Shared Leadership: Clinical Nurse Leaders Improving Continuity of Care and Quality Outcomes for Hospitalized Stem Cell Transplant Patients

Topic Significance & Study Purpose/Background/Rationale 

As increasingly more complex hematopoietic stem cell transplants (HSCT) are preformed there is a need to improve continuity of care and quality outcomes for inpatients.  A shared leadership approach was use to on-board four Clinical Nurse Leaders (CNLs) to a 48-bed HSCT unit in a novel patient care delivery system as part of an institutional roll out.   Each CNL functioned as the primary lead over staff and patients assigned to 12-bed pods in a patient-centered care delivery approach called Primary Team Nursing (PTN).  The purpose is to discuss nurse sensitive quality and patient satisfaction outcomes following the implementation of PTN using CNLS on a large inpatient stem cell transplant unit

Methods, Intervention, & Analysis 

Four CNLs trained with bedside nurses learning the care of HSCT patients on a 48-bed unit over a 3-month period, and were then moved into the CNL role overseeing teams of nurses and assistants working on 12-bed pods with the implementation of PTN.  Quality and patient satisfaction data were trended prior to and following the implementation of PTN.  Additionally team based outcomes were evaluated using TeamSTEPPS assessment tools

Findings & Interpretation 

Metrics indicate significant improvements in most nurse sensitive quality indicators including patient satisfaction, fall reduction, hourly rounding, and CLABSI.  Additionally TeamSTEPPS assessments preformed at intervals throughout the first year of implementation show improvement across the domains of team structure, leadership, mutual support and communication.

Discussion & Implications 

Using CNLs as the team leader in the Primary Team Nursing Model may contribute to enhancing quality and continuity of care for complex HSCT patients