Registed Nurses' Association of Ontario

Refining point of care leadership: Research to support role clarity and role enactment of the Clinical Care Leader

Marcella Honour
Trillium Health Partners-Credit Valley Hospital Site

Collaborative Care by Design (CCbD) model of care was implemented in 2010 at Trillium Health Partners (THP). As part of the model, a new Clinical Quality Care Leader (CQCL) role was developed to enhance the work environment for interprofessional teams. In this specialized role, the CQCLs practice at the unit level and function as an expert clinician and leader within the interprofessionalteam. My overall learning goal for this leadership stream ACPF (research sub-stream) was to gain an understanding of the CQCL role in the acute care areas of Trillium Health Partners,particularly as it relates to coaching and mentoring, data collection for quality improvement projects, and participating in the unit leadership. The aim of the project was to work with the existing CQCL group to: a) clearly articulate the CQCL role in order for staff at all levels to understand the role, b) examine if the CQCLs are utilized appropriately and work according to their identified role, c) determine the gaps in CQCL role enactment and, d) develop an education toolkit to address gaps in CQCL role enactment.

This fellowship experience provided me with a unique opportunity to advance both my skills as a nurse researcher and to facilitate corporate model of care activities for role clarity within the organization for a defined professional group. Further, the experience was a positive adjunct to my current RNAO BPSO candidacy activities related to the implementation of the “Developing and Sustaining Nursing Leadership” Best Practice Guideline. The fellowship provided me with dedicated time to hone my research skills in conducting literature reviews, engaging in the Research & Ethics Board Review process, and qualitative research methods such as focus group interviews, field observation and qualitative data analysis.Though these activities I advanced my knowledge related to nursing research, knowledge in research strategies and the application of best evidence as the basis for clinical and professional decision making.

The literature review I conducted solidified my skills in how to use current evidence to inform a targeted approach to problem-solving. From the literature, I gleaned that the CQCL role was emerging and thus, role enactment within various settings remains inconsistent, further contributing to lack of role clarity for CQCLs. The literature review process helped inform discussions with my mentoring group as I developed questions about role clarity for the focus group portion of my fellowship activities. Going through the REB process I learned the importance of keeping to the project scope and paying attention to the smallest details so that all ethics-related concerns were adequately addressed. The focus groups themselves provided me with the opportunity to hone interviewing skills, and at the same time to establish a relationship with the CQCL group. I was able to gain valuable insight into their experiences in their day-to-day activities and how they perceive the role. The observational time-studies I conducted (field research) also allowed me to see role enactment in a live environment and to identify gaps contributing to role enactment. It was interesting to note the similarities and differences from the information collected from focus group discussion and actual role enactment in the field.

Key deliverables for my fellowship are first, a revised job description for the CQCL role informed by the current literature, focus group discussion, qualitative data analysis and role observation in the field and second, the development of an education/standard work tool for CQCLs to support role clarity and role enactment. With the support of my mentoring team, I was able to achieve these deliverables.

The Advanced Clinical Practice Fellowship has allowed me to develop a better appreciation for how to approach organizational change using nursing research. In addition, I valued the structured, dedicated time it afforded me to engage in this important work in such a short amount of time. The RNAO requirement of a mentor/mentoring team was a critical factor in helping me achieve my deliverables for this project. I especially would like to thank Dr Sharyn Gibbins and Dr Christine Covell for their support and research expertise to aid in my own learning journey. Each mentoring team member was a role model for me in how to approach nursing research using a logical, organized approach in order to effect change at a corporate level. The relationships I’ve developed through this fellowship experience, both internal and external, will aid this work going forward.

I believe that knowledge of where we are, where we need to go and how to get there is best addressed through a comprehensive approach, using a variety of research methods. Through this exceptional opportunity provide by the RNAO Advanced Clinical Practice Fellowship, I feel I am on a new journey as an emerging nurse researcher.
Moreover, I believe the knowledge I’ve gained will help ensure our THP model of care is based on evidence, validated by stakeholders, endorsed by administration and supported by the community we serve. Many thanks to the RNAO for supporting nurses in specialized knowledge acquisition and knowledge translation skills through this wonderful program and in advancing the nursing profession!

Sustaining Learning

The research skills I have acquired through this leadership fellowship will be sustained through varied avenues. Firstly, I will form a partnership with our newly launched “Trillium Health Partners Institute for Better Health”. The institute is the research and innovation program within THP which aims to promote and support design solutions with leaders at all levels aimed at providing the best quality of evidence-based care to patients and families. I will access the services the institute provides which include

• Grant opportunities information
• Expertise in writing successful grant applications
• Research education and access to research education materials
• Access to expertise in, and assistance with developing and conducting meaningful statistical analysis of existing outcome data
• Assistance with preparing submissions for publication in peer reviewed scientific journals, including case reports

Secondly with the support of my mentor and other senior leaders, I have established a committee to review the roles and responsibilities of point-of-care nurse leaders and the educational toolkit to enable nurses to lead at the bedside. This group will look for further research opportunities regarding role clarity and enactment as it relates to other support roles within our model of care (e.g. allied health).

Thirdly, I will work with Dr Sharyn Gibbins to look for opportunities to disseminate the results of the qualitative research resulting from this fellowship through appropriate journal publication and conference oral/poster presentation.

Finally, I will work with members from our Professional Practice and Research departments, as well as external partners from McMaster University to explore future opportunities in which point-of-care nurses could begin to explore research in their daily practice such as a beginner level research course offered onsite specifically geared to nurses practicing at the bedside.

Learn more about Advanced Clinical/Practice Fellowships now.