Collaboration and Communication in Pediatric Oncology: A Case for the Clinical Nurse Leader. M. Danielle Gunter PhD, RN, CPN

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1 Collaboration and Communication in Pediatric Oncology: A Case for the Clinical Nurse Leader M. Danielle Gunter PhD, RN, CPN gunter@uiwtx.edu

2 Objectives Attendees will be better prepared to: Discuss the psychosocial and educational barriers faced by families of children undergoing treatment for oncological diseases. Discuss the clinical and nursing environments of pediatric oncology treatment centers. Discuss the foundation for the clinical nurse leader role and the rationale for use in this setting.

3 Study Overview Descriptive single embedded case study of a south Texas children s cancer unit with multiple informants Determination of variables that will assist in developing a program of support for this population

Study Background: Pediatric Oncology Families Chronically ill children Living longer and better Changes in home-life normalities and financial stability Volume of information provided

4 Study Background: Pediatric Oncology Families Chronically ill children Living longer and better Changes in home-life normalities and financial stability Volume of information provided requires education Readiness to learn must be reassessed throughout the treatment Flury, Caflisch, Ullmann-Bremi, & Spichiger (2011); Gannoni & Shute (2010); Kästel, Ensär & Björk (2011)

5 Study Background: Pediatric Oncology Clinical Environment Usually hospital-based in major medical centers Inter-professional teams are common Hierarchy can be disruptive to full team collaboration Supportive care is often lacking Friese (2005); Hill-Smith, Taverner, Greensmith & Parsons (2012); Lowe, Bravery & Gibson (2008)

6 Study Background: Pediatric Oncology Nursing Environment Lack of experience at the bedside Lack of funding for unit-based nursing leaders with higher education Current focus on reimbursement led to funding cuts in supportive positions Many units without nursing educators or clinical nurse specialists (CNS) compared to historical norms Gregorowski et al., (2012); Sprayberry (2014); Tomlinson (2004)

7 The Clinical Nurse Leader (CNL) Role Introduced in 2003 by the American Association of Colleges of Nursing (AACN) Master s prepared generalist Accountability for patient care outcomes Integrates use of evidence-based practice to design, implement, and evaluate patient-care processes and models of care delivery (AACN, p.4) AACN (2013); Poulin-Tabor et al. (2008); Stachowiak & Bugel (2013); Wilson et al. (2013)

9 staff Why the CNL Works for Pediatric Oncology: AKA.it s worth the investment! Team collaboration crucial for patient safety and satisfaction An anchor/point of contact for families in need of assistance in understanding and navigating their treatment plan Hospital reimbursement is quality and patient outcomes focused Mentorship and role-modeling for inexperienced nursing

10 Financial Benefits.. Cost Effectiveness of the Position Average salary costs between 72K-85K (USD) Outcomes improvement related costs/revenues 20-25K (USD) per patient for all healthcare acquired infections Ranges from $750 for one CAUTI to $29K for one SSI Innovation to fund the FTE position Glassdoor, 2017; Scott, (2009)

11 Conclusion CNLs can address needs in pediatric oncology by serving as: Integrator of evidence-based practice processes Mentor and role model for less experienced nurses Communication coordinator and educator for patients and families Lateral integrator for improvement in health care team collaboration

12 References AACN (2013). Competencies and curricular expectations for clinical nurse leader education and practice. Retrieved from: Flury, M., Caflisch, U., Ullmann-Bremi, A., Spichiger, E. (2011). Experiences of parents with caring for their child after a cancer diagnosis. Journal of Pediatric Oncology Nursing, 28(3), Friese, C.R. (2005). Nurse practice environments and outcomes: Implications for oncology nursing. Oncology Nursing Forum, 32, doi: /05.ONF Gannoni, A.F. & Shute, R. H. (2010). Parental and child perspectives on adaptation to childhood chronic illness: A qualitative study. Clinical Child Psychology and Psychiatry,15, doi : / Glassdoor (2017). Clinical nurse leader salaries. Retrieved from: SRCH_KO0,21.htm Gregorowski, A., Brennan, E., Chapman, S., Gibson, F., Khair, K., May, L., & Lindsay-Waters, A. (2012). An action research study to explore the nature of the nurse consultant role in the care of children and young people. Journal of Clinical Nursing, 22, doi: /j x Hill-Smith, A., Taverner, R., Greensmith, H., & Parsons, D., (2012). Staff relationships in multidisciplinary teams. Mental Health Practice, 15(8), Kästel, A., Ensär, K., & Björk, O. (2011). Parents views on information in childhood cancer. European Journal of Oncology Nursing, 15, doi: /j.ejon Lowe, R., Bravery, K., & Gibson, F. (2008). Navigating the maze: Parents views and influence on a paediatric haematology and oncology day care service. Journal of Clinical Nursing, 17(23), Poulin-Tabor, D., Quirk, R.L., Wilson, L., Orff, S., Gallant, P., Swan, N. & Manchester, N. (2008). Pioneering a new role: The beginning, current practice and future of the clinical nurse leader. Journal of Nursing Management, 16, doi: /j x Scott, R.D. (2009). The direct medical costs of healthcare-associated infections in U.S. hospitals and the benefits of prevention. Retrieved from: Sprayberry, L.D. (2014). Transformation of America s health care system: Implications for professional direct-care nurses. MEDSURG Nursing, 23(1), Stachowiak, M.E. & Bugel, M.J. (2013). The clinical nurse leader and the case manager: Are both roles needed? American Journal of Nursing, 113(1), Tomlinson, D. (2004). Paediatric oncology nurse education: the development of a national framework. Journal of Clinical Nursing, 13(5), Wilson, L., Orff, G.T., Shirley, B.R., Tabor, D., Caiazzo, K., & Rouleau, D. (2013). Evolution of an innovative role: The clinical nurse leader. Journal of Nursing Management, 21, doi: /j x

13 Questions? Thank you for the opportunity to share with you today!

Aclinical nurse leader (CNL) is an advanced generalist

Professional Issues Veronica Rankin Clinical Nurse Leader: A Role for the 21st Century Aclinical nurse leader (CNL) is an advanced generalist prepared at the master s degree level to oversee the lateral