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Clinical Nurse Leader Impact on Microsystem Care Quality

Bender, Miriam; Connelly, Cynthia D.; Glaser, Dale; Brown, Caroline

doi: 10.1097/NNR.0b013e318265a5b6

Background: The current fragmented healthcare system, characterized by a lack of collaborative, patient-centered care processes, creates significant barriers to providing quality patient care. The clinical nurse leader (CNL) is theorized to provide clinical leadership at the point-of-practice to maintain cross-disciplinary collaborative processes that lead to integrated quality care.

Objectives: The aim of this study was to assess the impact of CNL integration into an acute care microsystem on care quality, as measured by patient satisfaction with care.

Methods: A short interrupted time series design was used to measure patient satisfaction with multiple aspects of care 10 months before and 12 months after integration of the CNL role on a progressive care unit, compared with a control unit. Data were obtained from Press Ganey surveys, and analysis was completed using a publicly available program for short time series data streams.

Results: Clinical nurse leader implementation was correlated with significantly improved patient satisfaction with admission processes (r = + .63, p = .02) and nursing care (r = +.75, p = .004), including skill level (r = .83, p = .003) and keeping patients informed (r = .70, p = .003). There was no significant correlation with improved patient satisfaction with physician care (r = .31, p = .14) or discharge processes (r = .33, p = .23) postimplementation. Control data showed no significant changes in patient satisfaction measures throughout the study time frame.

Discussion: The positive correlation between CNL-mediated collaborative care processes and improvements in patient satisfaction with care quality provides empirical evidence of outcomes achievable through CNL implementation. Research is needed to explore the full range of achievable outcomes and to determine the specific processes by which these outcomes are realized.

Miriam Bender, MSN, CNL, is PhD student, Hahn School of Nursing and Health Science, University of San Diego, California, and Outcomes Research Specialist, Sharp Healthcare, San Diego, California.

Cynthia D. Connelly, PhD, is Director of Nursing Research; and Dale Glaser, PhD, is Adjunct Faculty, Hahn School of Nursing and Health Science, University of San Diego, California.

Caroline Brown, DED, is Research Liaison, San Diego Medical Center, Thornton Campus, University of California, La Jolla.

Accepted for publication June 18, 2012.

The authors would like to thank Mary Jo Clark, PhD, for her expert guidance during the preparation of this manuscript.

The authors have no funding or conflicts of interest to disclose.

Corresponding author: Miriam Bender, MSN, CNL, Sharp Health-Care and Hahn School of Nursing and Health Science, University of San Diego, 8695 Spectrum Center Boulevard, San Diego, CA 92123 (e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.