Table 2.

TCU/RCU CNL Practice Exemplars

Staff engagement	• Unit-based peer-to-peer staff recognition program ○ Nominations are submitted to the CNLs, nominations are reviewed during bimonthly unit leadership meetings, and unit leaders vote on the winner • Flash skills education ○ Come-and-go rapid education events offered to staff during their previously scheduled shift on both day shift and night shift • Nursing PDC ○ Members performed a monthly article review, made a unit-based newsletter for sharing current health care news, and gained knowledge by learning from a special guest speaker presentation during the monthly PDC meeting ○ Guest speakers offered PDC members a unique opportunity to interact with hospital employees or community members who do not usually interact with frontline nurses but have an impactful point of view to share
Evidence-based practice	• Bedside nurse-driven constipation prevention protocol6 ○ A trend was identified of patients experiencing advanced constipation, leading to invasive constipation treatment methods ○ CNLs designed a successful bedside nurse–driven constipation prevention protocol based upon guidelines published by the North American and European Societies of Pediatric Gastroenterology Hepatology and Nutrition ○ This practice change led to a statistically significant reduction in rates of invasive medication administration • Gemba board ○ Designed based on the Gemba walk philosophy that brings leaders to the “real place” where employees perform work to learn what does and does not work and why7 ○ Created to improve processes, increase transparency, and ensure accountability of unit leaders ○ Since implementation in August 2018, over 145 staff-requested projects have been completed, including implementing a daily quiet time for infants
Clinical leadership	•Attend daily charge nurse reports and daily interdisciplinary huddles •Facilitate weekly interdisciplinary care coordination planning meetings • Boot camp training program ○ CNLs created 18 innovative boot camp training programs to teach clinical skills to caregivers of children with medical complexity ○ Examples of boot camp topics: tracheostomy, gastrostomy, cervical collar, and seizures ○ A quasi-experimental research study of the impact of the tracheostomy boot camp training program showed improved caregiver satisfaction, decreased caregiver stress levels, and a decrease in median patient length of stay on the unit from 77 days to 48 days and associated cost savings of approximately $1,900,000 over 18 months8 • Physically present on the clinical unit to mentor staff at the point-of-care delivery ○ The CNL arrives early to the unit when the night shift staff are still present to ensure a nursing leadership presence on both shifts
Clinical outcomes	• CNL discharge huddle ○ A strengths, weaknesses, opportunities, and threats (SWOT) analysis revealed a threat for patient readmissions related to caregiver perception of their child's medical readiness for discharge9 ○ An evidence-based discharge huddle to evaluate caregiver perception of their child's health at discharge was created by the CNLs ○ TCU/RCU CNLs assessed patient and caregiver discharge readiness and evaluated caregiver progress in boot camp training programs during weekly rounding ○ Within 7 days of discharge, patient readmissions decreased 50% in the first 13 months after the discharge huddle implementation • Actual patient satisfaction surveys ○ CNLs identified there was no opportunity for pediatric patients to provide feedback on the care they received; instead, post-discharge satisfaction surveys were delivered to their caregivers ○ The TCU/RCU child life specialist, speech-language pathologist, and CNLs collaborated to create a pediatric patient satisfaction survey for patients over 7 years old ○ Trends identified using survey, including the need for staff to explain what to expect during procedures before they occurred ○ After staff education on the trend was implemented, patient satisfaction improved to 100% in the next quarter of the year ○ Narrative feedback from patients included: “You are my best friends” and “More dogs”

PDC, Professional Development Council.