Improving Care Coordination: Impact of a Doctorate of Nursing Practice Prepared Clinical Nurse Specialist

Transformations in healthcare have challenged organizations to control costs while continuing to provide high quality care. Simultaneously, patients continue to present with higher acuities and increased complexity of healthcare needs. These organizational challenges have provided an opportunity for the doctorate of nursing practice (DNP) prepared advance practice nurse to utilize the core competencies outlined by the American Association of Colleges of Nursing (AACN) to improve quality of patient care (AACN, 2006).

Consistent with the 2010 Institute of Medicine Report, The Future of Nursing: Leading Change, Advancing Health,we identified opportunities for improvements in the coordination of care (Institute of Medicine. 2010). Our organization concentrated its’ efforts on re-examining our model for delivering patient care. After conducting an extensive literature review, the project goal was established: to create, implement and evaluate an innovative new nursing role, the Clinical Coordinator. This new role focused on patient-centered care and overall facilitation of care coordination. To initiate this major transformation in care delivery, our newly DNP prepared Clinical Nurse Specialist (CNS), was identified as the individual who possessed both the knowledge and skills to lead the interdisciplinary team in this major initiative.

Utilizing The Essentials of Doctoral Education for Advance Nursing Practice (AACN, 2006) as the guiding framework with a focus on organizational and systems leadership, inter-professional collaboration, and advanced nursing practice, the DNP prepared CNS began the project. The overarching project goals and outcomes were selected. A role description for the Clinical Coordinator was developed which included core competencies, ideal attributes, and key responsibilities. Three medical-surgical units were initially selected to pilot the transformation. Specific measureable project outcomes selected included length of stay, hospital readmissions, and select patient satisfaction scores. Staff RN’s who were interested in the new role were interviewed and then selected. This was followed by targeted educational and on-boarding programs for the entire staff. The outcomes of the initial pilot were successful demonstrating improvement in patient satisfaction, and decrease in length of stay with adoption of the new role Clinical Coordinator role. Based on these outcomes, the program was extended to five other medical surgical units at our organization.

Our DNP prepared CNS continues to lead this initiative by expanding this program throughout our organization with a focus on refining and individualizing the Clinical Coordinator role based on specific unit needs and metrics. This effort provides an excellent exemplar of the added benefit of a DNP prepared CNS with respect to the management of quality initiatives and the ability to respond to health care policy challenges (Melynk, 2013).