2013 CNL® Summit
January 17-19, 2013
Abstract Submission Form
Abstract title: Clinical Nurse Leader . . . A Marathon . . . Not a Sprint
Author Name & Credentials: Elizabeth A. Murphy, BScN, MSBA, RN, NEA-BC, FACHE
Institution: Trinity Health - Saint Mary's Health Care
City/State: Grand Rapids, Michigan
Primary Contact Email: Murphyea@trinity-health.org
Instructions: Please complete each of the following sections, when applicable. Each section
should contain between 50 and 250 words, using Times New Roman, 12 point font.
Background Information:
In the fall of 2008, Trinity Health Saint Mary's Health Care began a journey towards integrating
the Clinical Nurse Leader into the care delviery model with a goal of transforming care through
clinical leadership at the point of care delivery. Saint Mary's was selected by Trinity Health to be
one of two pilot sites for the CNL role based upon the commitment and vision of the CNO and
the previously developed care delviery model which had called for a new role with similar
characteristics to the CNL white paper.
Saint Mary's created selection criteria and identified 17 internal professional RNs to begin the
CNL curriculum at the University of Detroit Mercy in the winter 2009. These RNs were awarded
a full scholarhsip through Trinity Health. During their 18 month graduate program there was a
systematic process for support, coaching and mentoring of the CNL students by the CNO and
clinical service directors. All 17 graduated and completed their national certification in May
2010.
The CNO gained support for the role through edcuation of senior leaders, baord members and
medical staff. The Clincial Service Directors served as champions of the students and the role.
The CNO and Directors, along with 2 representatives from the CNL Cohort and representatives
from case management, CNS, and educators to redesign the care delviery model in order to
integrat the CNL role. The CNO committed to the Executive team that this new model would
result in moving the bar on outcomes - clinical quality, service, RN engagement, turnover, along
with LOS and costs. The CFO asked for a commitment to a net volume adjusted FTE impact of
zero, and the CNO agreed in order to move the model forward.
In June 2010, all 17 CNLs were deployed across the organization at the point of care - 14 of
them to unit level microsystems, 1 to the ED, and the other 2 to population based microsystems
of care.
Aim:
ADVANCING HIGHER EDUCATION IN NURSING
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The CNO desired to enhance the professional practice of RNs while creating excellence in
safety, clinical outcomes and service. The organization has been on the journey towards Magnet
designation.
What SMHC Leaders wanted:
Someone to serve as the “Holder of the patient story” (communication)
Someone to “connect the dots” (continuity)
Best experience (patient experience of care)
Retain talent and succession planning (mentoring, coaching and engagement at point of
care)
Support implementation of Evidence-Based Practices (outcomes)
Enhance professional practice (clinical leadership, complex care, interdisciplinary teams)
Realize the Triple Aim - Improving the patient experience of care (including quality and
satisfaction); Improving the health of populations; and Reducing the per capita cost of health
care.
Methods/Programs/Practices:
CNO role included the following:
Advocacy
Touch base meetings
Barrier reducing
Availability
Celebration
Strategies included:
Monthly meetings w CNO and CNL Cohort which began 12 mos prior to graduation
Systems thinking – Trinity Health LEAN curriculum
LEAN work to revise standardized work and processes
CNL brochure
Clarification of roles and expectations
Inservices from key clinical experts
Competency & clinical experience with validation
16 hours of didactic education
Clinical Service Director/Manager/CNS as leadership team
Outcome Data:
Two years after implementation of the CNL cohort, including the need for some workforce
changes during the 2 years, the roganization has measurable changes in outcomes. Professional
RN turnover went from more than 10% to <7%; organizational clinical weighted grade point
went from 2.5 (June 2010) to 3.7 in June of 2012. Additional outcomes include impoved patient
perceptions of pain, increased rates of immuniation, creation of an accountability model for use
by CNLs and managers in working with staff. CNL led teams have improved processes for handAACN Call for Abstracts, 2013 CNL Summit
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offs between psychiatric hospitals and the ED, reduced documentation time for staff on a
psychiatirc medicine unit allowing 8 additional hours daily focused towards direct patient care.
Additionally the analysis of repeat ED patients, readmissions more than 3 times annually, and
survey of medical staff leaders for complex patients has resulted in the development of a process
for understanding and managing these complex patients through interdisciplinary complex care
plans. This work in its initial 6 months has resulted in reduction of ~300 LOS days for just 10
patients.
These are just a few of the positive outcomes generated since the integration fo the CNL cohort
across an organization.
Conclusion:
Strong CNO leadership is critical to the integration of the CNL role into an organization. It
requires being a risk-taker, the ability to deal with ambiquity, a willingness to create stretch goals
and targets, and consistency of vision - - it is a marathon, not a sprint.
AACN Call for Abstracts, 2013 CNL Summit
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