Cheryl McDonald — Clinical Resource Nurse

Code H (Help) expanded to surgical units 9CD and 10AB at St. Paul’s Hospital on February 26 and was recently awarded as a Leading Practice by Accreditation Canada. We sat down with Cheryl McDonald to talk about Code H and her role supporting patients and families as a clinical resource nurse (CRN).

What is your title?
I am a clinical resource nurse at St. Paul’s Hospital.

What does a clinical resource nurse do?
We provide hands-on clinical support for nurses and psychiatric nurses in acute care. There are three full time CRNs and two part time CRNs at St. Paul’s, with one CRN on call at all times to provide expertise, guidance and support. We also follow some patients who are particularly sick in order to provide additional support to their care team. My job isn’t just about providing hands-on support, it’s also very much about improving communication within care teams, role modeling conversations and looking out for teachable moments. 

Tell me about your career at Providence Health Care. What was your first role here?
I started at St. Paul’s Hospital in 1985 as a casual nurse in the Medical Surgery department, and then worked in different roles in the GI clinic and Medical Short Stay unit. In 1999 I took a critical care course and worked for 5 years in the ICU and 4 years in CCU. I was a CNL for a short time in CCU, just prior to becoming one of the first CRNs during the pilot project at Mount Saint Joseph Hospital, which later expanded and became an established role. 

Why did you choose to work at PHC?
Prior to coming to St. Paul’s Hospital I worked at UBC Hospital. I left there to go travelling and when I returned I wanted to work in a larger hospital. I was young and living in the West end and liked the idea of working closer to home, and here I am 30 some years later. Working here has been very rewarding. I am grateful for the support and learning opportunities that have enhanced my knowledge, skills and experience which have benefitted me in my current role.

Code H is a patient and family activated safety system that allows patients and families on medical and surgical units at SPH to contact a clinical resource nurse 24 hours-a-day, 7 days-a-week if they have questions or concerns about care. How has Code H changed your role?
CRNs now carry the Code H phone in addition to the pager that staff the use to reach us. We’re there as a safety net to hear concerns from patients and families and to help them navigate the system. We work with patients, families and their care team — bedside nurse, clinical nurse leader, operations leader, the medical team – to help resolve issues. 

What’s the biggest challenge of Code H?
We can’t always fix every problem, and that can be difficult. But often times we can provide other resources even if we can’t fully resolve the patient’s issue. A couple of times we received calls from patients after they had been discharged — not something we were expecting, as the program is designed for inpatients at this point.

What does success look like with Code H?
We’re successful if we’ve improved communication and facilitated a resolution to the patient or family member’s concern. Sometimes this is not knowing the plan of care, sometimes it’s questions about discharge planning or personal belongings.

Do you have any advice for staff or other departments looking to welcome patient and family input?
We need to be more inclusive in involving families in care, and we need to expand our definition of what “family” is — it may not be a blood relative, but someone who is equally important to the patient. There is great value in involving families, especially in areas where patients can’t speak for themselves. Everyone needs to know the plan of care.