1. Zangerle, Claire M. MBA, MSN, RN

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Frontline clinical nurses are the ultimate multitaskers; from providing direct care to educating the patient and family to fielding calls on lab values and test results, they're constantly "doing." Yet, clinical nurses must also critically think as they make decisions that affect the patient's care outcomes. Add to all of this the increased pressure to decrease length of stay and transition the patient to the next care setting appropriately. The last thing clinical nurses may want to add to their plate is getting involved in the care coordination process. However, research shows that engagement in this work, including involvement in the postdischarge process, has a significant effect on patient outcomes.1

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Start with the basics

Generally, engagement goes beyond job satisfaction; rather, it's defined by a broader set of perceptions, attitudes, and behaviors. The work environment, trust, and autonomy are paramount to achieving optimal engagement.2 It's suggested that embedding engagement principles and promoting their adoption within the professional practice model (PPM) is ideal. For example, the relationship-based care model can include the domain of a healing environment, with the elements of effective communication, relationship management, and interdisciplinary collaboration all speaking to nurse engagement.3


Fully adopted, a PPM with engagement elements provides the collateral benefits of better patient outcomes, improved patient experience, and a healthier financial bottom line. A skilled nurse leader leverages the PPM to tease out the engagement elements and implement them on the unit. Further, you can extract engagement within a PPM to support services, specifically care coordination.


In action

Engagement starts with the nurse-patient relationship as a core component of the acute care episode. Upon admission, the clinical nurse and the patient move through four phases of an interactive relationship: translating information, getting to know each other, establishing trust, and going the extra mile.4 It's in the last two phases that clinical nurses can engage in and influence a successful care coordination transition.


In most organizations, a care management team initiates care coordination. These team members are well versed in assessing the patient's current clinical status and determining the appropriate placement and postacute care requirements for optimal outcomes. Conversations between the clinical nurse and care management team are essential because the nurse-patient relationship may have produced information not readily available to the care manager. This valuable clinical nurse insight may prevent a readmission.


Comprehensive care coordination and transition management doesn't happen in a vacuum. When the clinical nurse engages with the care manager, and vice versa, we reap great benefits from a value-based care perspective. But how does this happen in the daily chaos of the clinical nurse's role? Recently, the American Organization of Nurse Executives and the American Academy of Ambulatory Care Nursing issued a joint statement offering advice on how engagement can occur through bridging the gap between the acute care and postacute care settings.5 Embracing engagement at a clinical nurse level provides a framework for collaborative relationship building between the nurse and care manager. No longer is a patient discharged; he or she is transitioned with the collaborative efforts of the care management team and an engaged clinical nurse.


Table 1 outlines six strategies to guide the clinical nurse in simple ways that lead to better transitions, shorter lengths of stay, and an improved patient experience.

Table 1: Strategies ... - Click to enlarge in new windowTable 1: Strategies for clinical nurses

Say "I do"

This type of engagement doesn't include a diamond ring and a honeymoon, but when clinical nurses connect to patients and colleagues with a purpose, it can lead to a better chance of "happily ever after."




1. Press Ganey. Nursing special report: the influence of nurse work environment on patient, payment, and nurse outcomes in acute care settings. [Context Link]


2. Bargagliotti LA. Work Engagement in nursing: a concept analysis. J Adv Nurs. 2012;68(6):1414-1428. [Context Link]


3. Small D, Small R. Patients first! Engaging the hearts and minds of nurses with a patient-centered practice model. [Context Link]


4. Fosbinder D. Patient perceptions of nursing care: an emerging theory of interpersonal competence. J Adv Nurs. 1994;20(6):1085-1093. [Context Link]


5. Zangerle C, Kingston MB. Managing care coordination and transitions: the nurse leader's role. Nurse Leader. 2016;14:171-173. [Context Link]