Formalizing the role of the clinical nurse leader in a progressive care unit

Abstract

<p>This comprehensive evidence based project was a culmination of almost two years of trialing the Clinical Nurse Leader (CNL) role and then implementing a formalized CNL role in a Progressive Care Unit at UCSD Medical Center in La Jolla, California. It was maintained that the CNL could positiviely affect patient outcomes and staff satisfaction, and thus the role was formalized in May of 2011 as a Clinical Nurse IV (the highest clinical position a staff RN can achieve). This project will demonstrate that using Lewin's Change Theory and Roger's Theory of Diffusion of Innovation as a framework for this change, the CNL role was successfully implemented to provide a different delivery of care model that is accepted by the nursing staff. The setting is a 26 bed Progressive Care Unit with three levels of care: Intermediate, Telemetry and Medical-Surgical care. Within this mix there is a heavy population of oncology patients, both medical, surgical and post-bone marrow transplant. The nurses are trained by attending the 80 hour American Association of Critical Care Nursing Internship program and 32 hours of oncology class work. The unit is a training ground for Critical Care and therefore has a large turnover of nurses who want to work in ICU when they become adequately trained in the PCU. It is an emotionally and physically demanding unit with frequent Rapid Response calls, recent ICU transfers who still require multiple nursing interventions, complex surgeries requiring astute nursing assessments, and many end of life issues that challenge the nurse to collaborate effectively with other health care professionals in order to meet the patient's needs. Therefore, a Clinical Nurse Leader was an ideal addition to our nursing team in that the identified aspects of the CNL would positively affect our patient outcomes, enhance our collaboration with the health care team and provide a "go to" person for the newer nurses.</p>