Nurse leaders who hear comments like “I didn’t know that happened,” “I didn’t realize that was important,” or “I didn’t know you wanted me to do that” from the charge nurses and certified nurse aides (CNAs) may feel frustrated and confused about why a gap exists between their expectations and their team’s actions. But, if nurse leaders pause to recall their own personal experiences practicing as a charge nurse or CNA, it’s likely they will also remember being confused about how to manage residents’ clinical needs, uncertain about the priorities for care, and perhaps even overwhelmed at being asked to make decisions that were beyond their competence level at the time.
This article will introduce nurse leaders to a daily clinical brief, which is a best practice for nursing teams—the charge nurses and CNAs caring for residents on a unit or specific area of the facility. By setting the team up for success each day, a clinical brief can help to facilitate the delivery of care that upholds clinical standards of practice and fosters compliance with regulatory requirements.
Purpose of a Daily Clinical Brief
Each day poses unique clinical challenges that require the nursing team to respond in ways that meet individual residents’ needs. To adapt to such changing circumstances, direction from nurse leadership is essential. The nurse leader is the expert in gerontological nursing and clinical standards of practice, as well as the regulatory requirements, so his or her guidance is necessary for team success. A daily clinical brief, led by the nurse leader and including the nursing team on each unit, is an opportunity to set the tone for the day, establish priorities for care, and reinforce consistent excellence in care.
Sometimes, nurse leaders take for granted that the charge nurse and CNAs know what they should do. But these assumptions can cause grave problems, such as missing early signs that a resident is experiencing a change in condition, a lack of monitoring for side effects when there is a change in a resident’s medication, or not following post-fall protocols. Rather than assume, the nurse leader should provide direction and answer the basic question “what should I do” for the CNAs and charge nurses.
Differentiating a Daily Clinical Brief from Daily Stand-Up
Don’t confuse a daily clinical brief with a daily stand-up meeting. In her article “How Does Your Daily Stand-Up Meeting Measure Up?” Denise Winzeler describes the purpose of a daily stand-up meeting as the opportunity “to exchange information that affects multiple departments’ operations on that day. The information exchanged should be shared with the intent of facilitating connection between all departments and coordinating operations.” On the other hand, the purpose of a daily clinical brief is to help establish daily priorities and areas of focus specifically for a team in one unit. The table below further highlights some of the differences between a daily clinical brief and a daily stand-up meeting.
Focus Areas in a Daily Clinical Brief
The daily clinical brief is a short meeting and covers the essential clinical priorities and high-risk areas of care that the nursing team needs to focus on for that day. These may include:
- Incidents and accidents – falls, elopements, medication errors, or injuries of unknown origin
- Changes of condition or clinical concerns – infections, new wounds, uncontrolled pain, changes in mental status, or changes in behavior or mood
- Skilled care – reasons for skilled care, progress towards goals for discharge, or functional status
- High-risk medication changes – anticoagulants, hypoglycemics, cardiac, oxygen, hypnotics, antipsychotics/anxiety, or anticonvulsants
- New treatment or new devices – splints, BiPAPs, CPAPs, VADs, IVs, or specialized mattresses
- Diagnostics and labs – CBCs, metabolic panels, lipid panels, anticoagulant monitoring, thyroid levels, liver function, culture and sensitivity, x-rays
- Resident or responsible party – Leaves of absence, compliments, grievances, notifications, appointments, or new guardians
Examples of a Daily Clinical Brief
Initially, conducting a daily clinical brief may feel awkward and take longer to conduct than desired; however, with practice the nurse leader can deliver a clinical brief in a relatively short period of time by prioritizing and sharing important information. The script below is an example of what a brief may sound like. For an additional example, watch the TeamSTEPPS Leadership Briefing (Long-Term Care) video.
Implementation of a Daily Clinical Brief
Before a daily clinical brief process is put in place for the entire nursing department, the DNS can convene a test group, composed of one nursing team and the nurse leader who will lead the daily clinical brief for that team. This group will plan, pilot test approaches, adjust until the process is consistently producing the desired outcomes, and then implement a daily clinical brief. Establishing a group to pilot test will ensure that when the final process for a daily clinical brief is implemented across the facility, it will be productive and help each nursing team provide the best care possible for the residents.
During the initial planning meeting, the DNS should pose to the group questions that must be answered to eventually implement a successful daily clinical brief. These questions include:
- Which nurse leader will lead the brief?
- How will the nurse leader prepare?
- When during the earlier part of the day shift can everyone usually gather for 10 minutes?
- What does the nursing team need direction on, and what does the nurse leader need to learn from them?
- How will this information be shared with the next shifts?
As the group works through answering the questions, other questions may arise, or they may encounter barriers and uncertainties. The DNS must keep everyone focused on what is to be accomplished while facilitating problem solving to address the barriers and uncertainties. It can be helpful to remind the group that perfection is not expected, especially in the beginning, as the team tests different approaches and works through challenges.
Once the group is satisfied with the daily clinical brief process that it has developed, they can assist other teams to implement the process by providing education, answering questions, and sharing how it has helped them achieve better care for the residents.
For related information, check out the following resources AAPACN offers:
- Guide to a Successful Meeting Tool
- Morning Stand-Up Meeting Minutes Tool
- 3 Core Practices for Quality Care Webinar
- Documentation Toolkit for the Nurse Leader
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