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Department: Pathway to Excellence®

2020 ANCC Pathway Award® winner

Ball, Sarah MSN, ARPN, FNP-BC; Diggins, Kristene DNP, MBA, CNE, NEA-BC, FAANP; Martindale, Nairobi DO; Patterson, Angela DNP, FNP-BC, NEA-BC, FAANP; Pohnert, Anne M. MSN, FNP-BC; Thomas, Jacinta DNP, FNP-C; Todd, Tammy MSN, CRNP, CPHQ; Bates, Melissa DNP, RN, CDE

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Nursing Management (Springhouse): August 2021 - Volume 52 - Issue 8 - p 7-10
doi: 10.1097/01.NUMA.0000758716.87748.ae
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Each year since 2011, the American Nurses Credentialing Center (ANCC) has partnered with Cerner to bestow the ANCC Pathway Award® on a Pathway to Excellence®-designated organization to elevate the practice environment using innovative technologies. Cerner has generously doubled the award prize from $25,000 to $50,000 in 2020. MinuteClinic, the retail medical clinic of CVS Health, is the first national retail clinic to be recognized with this award. They stood out from other submissions with their proposal “Virtual Collaboration (VC) for Nurses.” Being a national organization means that the benefits of their proposed program can impact millions of people across the country.

“Nurses do so much for our communities, facing complex challenges and great demands with dedication and compassion. The past year has given new meaning to the way we think about the contributions of these trusted advocates as they've battled COVID-19 from the front line,” said Eva Karp, DHA, MBA, RN-BC, FACHE, senior vice president and chief clinical and patient safety officer for Cerner Corporation. “Cerner is honored to help recognize organizations that are advancing the nursing profession and transforming the delivery of care. We applaud MinuteClinic for their work to improve virtual nursing collaboration and impact the quality of patient care.”

The Pathway framework and its six standards—shared decision-making, leadership, safety, quality, well-being, and professional development—guides organizations in creating and sustaining a positive work environment where nurses thrive. MinuteClinic's application clearly linked the Pathway standards to their proposal. The vision to increase access to VC coupled with the potential for better patient and staff outcomes merited MinuteClinic winning the 2020 Pathway Award.

This column details MinuteClinic's VC efforts, their use of the Pathway framework, and the associated impact on their interprofessional team.

Background

CVS Health's MinuteClinic provides an innovative solution to today's healthcare access challenges through a holistic and interprofessional care approach with new technologies, enabling improvement in the quality of patient care.1 Requiring a system-wide approach, new technologies are important in nursing and can improve nurse retention as the need for convenient collaboration continues to grow.1

MinuteClinic can be found in 35 states and the District of Columbia and is staffed by a team of advanced practice registered nurses (APRNs), physician associates (PAs), RNs, and LVNs or LPNs. The care team provides a wide range of ambulatory care services, including acute illness and injury care, wellness services, labs, and diagnosis and management of chronic conditions such as diabetes and hypertension. Collaborating physicians are available to consult on individual patient cases as needed.

Virtual collaboration pilot

The MinuteClinic VC pilot was first launched at several locations in Houston, Tex., as the company first began expanding chronic care services in select HealthHUB locations. The quick access to physician consults and the video capability helped the APRNs and PAs provide a higher level of chronic care with virtual support. APRNs and PAs also use VC to communicate with each other and with RNs and LVN/LPNs, supporting the team concept of providing holistic and coordinated care. MinuteClinic regional leadership teams also recognized the impact that VC function had on creating an environment of support. Many providers commented that having the ability to collaborate with other professionals improved their well-being and sense of connectedness with the team.

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According to Dr. Nairobi Martindale, one of the physician leaders of collaborative practice, video consults occurred most days in the first 3 months of the Houston pilot. APRNs and PAs consulted physicians using video primarily for dermatologic conditions, complicated chronic care cases, and pediatric cases. Dr. Martindale stated that the use of VC was well received by the APRNs, PAs, and collaborative physicians.

The success and relevance of the pilot supported the need to expand the program on a broader scale. In addition, with the learnings from the pilot, process improvements were identified to support the future growth and enhancements of a system for VC. The VC platform is an effective method to increase professional nursing and interprofessional communication. This virtual process could be replicated in other nursing settings with sufficient funding and infrastructure. The goal was to expand the pilot to the remaining 1,100+ MinuteClinics across the country, which would be enabled by the Pathway Award.

