Partnering for Success : NP, CNS and CNL Student

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Partnering for Success NP, CNS and CNL Student

• AACN CNL Teleconference
• April 25, 2007

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Questions?

• Please email them to
• jstanley_at_aacn.nche.edu

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Background on Partnership

• University of Portland School of Nursing CNL
  Program has two clinical partners
• Providence Health System
• Portland Veterans Hospital

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Clinical Placements

• First CNL cohort graduates May 07
• Student placements
• Providence medical facilities
• Portland VA Hospital
• Parish Nursing

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Preceptors

• A mixture
• Nurse educators
• Nurse managers
• NPs
• CNSs
• The best fit is often a combination

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One Students Residency Experience

• Center for Medically Fragile Children at
  Providence Child Center

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The preceptors

• Jean Wilkinson, RN, PCNS, MSN
• Clinical Nursing Manager
• Rebecca L Jones RN, MN, PNP
• Resident Care Manager

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Residency at CMFC

• Assessment of unit
• Assessed populations demographics
• Visits/interviews with staff management
• What works
• What doesnt work
• Systems/processes
• Culture/feel of the unit

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Nursing Questions from Assessment

• Is there research to support turning the children
  every two hours?
• Are we doing everything we need to be doing in
  regards to bone density in this immobile
  population?

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Positive Trend in Decreasing Fractures
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Literature Search on Population

• Cerebral Palsy
• Seizure Disorders
• Birth Anomalies/Syndromes
• Profound learning developmental disabilities

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What did they all have in common?

• Fragmented sleep patterns usually from birth
• Difficulties falling asleep staying asleep
• Catch up sleep during day
• Behavioral problems

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Quality Question

• Will NOT turning this population cause any
  problems?
• Will adding melatonin to the night time regimen
  improve outcomes?
• Seizures
• GERD
• Level of alertness

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Project Design

• Before After Design
• 1 week baseline
• 3 weeks interventions
• Project Timeline
• Goals

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Sleep Project Interventions

• A quiet bedtime environment
• Soft music played at night prior to sleep
• Give melatonin at 9 PM
• A darker room with only the dim bedside light or
  flashlight for routine checks

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Interventions

• One brief turn/change at 2AM
• decrease sleep interruptions between 10 PM until
  6 AM
• Replacing the bedside fluorescent light bulb with
  a red light
• Hourly notations on individual diaries

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Project Goals

• Decrease seizure activity
• Decrease sleeping during the day
• Increase alertness interaction during day
• Improve school performance improved alertness
  social ability

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Results
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Interpretation of Results

• Most data points improved
• No bad outcomes
• No skin breakdown
• No pneumonia or other resp. comp
• No increase in seizure activity
• No side effects from melatonin

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Positives from the Project

• Collaborative atmosphere
• A palpable shift in thinking in the culture of
  the way things are always done
• Staff adopted a it just makes sense stance
• Great buy-in from management for the extra
  and ordering

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Problems Encountered

• Needed heavier-duty briefs
• Changing out lights had a cost
• Redistribution of work
• Timing of laxatives/suppositories
• Temperatures

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Other Issues

• Staff began implementing interventions too soon
• Confusion over diary charting not enough codes
  or people making up own codes

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Dollars and Sense

• Changing from regular briefs to heavy-duty
• Regular briefs cost .22
• .22 X 3 (changes/night) .66
• Heavy-duty briefs cost .40
• .40 X 1 (change/night) .40
• That is a savings of .26
• Potential cost savings (per 50 kids) of 13.00
  per night or 4745.00/year

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Plans for the Future

• Full spectrum lighting in all rooms
• Red lights at bedsides
• Implementation into the greater population
• The resident care managers nursing leadership
  will meet to discuss further
• Jean has been awarded a Sigma Theta Tau grant to
  continue

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Preceptor Perspective

• Jean Wilkinson, PCNS
• Becky Jones, NP
• How was it precepting a CNL student?
• Do you have a good understanding of the CNL role
  now?

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Preceptor Perspective

• How do you see these 3 roles (CNS, NP, CNL)
  working together?

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Questions?Please email them tojstanley_at_aacn.nc
he.edu