Leslie McKeon

Clinical nurse leader impact on clinical microsystems outcomes.

The clinical nurse leader (CNL) role is being rapidly implemented in healthcare settings. A major component of the CNL role is to provide a leader at the center of the microsystem to promote quality outcomes. To examine the impact of CNLs at the Department of Veterans Affairs Tennessee Valley Healthcare System, outcomes from 5 diverse microsystems were evaluated before and after CNL implementation using electronic scheduling system reports, patient medical records, and quality improvement reports. Statistically significant improvements were found in all 5 of the indicators evaluated. The authors discuss the implications of improvement for clinical, satisfaction, and financial performance.

Using Quality and Safety Education for Nurses to Guide Clinical Teaching on a New Dedicated Education Unit

Gaps exist in health professional education versus the demands of current practice. Leveraging front-line nurses to teach students exemplary practice in a Dedicated Education Unit (DEU) may narrow this gap. The DEU is an innovative model for experiential learning, capitalizing on the expertise of staff nurses as clinical teachers. This study evaluated the effectiveness of a new academic-practice DEU in facilitating quality and safety competency achievement among students. Six clinical teachers received education in clinical teaching and use of Quality and Safety Education for Nurses (QSEN) competencies to guide acquisition of essential knowledge, skills, and attitudes for continuous health care improvement. Twelve students assigned to the six teachers completed daily logs for the 10-week practicum. Findings suggest that DEU students achieved QSEN competencies through clinical teacher mentoring in interdisciplinary collaboration, using electronic information for best practice and patient teaching, patient/family decision making, quality improvement, and resolution of safety issues.

Developing Patient-Centered Care Competencies Among Prelicensure Nursing Students Using Simulation

Health care improvement requires collaboration between academia and practice to bridge gaps in nurse education and achievement of quality outcomes. Quality and Safety Education for Nurses identified six domains, including patient-centered care, that should be addressed during prelicensure education. Simulation is a recommended strategy to teach safe clinical practice; however, cost, space, and faculty resources are barriers to its use. Computer-based social simulation is less resource intensive and effective in improving critical-thinking skills. A pilot study was conducted to compare required resources and student learning outcomes for traditional versus computer-based simulation. Fifty-three baccalaureate nursing students participated in the study; 34 completed the computer-based simulation and 31 completed the traditional simulation. Group patient-centered care competency scores improved similarly (p < 0.001), although fewer faculty hours were required to administer the computer-based intervention. Findings suggest computer-based simulation is an efficient and effective learning strategy to develop patient-centered care competencies.

A sustainable model for pediatric oncology nursing education in low-income countries

Effectiveness of a nurse educator in the pediatric oncology unit in Guatemala was assessed by measuring completion of an education course, chemotherapy and central line competency, continuing education, and cost. All newly hired nurses completed the education course. Of the nurses employed, 86% participated in the chemotherapy course, and 93% achieved competency; 57% participated in the central line course, and 79% achieved competency. The nurses completed a mean of 26 hours continuing education yearly. The annual direct cost of the educator (

A model academic-practice partnership.

244/nurse) was markedly less than other models. This is an effective and sustainable means to educate nurses in low‐income countries. Pediatr Blood Cancer 2012; 58: 163–166.

Using QSEN to measure quality and safety knowledge, skills, and attitudes of experienced pediatric oncology nurses: an international study.

Academic-practice partnerships are increasingly viewed as requisite for the future of nursing and paramount to bridging education preparation and achievement of excellence in professional practice. A model partnership that grew out of a decision to transition a hospital diploma program to a baccalaureate degree program is described and lessons learned from that experience follow. In the 1900s, Memphis, Tennessee was witness to early evolutions in nursing education. In 1918, the Methodist Hospital School of Nursing (MHSON) was established, while just down the street, two years later, the Memphis City Hospital and its 33-year-old School of Nursing affiliated with The University of Tennessee Health Science Center (UTHSC). By 1927, the university assumed responsibility for the city hospital’s school of nursing and, in 1950, the school became one of the earliest baccalaureate (Bachelor of Science in Nursing [BSN]) programs in the country. For the next half-century, both the MHSON and the UTHSC programs coexisted with graduates of both playing critical roles throughout the growing Methodist-Le Bonheur Healthcare (MLH) system. By mid-1990, interest in nursing waned and schools experienced difficulty filling classes. In response to this trend and other emerging forces in nursing and healthcare, the UTHSC College of Nursing (CON) made the bold decision to hold the BSN program in abeyance and focus on graduate education as Methodist and other local schools were meeting regional demands for entry-level nursing education. As the new millennium dawned, an even more challenging healthcare environment emerged. The increasing complexity of care in general, emphasis on the need to improve quality, and the burgeoning interest regarding the impact of professional nursing created new demands for nursing practice and education. It was in this environment that schools of nursing experienced a rapid increase in applications. Concurrently, MLH created the new role of senior vice president/chief nurse executive and selected a nurse leader who was charged with oversight for patient care and nursing practice in the multihospital system, including establishing a longrange plan for MHSON.

