Leadership & Professional Development

Integrating Quality and Breast Cancer Care: Role of the Clinical Nurse Leader

Cathy Coleman

clinical nursing research, quality, breast cancer care
ONF 2013, 40(4), 311-314. DOI: 10.1188/13.ONF.311-314

Breast cancer remains a global public health problem that consistently challenges oncology nurses and interdisciplinary healthcare professionals to reduce mortality, increase length and meaningfulness of survivorship, or alleviate discomfort if longevity is not a possibility. Although significant progress has been achieved, a fragmented, complex healthcare system has stimulated the creation of new paradigms, roles, and leadership initiatives. One emerging and multifaceted nursing role, the clinical nurse leader (CNL), has been developed to use evidence-based practice and identify gaps in quality of care delivery, coordination, and management for a specific population of patients. CNLs improve organizational effectiveness and optimize client outcomes by working with frontline teams at the level of the clinical microsystem (Harris & Roussel, 2010). Because quality and continuous performance improvement are the catalysts for transforming care, oncology nursing must incorporate this new leadership role to inspire professional development and address the six quality aims defined by the Institute of Medicine (IOM) (Rose, Stovall, Ganz, Desch, & Hewitt, 2008) (see Table 1). This article will introduce the CNL role and describe a CNL-led project that enabled a breast center's national accreditation by integrating quality improvement interventions into comprehensive breast cancer care.

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    Adcock, K. A. (2004). Initiative to improve mammogram interpretation. Permanente Journal, 8(2), 12-18.
    American Association of Colleges of Nursing. (2007). White paper on the role of the clinical nurse leader. Retrieved from http://www.aacn.nche.edu/Publications/WhitePapers/ClinicalNurseLeader07.pdf
    Bender, M., Connelly, C. D., & Brown, C. (2013). Interdisciplinary collaboration: The role of the clinical nurse leader. Journal of Nursing Management, 21, 165-174.
    Bennis, W. (2007). The challenges of leadership in the modern world: Introduction to the special issue. American Psychologist, 62(1), 2-5.
    Berwick, D. M. (2011). Preparing nurses for participation in and leadership of continual improvement. Journal of Nursing Education, 50, 322-327. doi:10.3928/01484834-20110519-05
    Coleman, C. (2005). The breast cancer clinic: Yesterday, today, and tomorrow. In P. C. Buchsel & C. H. Yarbro (Eds.), Oncology nursing in the ambulatory setting—Issues and models of care (2nd ed., pp. 231-245). Sudbury, MA: Jones and Bartlett.
    Coleman, C. (2010). Comprehensive breast care: Exceptional people, extraordinary programs. Unpublished manuscript, School of Nursing, University of San Francisco, San Francisco, CA.
    Coleman, C., & Lebovic, G. (1996). Organizing a comprehensive breast center. In J. R. Harris, M. E. Lippman, M. Morrow, & S. Hellman (Eds.), Diseases of the breast (pp. 963-970). Philadelphia, PA: Lippincott-Raven.
    Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., … Warren, J. (2007). Quality and safety education for nurses. Nursing Outlook, 55, 122-131. doi:10.1016/j.outlook.2007.02.006
    European Society of Breast Cancer Specialists. (2000). Position paper. The requirements of a specialist breast unit. European Journal of Cancer, 36, 2288-2293.
    Harris, J. L., & Roussel, L. (2010). Initiating and sustaining the clinical nurse leader role. A practical guide. Sudbury, MA: Jones and Bartlett.
    Harris, J. L., Roussel, L., Walters, S. E., & Dearman, C. (2011). Project planning and management. A guide for CNLs, DNPs, and nurse executives. Sudbury, MA: Jones and Bartlett.
    Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.
    Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Washington, DC: National Academy Press.
    Kaufman, C. S., Shockney, L., Rabinowitz, B., Coleman, C., Beard, C., Landercasper J., … Wiggins, D. (2010). National Quality Measures for Breast Centers (NQMBC): A robust quality tool: Breast center quality measures. Annals of Surgical Oncology, 17, 377-385.
    La Fargue, M. M., & Coleman, C. (2008). Introduction: In search of excellence—Exploring the economics of breast care. Seminars in Breast Disease, 11, 113-115. doi:10.1053/j.sembd.2009.04.003
    Nelson, E. C., Batalden, P. B., & Godfrey, M. M. (2007). QuDality by design: A clinical microsystems approach. San Francisco, CA: Jossey-Bass.
    Norris, T. L., Webb, S. S., McKeon, L. M., Jacob, S. R., & Herrin-Griffith, D. (2012). Using portfolios to introduce the clinical nurse leader to the job market. Journal of Nursing Administration, 42, 47-51. doi:10.1097/NNA.0b013e31823c18e3
    Ogrinc, G. S., Headrick, L. A., Moore, S. M., Barton, A. J., Dolansky, M. A., & Madigosky, M. D. (2012). Fundamentals of health care improvement. A guide to promoting your patients' care. Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations.
    Rose, C., Stovall, E., Ganz, P. A., Desch, C., & Hewitt, M. (2008). Cancer Quality Alliance: Blueprint for a better cancer care system. CA: A Cancer Journal for Clinicians, 58, 266-292.
    Winchester, D. P. (2011). The National Accreditation Program for Breast Centers: Quality improvement through standard setting. Surgical Oncology Clinics of North America, 20, 581-586.
    Winchester, D. P., Stewart, A. K., Phillips, J. L., & Ward, E. E. (2010). The National Cancer Data Base: Past, present, and future. Annals of Surgical Oncology, 17, 4-7. doi:10.1245/s10434-009-0771-3