In late 2019, MinuteClinic expanded the project to 18 more clinics in Houston. With the expansion of the CVS HealthHUB concept, MinuteClinic developed a laser focus of the Pathway to Excellence standards of professional practice and shared governance. Evidence-based practice (EBP) further substantiates that interprofessional collaboration in healthcare can make all the difference in nurse engagement and improved patient outcomes in everyday practice.2

Virtual collaboration expansion

The ANCC Pathway Award for the VC for Nurses project enabled the expansion of the VC pilot at MinuteClinics beyond the Houston market. The expansion provided greater access to a Health Insurance Portability and Accountability Act (HIPAA)-compliant iPad and ready access to collaboration with healthcare professionals, such as collaborating physicians and fellow APRNs, PAs, RNs, LVN/LPNs, mentors, preceptors, quality leaders, educators, and managers at the point of care.

Through the VC expansion implementation, the HIPAA-compliant iPads were provided nationally in a phased approach, with training to over 700 providers in 26 states by February 2021. This enabled more point-of-care nurses to have access to the virtual platform for attending virtual morning huddles and clinical educational offerings. With the iPad technology, nurses have also been equipped to join clinical education sessions on professional practice and improving patient outcomes through advancing EBP in nursing. This tool not only continues to increase collaboration, but also fosters professional practice development to engage nurses in the standards and principles of care relating to safety, quality, and interprofessional collaboration.

In her role as a regional quality lead, Erin Vierus, PA-C, found the VC iPad to be instrumental in connecting, coaching, and supporting providers during the COVID-19 pandemic. Erin conducted virtual meetings with her peers to review chronic care best practices. According to Donna Cowart, FNP, the VC iPad allowed NPs and PAs to support their colleagues by virtually observing the workflow, working through clinical processes, and interpreting clinical guidelines. Nurse preceptors and regional quality leads also perform Joint Commission required skills validations using the virtual platform.

Pathway Award opportunities

The outcomes of the MinuteClinic VC project are shown in Figure 1, 4 months postimplementation and delivery of the VC equipped iPads to the pilot group. The pilot group, with 32 survey respondents from the Houston NPs and PAs, represents the group of clinicians who have the most experience using the VC iPads. The early pilot users who had been using the iPads for a longer period of time and had more engagement with the collaborating physicians had a higher percentage of respondents who viewed the VC iPad as having a positive influence on their work environment. Beyond the data from the survey, the following clinician testimonials are evidence of the positive impact of this collaborative tool on nursing practice.

Figure 1:
Figure 1::
VC project outcomes

Michela Posevitz, FNP, trained during the 2020 expansion and looks forward to connecting with her team each morning, letting them know that she's available for VC. She uses VC for sending encouraging notes to providers, completing skills validations, and collaborating with APRNs on clinical documentation workflows. She credits all of this to the readily available virtual platform on the iPad. She finds VC easy and convenient to use and states that it has facilitated her work as a regional quality lead by expanding her reach and support to her team and connecting with fellow regional quality leads. She feels that VC at MinuteClinic will be the future of accessible, high-quality patient care and increased provider collaboration and support.

Erin Vierus, PA-C, states, “By connecting with our physicians face to face, we're able to offer confidence in our care to our patients and miscommunication regarding patient presentation is lessened, resulting in safer visits.”

Serena Lopez, FNP, states, “I had several patients who I used VC to connect with my collaborating physicians. I feel the virtual connection helped empower the patients to know that they have a healthcare team working to improve their outcomes and provide support, even if virtually.”

Donna Cowart, FNP, says, “As a preceptor, VC is extremely helpful for virtual skills validations, as well as being able to virtually help providers navigate workflow issues.”

During the VC expansion, Yvette Heflin, FNP, shared a time that she consulted her collaborating physician when a pediatric patient presented with a rash and she knew from her assessment that something more clinically significant was going on. Once she discussed the case with the collaborating physician and showed the rash by video, the collaborating physician recommended the patient go to the children's hospital ED. Yvette informed the patient and father that it was a must for them to go. Later that day, the mother informed Yvette that the child was admitted to the hospital and was being worked up for meningitis. The mother was very appreciative, stating that it was a good call and thanked her. She later stopped by to thank Yvette personally and let her know that her son was being discharged and doing well.

