The Clinical Nurse Leader

1. The Clinical Nurse Leader Advancing Home and Hospice Care Jennifer Beasley Collier, RN MSN CNL Director of Education Alacare Home Health and Hospice, Inc.

2. Setting • Headquartered in Birmingham, Alabama • Provides skilled nursing, rehabilitative, palliative • and hospice services. • Provides services statewide, through 27 branch • offices.

3. Interdisciplinary Team • Nurses • Home Care Aides • Physical, Occupation and Speech Therapists • Medical Social Workers • Nutritionists • Certified Diabetes Educator • CWOCN • Chaplains • Volunteer Coordinators

4. Home Care Average Daily Census: 5800 • Hospice Average Daily Census: 590

5. Challenges in Setting • Coordination of Care • Identification of appropriate level of care • Disease State Management • Reducing re-hospitalizations • Reducing hospice revocations • Retention/Turnover

6. Challenges in Setting • Standardization of processes • Providing standardized, comprehensive orientation • Reimbursement issues

7. Job Role • Directs and coordinates overall departmental administration. • Two (2) Education Coordinators • One (1) Diabetic Nurse Educator • Two (2) CWOCNs Specialty staff function as Clinical Educators.

8. Primary Job Functions • Directs and coordinates overall department administration. • Develops and monitors an orientation program for agency staff. • Directs specialty clinical services and coordinates the development of specialty programs to meet the specific needs of the agency. • Develops, implements and evaluates patient and family education materials for use in community and home

9. Secondary Job Functions • Facilitates special committees/projects that benefit the agency in terms of cost, quality and personnel. • Develops and participates in educational activities related to the medical community, area community and schools of nursing. • Other duties as assigned.

10. Impact of CNL

11. What I Learned and How I Grew…. • Advocate • Identify clinical and cost outcomes that improve safety, effectiveness, timeliness, efficiency, quality and client-centered care. • Examples: • Underpads, diapers • Formulary medications • Policy Committee • Palliative Care Program

12. What I Learned… • Communicates effectively to achieve quality client outcomes. • Examples: • Hospice Standing Guidelines • Protocol for Referral for CWOCN

13. What I Learned… • Member of a Profession • Actively pursues new knowledge and skills as the CNL role, needs of clients, and healthcare system evolve. • Examples: • Provided fourteen (14) external presentations during 2009 to community hospitals to increase awareness of current healthcare environment, common challenges and need for collaboration from setting to setting.

14. What I Learned… • Team Manager • Properly delegates and utilizes the nursing team resources (human and fiscal) and serves as a leader and partner in the interdisciplinary health care team. • Examples: • Redesign in the Hospice Interdisciplinary Group Meeting. • On-call readiness. • Discipline specific orientation and professional development programs. • Case Management Redesign.

15. Data Overload • POC System (HCHB)- approx 250 standard reports • ProClarity- customized reporting • FlexTrain • Home Health Compare • Press Gainey • Routine Audits • QI Audits

16. Data Overload • QAPI Audits • HospiScripts • Answering Service Reports • Fleet Management • Survey Monkey • Home Health QI Council • Hospice QI Council • Employee Viewpoint Surveys • Voice Committee

17. Data Overload • Exit interviews • Stay surveys • Retention reports/data

18. What I Learned… • Information Manager • Uses information systems and technology at the POC to improve health care outcomes.

19. What I Learned… • System Analyst/Risk Anticipator • Conduct a micro system analysis • Analysis of outcome • Analyze barriers and facilitators • Develop action plan • Present and disseminate to appropriate audiences. • Examples: • Discontinuation of Hospice Comfort Kits • Medication Reconciliation • VIP Orientation

20. The Director of Education a Clinician? • Recognizing the influence of the meso and macrosystems on the microsystem. • Contribute to interdisciplinary plans of care based on best practice guidelines and evidence based practice. • Palliative Performance Scale • Braden Scale • Disease Management Programs

21. CNLs Greatest Contribution in Homecare/Hospice Setting • Immunity from the “day-to-day” whirlwind.

22. CNL Educator • Uses appropriate teaching/learning principles, as well as materials and technologies. • Distant Learning Orientation utilizing multi-media. • CHEX • FLEX TRAIN- in house development • Live Meeting- Web Conferencing • Monthly CEU presentations via web-cast to meet agency specific needs. • In-house infomercials.

23. CNL as Educator • ELNEC Training (End of Life Nursing Education Consortium) • Annual in-service calendar • Ring of Knowledge • Hospice Boot Camp • Nursing Skills Fair • Quarterly Clinical Digest • “What’s on Tap” Monthly Newsletter • Monthly Customer Service Campaign

25. Why apply for CNL certification if in non-traditional role? • Defines specific set of competencies the CNL will bring to a non-traditional job role that will further advance bedside patient care. • Validates individual has completed all requirements for CNL certification.

26. Questions? Comments? Contact Information: Jennifer Beasley Collier Jennifer.beasley@alacare.com 205-981-8759 Work Alacare Home Health and Hospice