The pandemic of 2020 has brought an opportunity for the clinical nurse leader (CNL) skill set to shine. During such a dynamic time, the health care system needs trained leaders to assist with the rapid changes and provide a safe environment. The CNL skill set at a Texas medical facility addressed the challenges of delivering quality and safe care for patients during the COVID-19 crisis. An important component of the team approach to delivering patient care during the pandemic was the administrative authority of the unit managers and the director. Everyone worked together as a health care delivery team to address the unique challenges presented by the COVID-19 pandemic. The CNL helped lead by building interprofessional relationships, exemplifying evidence-based practices, and motivating the health care team to deliver high-standard evidence-based care. The unit managers' ability to formally hold the staff accountable to established standards is a vital component of the CNL's mission to close gaps in patient care and strive for improving patient outcomes. The unit managers' flexibility and willingness to partner with the CNL team during the COVID-19 pandemic were commendable. The CNL role is uniquely equipped to facilitate a multidisciplinary care delivery approach to patient care that incorporates patient advocacy and robust multidisciplinary team input. The rapid infusion and ever-evolving nature of information during the pandemic created an opportunity for the CNL to use multiple functions of their role.
The CNL, as a team manager, is skilled in open-ended communication, conflict mitigation, and interpersonal interactions that emphasize the cooperation and mobilization of the care delivery team to positively impact patient care.1 The CNL functioned as a team manager by collaborating with the multidisciplinary care delivery team and encouraging input from the end users. This helped facilitate the delivery of patient care that emphasized positive outcomes and the safety of both the patients and the staff.
Communication in a rapidly changing environment is essential. Multiple communication strategies were used to keep the staff informed. When compiling information, it was kept as simple as possible so that everyone could grasp the message and implement new practices quickly. Communication handoff logs were created and updated regularly to keep the staff informed of the multiple changes. Leadership huddles and conference calls were done daily. Processes were updated and communicated in these ways, and the staff was able to have input during the huddles and conference calls.
The CNL functions as an outcomes manager by utilizing evidence-based practice to inform patient care decisions and quality initiatives to close gaps in patient care and achieve positive patient outcomes.1 The CNL team managed outcomes by assisting in making decisions about how to utilize equipment and resources to promote safety for patients and health care providers. Proper use of personal protective equipment (PPE) was paramount in protecting both the patients and caregivers from COVID-19 infection. The CNL team researched the latest Centers for Disease Control and Prevention PPE recommendations to develop a modified process for donning and doffing PPE that emphasized safety while maintaining stewardship of and conservation of PPE supplies. They educated the staff and placed signage within the unit detailing the proper steps for PPE donning and doffing for the staff caring for COVID-19-positive patients or patients under investigation.
The CNL acts as a patient advocate by incorporating patients' unique values, desires, needs, and perspectives into patient care delivery.1 To advocate for patients, the CNL team ensured that patients were able to communicate with their family. Because of the crisis, medical facility visitation was prohibited except for extreme circumstances. To address the psychosocial needs of patients with COVID-19, the CNL team coordinated with the Information Technology department to supply tablets to facilitate communication between COVID-19 patients and their families. Utilization of the available technology enhanced the environment to create communication.
The CNL team as the risk anticipator and lifelong learner served as the investigator and preventer of harm throughout the patient's continuum of care. The CNL team coordinated with a multidisciplinary care delivery team to geographically isolate patients under investigation and COVID-19-positive patients from patients who had tested negative. This was done to maintain and emphasize an environment of safety to avoid cross-contamination scenarios. It was important to delineate the roles and responsibilities of all staff members involved in the care of COVID-19 patients. This time of crisis required research to be done quickly and solutions identified.
The CNL team as educator and information manager ensured that rapidly changing information was communicated effectively to maximize decision making. They worked to define and educate the staff about their roles and responsibilities by developing a handoff tool that outlined the various processes required to deliver quality and safe care for COVID-19 patients. The handoff tool was displayed throughout the unit, and the staff was encouraged to discuss this during all shift changes. The practice of educating, displaying handoff signage, and requiring its verbalization during shift change created practice standardization that emphasized consistency across the care continuum.
The CNL was a valuable member of the nursing profession and care team. CNLs assumed guardianship of the profession by maintaining safety while providing quality patient care. During this time, the CNL worked with the team and encouraged open communication to gather input from the end users. Good collaboration and communication built trust and produced a safe, dynamic care environment.
COVID-19 challenged health care systems to quickly adapt to protect the patients and the staff. Like never before, a master's prepared nurse trained in risk anticipation, process improvement, working in teams, researching best practices, and communication is in high need. The CNL skill set was uniquely created to shine during this time!
REFERENCE