Implementing the CNL Role
Michelle Lane
University of San Francisco
Implementing the CNL Role
Vision for the CNL Role
Many changes are taking place in healthcare that are driving the need for a leader at the point of care. Patient satisfaction scores are determining healthcare reimbursement, and a culture of safety is the current buzzword. Facilities struggle to balance quality care and financial risk and the Patient Protection and Affordable Care Act (2010) increases the necessity to evaluate and improve existing outcomes. I believe that implementing the CNL role at my facility, an ambulatory surgery center, would promote an increased culture of safety, decrease procedure cancellations and delays, and would lead to increased patient, nurse and physician satisfaction.
About seventy five percent of initiatives requiring behavior change fail because the leaders are not engaged or actively involved (Birk, 2015). As the CNL, I would utilize evidence based, patient centered care at my facility. Keeping the patient at the center of care, I would conduct a microsystem assessment of safety and quality based on the facilities’ key performance measures and utilize just culture principles and the use of safety tools, such as Failure Mode Effects Analysis (FMEA) and root cause analysis (RCA), to anticipate, intervene and decrease risk. This would include looking into errors and near misses as well as critiquing patient handoff reports. Using lateral integration of care I would communicate with the interdisciplinary team making recommendations for improvement and implementing strategies to increase safety, as well as leading change initiatives to decrease and eventually eliminate discrepancies between actual practices and identified standards of care (AACN, 2013).
As a patient advocate I would look at patient satisfaction indicators, evaluate the care of at risk populations and address the level of cultural awareness and any observed healthcare disparities. I would utilize technology and media to advance patient education in the discharge process. Representing the needs of the patients and the facility’s agenda, I would provide horizontal leadership by demonstrating effective communication with the interdisciplinary team. I would promote team decision and attempt to create an environment of understanding and appreciation among staff of similarities and differences in role characteristics and contributions of the team (AACN, 2013).
Utilizing cost benefit analysis I would evaluate the efficacy and utilization of resources and would implement a strategy to reduce surgery cancellations and delays, which results in financial waste and underutilization of staff, and negatively affects patient satisfaction scores as well as physician and nurse job satisfaction.
Barriers to Implementation
I anticipate that a barrier to fulfilling this role will be the issue of staff compliance. The traditional hierarchy of nursing management is a top down approach. The CNL role attempts to depart from traditional leadership and shift toward a facilitative role and this role demands cooperation from all disciplines. Because people come from various backgrounds, bringing different values and methods of performance, it is often difficult to have 100% agreement on anything. With the rapid changes occurring in healthcare, it seems that the nursing role has stayed rather stagnant and changes that do take place are usually small and unit specific. Making a major change in the way healthcare is executed, such as transitioning from fragmented to care to cohesive care, is bound to rock the boat. Currently there are four generations of nurses working, and each generation brings different generationally influenced values to work (Kupperschmidt, B., 2006).
Alleviating this barrier will require the CNL to create an environment of mutual respect on the unit. The CNL must adopt a leadership style that takes this multigenerational nursing aspect into account. Communication and reassurance are important factors as staff struggle with uncertainty of the unknown, loss of personal power or loss of their comfort zone. Harris & Roussel (2010) state that “complex organizations have many layers, resulting in slow reaction to the change that is needed (p.74).” Describing the benefit of change and beginning with a developmental approach to change may help to alleviate staff anxiety. The CNL needs to incorporate the competency of Demonstrating a leadership role in enhancing group dynamics and managing group conflicts (AACN, 2013). Poor group dynamics, can undermine the success of a project, and can diminish group morale. The CNL must facilitate the group to keep them on topic and engaged in discussion.
Driving Forces for Implementation
Driving forces to implementing the CNL Role will be the awareness of healthcare organizations to recognize the need to meet the changing demands for improved patient outcomes and nurse retention (Drenkard, 2004), participation from management, and nurses who will champion the role.
With the implementation of the Affordable Care Act (2010) it is time for healthcare organizations to capitalize on opportunities to increase patient safety and outcomes. To make this happen, an environment must be established that will allow the CNL to lead in change. A study of the adoption of safer alternatives to blood transfusion in hospitals found that "the presence of local clinicians who advocated or 'championed' a particular method was a significant influence on local practice" and that the absence of such a person was associated with poor adoption (Graham et al. 2002: 135). The Institute of Medicine (1999) suggests that a champion presence was one of the factors that helped anesthesiology become one of the safest sectors of medicine; and recommended clinician leadership and advocacy as a way to establish a system-wide culture of safety in healthcare overall.
It will be necessary for the CNL or other nurse leaders to champion the role by advocating for the patients. The CNL is a nurse and is first and foremost a patient advocate. How can any healthcare provider deny evidence-based approaches to caring which hold the patient’s best interest in mind? It is of utmost importance that an understanding is developed that the CNL role is not about replacing or managing anyone, but is about facilitating the best care for patients in the most cost effective manner for the facility.
The face of nursing is constantly changing and adapting to the environment around it. The challenge now is for nurses to step to the plate and up their game. Todays nurse must be emotionally intelligent, inquisitive and fearless. In the midst of a rapidly changing healthcare system, we cannot allow patients to fall between the cracks. As Porter-O’Grady, Clark & Wiggins so eloquently stated, “Nurses' traditional approach to valuing their work is now only partially meaningful. In this age of evidence, critical thinking and effort must more clearly reflect the interface between effort and outcome within the contextual framework of obtaining real and sustainable value—in short, making a difference in the life and health circumstances of those whom nurses serve” ( 2010, p.38).
References
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