Quality Improvement at the Population Level: A Role for Clinical Nurse Leaders in Public Health Nursing

Background and issues: Commonly known as performance improvement, public health quality improvement efforts use methods similar to health care, but published efforts are targeted at the systems level and poorly articulate population outcomes. Similarly, local practice-based public health QI initiatives may often be undertaken, but are not reflected in the literature. Use of public funds, accountability for program outcomes, and application of evidence-based practices must necessarily be evaluated at multiple levels. Public health nursing roles commonly incorporate practice and evaluation at the individual, family, community and population level, and include both clinical and non-clinical assessment, intervention, and evaluation. The relatively new Clinical Nurse Leader role, developed specifically to address quality and safety of care, possesses natural parallels to public health nursing competencies and practice.

Description: QI frameworks, PHN and CNL competencies, and public health nursing interventions were compared to elaborate a framework for a combined PHN/CNL practice.

Lessons-learned: The CNL role was conceived largely to address poor quality, high cost hospital care, however, there are naturally occurring parallels with PHN practice at the individual, family, and community level, and QI tools are the same in both roles. Furthermore, a combined role is easily situated within performance improvement models at systems and population levels. Elaborating comparative PHN and CNL frameworks and QI practices creates an opportunity to improve public health outcomes, contribute to published research, and to advance PHN QI leadership.