Piloting a Clinical Resource Nurse Role

  Topic Significance & Study Purpose/Background/Rationale

In April 2014, the Bone Marrow Transplant medical team began patient-engaged, bedside rounds.  This inhibited the primary nurse from attending rounds and decreased nursing presence during key discussions and decision making.  Rounding occurs between 8:00 am and 11:00 am; a peak time for clinical needs such as medication administration, chemotherapy infusion and stem cell transplant.  Nursing involvement during rounds was further challenged due to a vacancy rates, training requirements of inexperienced staff, and a new electronic medical record.  Charge nurse support was available but individuals in this role struggled to meet all clinical needs.  The purpose of the Clinical Resource Nurse (CRN) is to facilitate primary nurse presence at beside rounds by ensuring clinical tasks are completed in a safe and timely manner.

  Methods, Intervention, & Analysis

A job description was created and a member of the nursing leadership team was selected to pilot the role based upon clinical and leadership expertise. The pilot role was established as an 8 hour day, Monday through Friday, for 12 weeks.  Effectiveness of the CRN role was evaluated during a charge nurse focus group and through collection of anecdotal reports from staff.  Additionally, feedback was solicited through a post-pilot survey.

  Findings & Interpretation

The implementation of this role enhanced the charge nurse's ability to supervise rounds and manage patient flow.  The charge nurse group felt that they were more effective in leading rounds and supported through presence of an available clinically competent nurse.  Frequency of the patient care nurse attending bedside rounds increased.  Patient care nurses reported satisfaction with consistently attending bedside rounds, receiving uninterrupted lunch breaks, and having a clinical resource available.  Barriers to successful implementation of this role were more logistical and unit culture related. 

  Discussion & Implications

To further enhance utilization of the role, an increased focus on patient education and meeting discharge needs will be addressed.  Expanding the role to seven days a week in order to facilitate continuity of care is also being considered.  At the end of the pilot phase, the CRN role was found overall to be beneficial and plans are to dedicate a permanent position for this resource.