CNL EXPERIENCE
CULMINATION PROJECT
AND PRESENTATION
Nicole O’Neil
THE CNL AS A TEAM
MANAGER & LEADER:
The CNL as a Team Manager:
Properly delegates and manages.
Uses team resources effectively.
Serves as leader/partner on interdisciplinary team (AACN, 2006).
The CNL as a Leader:
The CNL knows what needs to happen to achieve quality patient care
and excellence in nursing by following this provided framework:
Decision-making and problem-solving
Communication
Collaboration and networking
Risk management
SOME OF THE SUGGESTED
TASKS OF LEADERSHIP
INCLUDE:
Envisioning goals
Affirming values: Regenerating and revitalizing the shared beliefs, values, and vision of the group.
Motivating: Having and promoting positive attitudes, instilling creativity in team members, and consistently encouraging other team members to be equally as excited about the future and how they can contribute to make positive changes and a difference in patient outcomes.
Managing: Facilitating change and keeping the clinical microsystem functioning smoothly as a cohesive unit.
Achieving a workable unit: Making an effort to establish trust with team members and effectively problem-solving through potential conflicts within the group.
Serving as a symbol: Always be willing to take a risk for the betterment of the team and patient outcomes.
Representing the group: Advocating for the team.
CNL ROLE EXPECTATIONS AS
A LEADER:
Keeps clients well informed
Includes clients in care planning
Advocates for the profession
Works with interdisciplinary
team
Strives to achieve social justice
within the microsystem
MY CLINICAL PRACTICUM/
MY PLACE OF EMPLOYMENT:
During my clinical
practicum at Children’s
Hospital of Orange County
in Orange, CA, I was able to
participate in various
activities in the specialty
clinics in the outpatient
setting.
I also continued to work at
a skilled nursing facility in
Hemet, CA as a charge
nurse where we cared for
up to 60 patients with a
diverse range of
KEY ISSUE #1
During a clinical rotation at CHOC, I was able to attend a Joint Commission Review survey readiness meeting with my preceptor, the other clinic managers, as well as their team members.
The intent of this meeting was to review what the Joint Commission was and their role in healthcare facilities, as well as some National Patient Safety Goals.
During this collaboration session, it was noted that the lab results didn’t have a time deadline to be submitted to the patient, and the labs were being faxed over instead of sent electronically, although the system is set up for electronic retrieval.
This results in delayed family notification; increased resources to receive the results and then upload the results to the electronic system base; and also a possible interruption in patient care.
Also, a policy in question regarding critical labs showed much conflict and in need of modification.
The policy in question stated that critical labs must be reviewed by either a RN or MD, and family notification must take place within a 10 minute time frame. However, mainly LVNs retrieve results and family notification is exceeding this expected time frame.
In addition, if the lab result was to be faxed over past 7pm when clinic closes, the results wouldn’t be made available until the morning when clinic opens; leading to a delay in the notification of potential critical results.
Therefore, the policy was not reflecting what was implemented in actual practice.
CNL ROLE
As a CNL, it is crucial to research the most recent evidence based practice and state
requirements for a given policy and procedure to ensure all patient goals are met (Systems
Analyst/Risk Anticipator).
The CNL is needed to collaborate with the organization leaders to develop written
procedures for managing the lab results, and to evaluate the timeliness of reporting the
results to the providers, and then ensuring follow up is given to patient and families.
Also, as a team manager, the CNL can present to the team ways to decrease costs by the
utilization of electronic submission, in comparison to the standard paper method
(information manager).
By incorporating electronic retrieval of patient information, this can also help save costs
and decrease the number of needed staff members on the floor.
By taking accountability of patient outcomes (outcomes manager) and the delivery of
quality and safe patient care, the CNL is needed to deliver care in a timely and cost-saving
way and contribute to the team strategies that lead to best practice guidelines.
My Involvement:
Aided in the identification of a
process in need of change and
assisted in the formation of a
new policy regarding lab
retrievals.
End of Program
Competency:
Identify clinical and cost outcomes that
improve safety, effectiveness, timeliness,
efficiency, quality and client-centered care.
Discover, disseminate and apply evidence
for practice and for changing practice.
Participate in development of or change in
policy within the health care organization
(AACN, 2006).
Evaluates/anticipates client risks to
improve patient safety.
Participates in system reviews.
PURPOSE
“Our mission is to
nurture, advance and
protect the health and
well-being of children.
Our vision is to be the
leading destination for
children’s health by
PATIENTS
The CHOC clinics provide outpatient care to children
from infancy to age 17. The clinics provide sick visits
and well-child care, including immunizations, and
primarily serve low-income families who would
PROFESSIONALS
Direct care personnel
include:
Registered nurses and
pediatricians with a range
of specializations to include
the following: endocrine,
rheumatology, neurology,
spinal bifida, nephrology,
gastrointestinal, adolescent
medicine, and immunology.
Supporting personnel
include:
Specialty managers, registered
diabetes educators, Spanish
interpreters, medical assistants,
early developmental
assessment staff, asthma
educators, nutritional service
members, lactation specialists,
pharmacy, social services,
PROCESSES
•Weekly specialty team leadership meetings every Wednesday to discuss things
that are going well, any changes since last meeting, upcoming events, projects
recently completed or scheduled to begin, and potential opportunities for future
improvements.