Use of joint commission international standards to evaluate and improve pediatric oncology nursing care in Guatemala

Objective This pilot study describes the development of an instrument to measure nursing quality knowledge, skills, and attitudes for practicing pediatric oncology nurses. Because many nurse leaders of academic centers are responsible for outcomes at both local and global level, ensuring nursing quality is critical, given the variability in practice outcomes. Methods Quality Improvement Knowledge, Skills, and Attitudes (QulSKA), a 73-item electronic questionnaire was developed using QSEN competencies; the six domains include: quality improvement (QI), safety, evidence-based practice, teamwork, patient-centered care, and informatics. Content validity was established by pediatric oncology, QI, and test-construction experts. Nurses from St Jude Childrens Research Hospital and US and Latin American affiliate sites were surveyed. Results Thirty-seven of 216 RNs surveyed participated in the study. The QulSKA inter-item correlation coefficient was 0.839 (P = .001). The mean knowledge score (based on 100) was 69.2 ± 11.3. Scores were highest for safety (82.9%) and lowest for teamwork (48.6%). The mean skills rating was 3.3 ± 0.74 (used 2–4 times). Lowest rated skills were in analysis and QI tools. The mean attitude rating was 3.8 ± 0.25 (highly important). Conclusion Data suggest that QulSKA may be reliable to measure quality knowledge, skills, and attitudes among pediatric oncology nurses-nurses were knowledgeable in QI, yet they lacked skills in practice application.

A standardized curriculum to introduce novice health professional students to practice-based learning and improvement: a multi-institutional pilot study.

Inadequate nursing care is a major impediment to development of effective programs for treatment of childhood cancer in low‐income countries. When the International Outreach Program at St. Jude Childrens Research Hospital established partner sites in low‐income countries, few nurses had pediatric oncology skills or experience. A comprehensive nursing program was developed to promote the provision of quality nursing care, and in this manuscript we describe the programs impact on 20 selected Joint Commission International (JCI) quality standards at the National Pediatric Oncology Unit in Guatemala. We utilized JCI standards to focus the nursing evaluation and implementation of improvements. These standards were developed to assess public hospitals in low‐income countries and are recognized as the gold standard of international quality evaluation.

Using portfolios to introduce the clinical nurse leader to the job market.

Background Practice-based learning and improvement (PBLI) combines the science of continuous quality improvement with the pragmatics of day-to-day clinical care delivery. PBLI is a core-learning domain in nursing and medical education. We developed a workbook-based, project-focused curriculum to teach PBLI to novice health professional students. Purpose Evaluate the efficacy of a standardized curriculum to teach PBLI. Design Nonrandomized, controlled trial with medical and nursing students from 3 institutions. Methods Faculty used the workbook to facilitate completion of an improvement project with 16 participants. Both participants and controls (N = 15) completed instruments to measure PBLI knowledge and self-efficacy. Participants also completed a satisfaction survey and presented project posters at a national conference. Results There was no significant difference in PBLI knowledge between groups. Self-efficacy of participants was higher than that of controls in identifying best practice, identifying measures, identifying successful local improvement work, implementing a structured change plan, and using Plan-Do-Study-Act methodology. Participant satisfaction with the curriculum was high. Conclusion Although PBLI knowledge was similar between groups, participants had higher self-efficacy and confidently disseminated their findings via formal poster presentation. This pilot study suggests that using a workbook-based, project-focused approach may be effective in teaching PBLI to novice health professional students.

Teaching Clinical Nurse Leaders How to Diagnose the Clinical Microsystem

Development of a portfolio is an effective strategy used by clinical nurse leaders (CNLs) to inform prospective employers of their specialized skills in quality improvement, patient safety, error prevention, and teamwork. The portfolio provides evidence of competence relative to the role of clinician, outcomes manager, client advocate, educator, information manager, systems analyst/risk anticipator, team manager, healthcare professional, and lifelong learner. This article describes the CNL portfolio developed by experts from the University of Tennessee Health Science Center and Methodist LeBonheur Healthcare. Examples of portfolio documents generated throughout the master’s entry CNL curriculum are provided, along with student experiences using the portfolio in the employment interview process.