When Jennifer Colwill, MSN, RN, CCNS, PCCN, started practicing as a clinical nurse specialist in cardiothoracic step-down units on Cleveland Clinic’s main campus, she wanted to get a handle on the day-to-day work the skilled position required.
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“My role went from taking care of a group of three to four patients as a bedside nurse to a very broad CNS role that was intangible and hard to quantify,” says Colwill. So what did the advanced practice nurse do? She conducted a research study, then created a technology tool called TrACWork© (Tracking Advanced Practice Competencies and Work).
Searching for a tool to track CNS tasks
Colwill did not initially set out to develop a technology tool. At first, she looked around for existing tools to help track her daily tasks, asked members of a listserv hosted by the National Association of Clinical Nurse Specialists for advice and perused nursing literature for a solution. But nothing she found met her needs, so Colwill began listing her daily tasks. Then she divided them into categories based on work roles, such as direct patient care, mentoring, consulting and research.
“But these lists didn’t give me a whole lot of information,” she says. “I could scan them and see what I’d done for the past week or month, but a long line of words did not mean a whole lot.”
So in 2008, Colwill created an Excel spreadsheet. It was more robust than the list of CNS tasks, allowing Colwill to track multiple competencies as well as the “spheres of influence” where she worked – the patient sphere, nursing sphere or organizational sphere. This allowed her to see how she functioned and where she needed to beef up skills or spend more time.
Research study helps clarify and measure nursing tasks
In 2011-2012, Colwill conducted a five-month research study based on her CNS work tool. She followed 14 clinical nurse specialists on Cleveland Clinic’s main campus, capturing the time they spent in work roles, spheres of influence and quality improvement. The purpose of the study was three-fold:
- To quantify how CNSs spend time in work roles
- To determine if work roles are associated with individual characteristics and ranking priorities
- To examine associations between work roles and expected quality indicator outcomes and changes in quality indictor outcomes over time
Among the conclusions of the study was that CNS work can, indeed, be measured. Since then, Colwill has received a Cleveland Clinic Innovations commercialization grant to work with a developer and create a web-based system and mobile app that captures and quantifies the work of advanced practice nurses (including CNSs) and ties the work to outcomes.
“The objective of this tool is not to be a time management tool, but rather a tool that helps discern practice patterns related to advance practice competencies and outcomes,” explains Colwill. “Evaluation of practice patterns informs individuals and groups of the effectiveness of strategy, and better strategy leads to better outcomes.” Colwill has tested the APN role tracking tool herself. In the last year, she began working with a coder to get the app “up and running.”
Current status of TrACWork
Colwill and the coder are currently beta testing the TrACWork app among a number of APNs at Cleveland Clinic. There is both a desktop version and a mobile application. The mobile application is used for real-time tracking at the point of service and takes seconds to track what APNs do daily. The desktop version can also be used to track duties, plus it has enhanced capabilities such as the ability to pull reports by individuals and groups, add users and configure the tool.
“As with every phase, there are always challenges and a broad range of users’ comfort with the technology, but I believe this has helped me build a system that appeals to novice and expert tech users,” says Colwill. She hopes TrACWork will be available in the marketplace and app store sometime in 2015.
It’s been a long journey and one that Colwill says wouldn’t have been possible without the encouragement and empowerment of mentors along the way. She is excited by the potential for TrACWork.
“It helps individual APNs evaluate what they do, where they are professionally and how they can get better,” she says. At the healthcare system level, it helps ensure that organizations are making the best use of staff. “If you can visually and objectively capture what a group of people do,” says Colwill, “then you can make sure the right group is used in the right way to provide positive outcomes for the right cost.”