•Morning “huddles” with providers and team members to discuss in details the
plan for the day such as scheduled appointments, any openings on the schedule,
review of needed supplies, recent patient survey results, goals for the clinic, etc.
•New scheduling process was recently implemented to include automatic access
to schedule future appointments via a separate phone line through CHOC.
•A kiosk was recently established to allow patients to check in upon arrival for
appointments, which has led to a decrease in cycle time, and a greater sense of
patient engagement.
PATTERNS
On a Macro-Level Analysis:
Named one of the best children’s hospitals by U.S. News & World
Report showing proven demonstration of continued excellence in the
health care sector.
In addition, CHOC also earned the Gold Level CAPE Award from the
California Council of Excellence, which thus far, is the only children’s
hospital in California to ever earn this distinction, and was awarded
Magnet designation, which is the highest honor given to hospitals who
have proven continued nursing excellence.
ISSUE # 2
Much negative feedback was
given on a recent employee
satisfaction survey and in
addition, patient satisfaction
surveys provided upon discharge
were also showing negative
feedback upon analysis.
MY INVOLVEMENT
Participated in the team
meeting to aid in the formation
of future goals and strategies to
include the following items:
Goals identified to increase
nurse satisfaction scores and
increase patient “customer
service” satisfaction.
Strategies that were identified to help facilitate these necessary changes include:
Ensuring to meet and greet all new admissions within 10 minutes of arrival to increase
customer service with the admission process.
Coordinate monthly team appreciation meetings where staff will be able to communicate their needs and voice their concerns.
I had a suggestion regarding discharges to improve patient satisfaction which led to
beneficial changes with the discharge process. The decided-upon outcome was to incorporate weekly meetings with case management to cover pending discharges, so nurses are more included in the discharge process.
Lastly, the team created a revision in the policy for family notification of changes in treatment and/or orders, since many complaints were submitted regarding a breakdown in
CNL ROLE & COMPETENCIES
CNL Role:
The CNL was needed to identify this
need for change, reassess common
team goals, and help other team
members see the need for change
(outcomes manager).
As a change agent, nursing leader,
and patient advocator, the CNL is
critical in facilitating changes to
promote quality improvements,
changes in healthcare policies, and
interdisciplinary communication and
team collaboration.
End of Program Competency:
Advocate for quality improvements
and an increase in patient
satisfaction with the involvement of
the interdisciplinary team.
Coordinate care for a group of
patients based on desired outcomes
consistent with evidence-based
guidelines and quality care
standards.
DISCUSSION OF PRIORITY
KEY ISSUE #2:
Continued negative feedback from patient surveys with general
complaint of poor nursing communication.
Haven’t achieved 100% compliance with new policy modification of
notifying family when there has been a change in orders.
Current cycle time for greeting new admission is on average
between 30 and 45 minutes upon arrival.
Great improvements have been made with the communication
between case management and nursing in regards to the discharge
process. Although these meetings still aren’t occurring on a weekly
basis, more communication through phone calls and emails has
ISSUE # 3:
Issue:
Too many assigned daily tasks for the RN were being expected of at my facility, which led to many patient care and safety concerns such as:
Patient critical orthopedic follow-up
appointments were not being scheduled
Lab results were missing and not followed up with
Patient change of conditions were not being addressed
Case management wasn’t being properly notified to aid in the coordination of discharges
My Involvement:
Communicated with other nurses and
the Director of Nursing to achieve
better quality client outcomes and
aid in the identification of clinical
outcomes that can improve safety,
effectiveness, timeliness, efficiency,
and quality patient care.
CNL ROLE & COMPETENCIES
CNL Role:
As a systems analyst and risk anticipator, the CNL can largely contribute to the
implementation of strategies geared
towards improving outcomes at all points of care.
As a clinician, the CNL assumes
accountability for healthcare outcomes for a specific group of clients within a unit, while delivering care in a timely manner.
Demonstrate leadership in affecting the necessary change.
Use existing resources to design and implement improvements in practice. As an advocator, ensure that the system meets the needs of the population it serves and is culturally relevant (AACN, 2006).
End of Program
Competencies:
Advocate by:
Communicating effectively to
achieve quality client
outcomes
Lateral integration of care for
a cohort of clients
KEY ISSUES FOR CONTINUED
CONSIDERATION
Future policy and procedure review will begin
occurring annually, instead of every 3 years. This will
help in the early identification of processes or
policies in need of change, and prevent potential
delays.
Further analysis will be needed to ensure the change
in lab policy was effective and there are no
REFERENCES:
American Association of Colleges of Nursing. (2006). AACN
End-of-Program Competencies & Required Clinical Experiences for the
Clinical Nurse Leaders.
Children’s Hospital of Orange County (CHOC). (2014). Retrieved
from: CHOC.org
Commission on Nurse Certification. (2012). Clinical Nurse Leader
(CNL) Certification Exam.
Grossman, S. C. & Valiga, T. M. (2013).
The new leadership
challenge: Creating the future of nursing
(4th ed.). Philadelphia,
PA: F.A. Davis Company
