Cultivating Nurse Leaders

In May 2015, three advanced practice nurses from Cleveland Clinic completed the year-long Duke-Johnson & Johnson Nurse Leadership Program. The program combines long-distance learning activities, small group mentoring, three retreats and a health project.

Anne Vanderbilt, MSN, CNS, CNP

“The curriculum and caliber of faculty were fabulous,” says Anne Vanderbilt, MSN, CNS, CNP, Advanced Practice Nursing Manager and Clinical Nurse Specialist for geriatrics. “The program promoted leadership and nursing initiatives, plus talked about dealing with a vulnerable or underserved population.”

Vanderbilt participated in the program along with Cheryl Cairns, DNP, RN, CPNP, and Carrie Cuomo, MSN, CPNP, both pediatric nurse practitioners at Cleveland Clinic. Here, Vanderbilt shares her thoughts on the program, plus details on her health project, upon her one-year anniversary of completing the program. (Cairns and Cuomo will discuss their projects in future posts on Consult QD: Nursing.)

Honing leadership skills

Thirty fellows were enrolled in the program, which aims to enhance the skills and competencies of APNs and develop qualities that support successful operation of a nurse-led clinic catering to an underserved population. Participants ranged from nurses at urban teaching hospitals to those from rural, federally-qualified healthcare centers. Vanderbilt gained as much from the other nurse practitioners, clinical nurse specialists and nurse midwives as she did from the faculty. “To be surrounded by and engaged with people from healthcare delivery systems across the country – and in much different settings – helped me look at healthcare from a much broader perspective,” she says.

While the program’s content was extensive, Vanderbilt cites three particularly memorable aspects. The first was a presentation by one of the creators of the Patient Protection and Affordable Care Act. “I got a broader understanding of the landscape of healthcare reform,” says Vanderbilt.

The other two notable takeaways occurred during workshops – one on leadership skills, and the other related to the business side of leadership. “One of the earlier workshops talked about dealing with people, both as a manager and a colleague,” recalls Vanderbilt. She learned communication strategies, in particular related to giving feedback, which she has since put into practice at Cleveland Clinic. “Learning about the business side of being a nurse leader was new to me, too – how to create a business plan and calculate return on investment,” she says.

Conducting research on the geriatric population

A highlight of the Duke-Johnson & Johnson Nurse Leadership Program is what it calls a “transformational health project.” Because she works with geriatric patients, Vanderbilt completed a project entitled “Identification of Elders at High Risk of Self-Care Deficits.” The timing was fortuitous: While in the program, Vanderbilt was simultaneously working with colleagues in Cleveland Clinic’s Medicine Institute on how the geriatric subsection of the institute could help their internal medicine peers better identify patients with cognitive impairment or depression.

Patients with dementia or depression have poor chronic disease outcomes and increased healthcare costs. If those patients have an absent or stressed care partner, they may be at risk for self-care deficits. Yet cognitive impairment and depression are underdiagnosed in primary care settings. Vanderbilt teamed with two geriatric fellows, a medical assistant and a nurse from Cleveland Clinic’s Medicine Institute to select and trial screening tools that might better identify elders at risk for self-care deficits.

They conducted a literature review and opted to use two of three tools recommended by the Alzheimer’s Association for cognitive screening in primary care – the Memory Impairment Screen (MIS) and the Mini-Cog. Vanderbilt and her peers picked the patient health questionnaire (PHQ2/9) tool to screen for depression since it’s the chosen tool of Cleveland Clinic.

For eight weeks, medical assistants and RNs screened all patients over 65 years old at the internal medicine clinic on the healthcare institution’s main campus for cognitive impairment and depression during the pre-visit assessment in the rooming process.

The following were some of the results:

• 6 percent of patients screened positive for cognitive impairment.
• 5 percent of patients screened positive for depression.
• 20 percent of the patients who screened positive for cognitive impairment or depression lived alone or without a care partner.

“While we do catch things early, more cognitive impairment was undetected than we previously thought,” says Vanderbilt. The next steps are to integrate screening tools into the electronic medical record and work with the Care Coordination team to better identify and serve those at risk for self-care deficits.

“Enhanced geriatric care coordination is probably one of the best things we can do to help these people because we are not going to fix their cognitive impairment,” says Vanderbilt. “We can engage family members or other caregivers to help support them so they can get back to a high level of managing their chronic diseases or anticipating their healthcare needs.”

Working on this health project through the Duke-Johnson & Johnson Nurse Leadership Program proved highly beneficial, she says.