Opportunities for Improving Patient Care Through Lateral Integration: The Clinical Nurse Leader

Begun, James W.; Tornabeni, Jolene; White, Kerr L.

doi:10.1097/00115514-200601000-00005

Cited by 24 publications

(13 citation statements)

References 3 publications

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“…Furthermore, leadership needs to be ongoing and involve the entire healthcare team for a collaborative care environment to be sustained (McCallin, 2001). The CNL role was created in direct response to this need for clinical leaders at the point-of-care healthcare setting, integrating care within and across care settings and disciplines (Begun, Tornabeni, & White, 2006).…”

Section: Care Environments and Collaborationmentioning

confidence: 99%

Clinical Nurse Leader Impact on Microsystem Care Quality

et al. 2012

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• Background: The current fragmented healthcare system, characterized by a lack of collaborative, patient-centered care processes, creates significant barriers to providing quality patient care. The clinical nurse leader (CNL) is theorized to provide clinical leadership at the point-of-practice to maintain cross-disciplinary collaborative processes that lead to integrated quality care.• Objectives: The aim of this study was to assess the impact of CNL integration into an acute care microsystem on care quality, as measured by patient satisfaction with care.• Methods: A short interrupted time series design was used to measure patient satisfaction with multiple aspects of care 10 months before and 12 months after integration of the CNL role on a progressive care unit, compared with a control unit. Data were obtained from Press Ganey surveys, and analysis was completed using a publicly available program for short time series data streams.• Results: Clinical nurse leader implementation was correlated with significantly improved patient satisfaction with admission processes (r = + .63, p = .02) and nursing care (r = + .75, p = .004), including skill level (r = .83, p = .003) and keeping patients informed (r = .70, p = .003). There was no significant correlation with improved patient satisfaction with physician care (r = .31, p = .14) or discharge processes (r = .33, p = .23) post-implementation. Control data showed no significant changes in patient satisfaction measures throughout the study time frame.• Discussion: The positive correlation between CNL-mediated collaborative care processes and improvements in patient satisfaction with care quality provides empirical evidence of outcomes achievable through CNL implementation.Research is needed to explore the full range of achievable outcomes and to determine the specific processes by which these outcomes are realized. • Key Words: clinical nurse leader & healthcare quality & microsystem redesignCurrent healthcare delivery is plagued by disciplinary silo approaches to patient care, including a lack of formal interdisciplinary collaborative processes. Until recently, overburdened healthcare providers were not educated to collaborate and build consensus regarding goals of care with the patient and members of an interdisciplinary team. This fragmented approach to patient care has been associated with preventable adverse outcomes, including increased mortality and morbidity, 30-day readmission rates, length of stay, and costs (Fewster-Thuente & Velsor-Friedrich, 2008). In response to this evidence, the Institute of Medicine (IOM) has identified creation of effective work teams as a priority for redesigning and improving healthcare (IOM, 2001). Teamwork and effective interdisciplinary collaboration have been linked to improved quality of care and patient outcomes (Zwarenstein, Goldman, & Reeves, 2009). Unfortunately, there is limited evidence describing effective processes for creating and sustaining a collaborative environment. The clinical nurse leader (CNL) is theorized to...

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Section: Care Environments and Collaborationmentioning

confidence: 99%

Clinical Nurse Leader Impact on Microsystem Care Quality

et al. 2012

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“…As a consequence, the patient is cast into a submissive role and the relationship between patient, nurse and task is lost (Allshouse 1993). Begun et al. (2006) and O’Connell and Warelow (2001) argue that inefficiencies and errors are likely consequences of such an approach.…”

Section: Discussionmentioning

confidence: 99%

Clinical teachers’ approaches to nursing

Forbes

2010

Journal of Clinical Nursing

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“…Communication skills facilitate lateral integration of care; this requires collegial discussions with various members of the health care team (Begun & Tomabeni, 2006;Bender, Connelly, & Brown, 2013, Spitzer, 2010). An example of how this skill is incorporated into the IPT model is the informal emails students send to all preceptor team members and the faculty member each week.…”

Section: Communicationmentioning

confidence: 99%