will be disseminated through several different avenues. As an active member of the VA National CNL Advisory Council, the lessons learned at the VA Palo Alto site will be shared in face-to-face meetings, teleconferencing and emails. The VA National CNL Advisory Council is in the process of developing several tools for the enhancement of the CNL initiative (see Appendices D to F).
The DNP candidate will also be available for consultation and presentation to other VA medical centers. A positive interest was indicated in the manuscript of this innovation by the
Journal for Nurses in Staff Development (JNSD). The candidate provided a podium presentation at the USF CNL Conference Summer in 2007, a poster presentation at the CNL Summit January 2009 in New Orleans, conducted a teleconferencing presentation to the Systems Redesign Nursing Community of Practice at the VA in May 2009, and has provided various presentations to VA leadership, departmental meetings, nursing councils and new nursing orientees. This candidate is an adjunct faculty member in the CNL program at the VA Palo Alto since inception in August 2008. She is the author of the quarterly column about CNL activities in the VA Palo Alto Nursing Newsletter. She is an active participant in the planning of the USF/SON CNL Institute (Summer 2009).
Next Steps
The candidate plans to participate in future research regarding CNL implementation and education innovation. Plans are in motion to continue the development of CNL consultant skills for the development of service/education partnership at other VA Medical Centers. As a member of the Recruitment and Retention Committee and a task force member for the Versant Residency Program at the VA Palo Alto, the DNP candidate will engage the members of both committees to examine the feasibility of the CNL program as a recruitment and retention tool. Finally,
sustainability ofthe project will be examined through the conduction of a survey in the fall of 2010 to determine interest levels for the development of another onsite educational cohort.
Conclusion
The 10M (1999&2001) reported on the major problems and gaps in the U.S. healthcare system. As a result, these seminal reports issued a call to all health care leaders to address challenges and gaps in the health care delivery system and to improve the quality and safety of patient care by focusing on the microsystem of clinical care. This in turn led to the genesis of the
CNL role and educational model. This DNP candidate hopes that through the successful
implementation and dissemination of this innovative onsite CNL academic/education
partnership, that ultimately the implementation of the CNL role at the micro system level
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