With the support of the Pathway Award, MinuteClinic providers around the country will continue to gain access to a powerful collaboration tool that provides a richer and more contextual experience in real time, allowing them to feel more connected to their peers, physician colleagues, nurses, and allied healthcare teams as they continuously provide high-quality, collaborative clinical care. As of April 2021, VC has been expanded to more than 750 providers, with plans to train 675 more providers in the upcoming months, for a total of nearly 1,500 providers using the technology. For comments by MinuteClinic's nurse leaders on this important evidence-based opportunity, see Table 1.

Table 1: - Leadership voices
  • Donna Learned, DNP, associate chief practitioner officer: “As we continue to evolve our national group practice and expand care to patients with more complex health issues, the addition of virtual-enabled collaboration provides MinuteClinic nurses with a clinical resource that will build a foundation of both clinical competence and confidence. By broadening access to nurse colleagues and collaborating physicians, VC provides timely, interactive, and patient inclusive opportunities that will lead to improved patient satisfaction and outcomes. I look forward to fully integrating this clinical support resource into our practice environment.”

  • Anne Pohnert, MSN, FNP-BC, director of quality: “Pathway to Excellence organizations demonstrate the use of interprofessional collaboration to meet organization-wide quality initiatives. The 2020 Pathway Award is enabling MinuteClinic to accelerate the innovative technology of VC, thereby facilitating quality improvement and allowing our clinical nurses to provide safe, timely, effective, efficient, equitable, and patient-centered care.”

  • Tammy Todd, MSN, CRNP, manager of quality: “VC has provided an additional communication venue, which strengthens the clinical collaboration support system for providers at MinuteClinic. Broadening provider interconnectivity across a national platform of clinics allows providers to experience real-time expert clinical advice to further strengthen the quality of care delivery at MinuteClinic.”

  • Sarah Ball, FNP, educator: “VC APRNs and educators are more accessible and efficient. It takes much less time to contact each other through VC on laptops and iPads than placing a phone call to a clinic when needing to reach each other for educational purposes. The quality of the interaction is enhanced by video technology as well.”


Nursing implications

With nurses at the front and center of care, innovative collaborative support will be pivotal to ensure that quality, shared governance, leadership, and well-being are provided through collaborative methods. Collaboration in healthcare is central to optimizing outcomes, specifically through technologic innovations.3 Leadership in nursing is also supported by technologic advances that promote collaboration.4

There's an opportunity to help disseminate and increase understanding of the iPad's usefulness in everyday practice. Serena Lopez, FNP, states that once providers start using the iPads consistently to improve their practice, they begin to enjoy it. Before equipping nurses and other healthcare professionals with the iPad, it would be best to educate and inform practitioners, ensuring that they're aware of the usefulness of the tool. Ultimately, the iPad with enhanced HIPAA-compliant features equips nurses in any setting to be able to collaborate with other professionals in real time, one connection at a time.

Always improving

It's important for nurse leaders to focus collaboration in practice on new technologies that improve patient outcomes in healthcare systems. This project provides a practical way to do so for large, multiprofessional organizations with nursing at the core. As MinuteClinic has shown, implementing VC while adhering to the Pathway to Excellence framework can advance collaborative efforts and facilitate identification of areas to improve clinical practice outcomes.

REFERENCES

1. Buerhaus PI, Auerbach DI, Staiger DO, Muench U. Projections of the long-term growth of the registered nurse workforce: a regional analysis. Nurs Econ. 2013;31(1):13–17.
2. Reeves S, Pelone F, Harrison R, Goldman J, Zwarenstein M. Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2017;6(6):CD000072.
3. Walker PH, Elberson KL. Collaboration: leadership in a global technological environment. Online J Issues Nurs. 2005;10(1):6.
4. Endersby L, Phelps K, Jenkins D. The virtual table: a framework for online teamwork, collaboration, and communication. New Dir Stud Leadersh. 2017;2017(153):75–88.
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