They are typically the first person you see after being admitted into a hospital and the last person to assist you at discharge. Nurses participate in every stage of a patient’s care, and their role in maintaining patient safety and quality at UF Health Jacksonville is vital.

Patrice Jones, DNP, RN, vice president and chief nursing officer, works closely with Kelly Gray-Eurom, MD, chief quality officer, to ensure quality initiatives are implemented by nursing staff. Making procedural changes can be challenging when there are approximately 1,500 registered nurses to train. Jones began investigating the role of clinical quality nurse leaders, or CQNLs, which she had heard of in other health systems.

“At that time, we had assistant nurse manager positions to help nurse managers on larger units,” Jones said. “I felt like we needed to change those positions and fill them with nurses who had master’s degrees and three to five years of clinical experience to help the staff with quality initiatives at the bedside.”

She created a proposal to transform the assistant nurse manager roles into CQNL positions, with the goal of improving quality scores from the ground up. As a result, UF Health Jacksonville has 12 CQNLs on staff today and has seen their direct impact on quality.

“CQNLs partner with the Performance Improvement division, physicians and nursing leadership on their unit,” Jones said. “They do not have management or administrative functions — they are clinical experts.”

CQNLs have had a major impact on the reduction of central line-associated bloodstream infections, or CLABSIs. Previously, hospitalwide infections numbered between six and 13 each month, with about half originating in the surgical intensive care unit. The CQNL of the surgical intensive care unit began examining every line on every patient daily, tracking dressing care, documentation and necessity. A CLABSI quality team investigated the best practices of hospitals with the lowest rates of CLABSIs, and along with the nurse leaders developed a “bundle” to teach all SICU, medical intensive care unit and inpatient dialysis nurses.

“CQNLs are part of these quality teams and make sure the teams’ findings come to life at the bedside,” Jones said. “They developed a bundle, which is a step-by-step process of how a catheter is maintained, and determined the correct supplies for dressing. It’s a strict practice to adhere to.”

Today, the hospitalwide CLABSI rate is down to two or three per month, on par with national benchmarks.

Many CQNLs are looking for ways to optimize the patient experience and improve Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS, scores. They are specifically concentrating on staff responsiveness. The CQNL in the neonatal intensive care unit has dramatically reduced infection rates by emphasizing hand hygiene. Others have added functional pain language to nursing assessments, motivating staff to learn more specific terminology for evaluating pain when treating patients.

“They always have measureable goals they are working toward, which are based on national benchmarks and quality metrics,” Jones said.

In the future, Jones hopes to hire the first CQNLs for UF Health North as well as additional CQNLs at UF Health Jacksonville.

“All of nursing leadership is extremely involved with quality,” she said. “For patient care to improve, I have to be engaged and have a very collaborative relationship with the Performance Improvement division and our physicians. We have that here. Then I can best understand how to utilize our nursing staff who are at the bedside 24/7 because they’re who will impact quality scores.”