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Clinical nurse leaders improve patient care and quality


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Professional practice

If your organization doesn’t employ clinical nurse leaders (CNL), perhaps it’s time it did.

Units with CNLs have been shown to have shorter lengths of stay and readmission rates; improvements in quality and patient safety, such as decreased falls and infection rates; and lower RN turnover.

In fact, these master’s degree–prepared nurses have had such a positive effect on patient care and the healthcare environment that the Veterans Health Administration (VA) has committed to having a minimum of three CNLs at every one of its facilities by 2016.

“These individuals take the evidence that’s out there in the literature and help to improve practice, as well as to evaluate patient outcomes,” says James L. Harris, DSN, APRN-BC, MBA, CNL, FAAN, deputy CNO in the office of nursing services at the VA, Washington, DC. “CNLs are individuals who can coordinate care and break down barriers. They can eliminate fragmentation in healthcare.”

The CNL role has only been around for a few years, but it is growing at an impressive rate and many ANCC Magnet Recognition Program® (MRP)–designated organizations—and those on the journey—are finding the role useful. The position allows nurses to advance professionally while staying in the clinical environment. According to the American Association of Colleges of Nursing, CNLs are responsible for patient outcomes by applying evidence-based practices. They design, implement, and evaluate patient care by coordinating, delegating, and supervising the care provided by the healthcare team.

In the hospital and health system setting, the CNL role should explode as the graduate degree gains popularity and the opportunities presented by this role become better understood. Adding CNL positions prepares organizations to meet quality improvement initiatives and deliver on these goals.

CNLs are also uniquely positioned to plan and coordinate care across entire patient populations or service lines, work with the multidisciplinary healthcare team across the care continuum, and help organizations reduce length of stay and prevent readmissions.

VA recognized the value of the role five years ago, began encouraging nurses to pursue the degree by offering scholarships, and has seen such good results that it expects to easily meet its 2016 goal. Harris advises that administrators not think of the CNL role as a replacement position, but rather as one that can be added to an environment to provide a higher level of clinical expertise.

“I see them as the clinical person who keeps the patient processes moving along, freeing up the nurse manager to be able to manage and develop the staff and really be a manager,” says Harris.

CNLs drive quality improvement and provide the clinical expertise that is desperately needed by bedside caregivers, says Karen M. Ott, RN, MSN, director for clinical practice at the office of nursing services at VA.

“Clinical leadership is really a full-time job, and the management part is really a full-time job, and for someone to try and do both doesn’t work effectively,” says Ott. “The nurse manager has ideas for outcomes he or she wants to see on that unit, and the CNL is the person who makes that happen. The two of them together set goals for the unit.”

To understand the effect CNLs can have on an organization, Ott recommends hiring a CNL for a turbulent unit and seeing what happens. She believes when an organization has one CNL, it will soon want more, and a good place to start is on an inpatient unit—such as a busy med-surg unit—with many admissions and discharges.

“A unit where bedside nurses are consumed with tasks all day is ripe for a CNL who can come in and provide leadership,” says Ott. “The key to growth will be when the private sector sees the outcomes.”

There are roughly 900 certified CNLs in the country right now, and the numbers should rise as healthcare embraces a genuinely new role in nursing. CNLs can raise the bar of clinical experience on a unit and thereby improve the quality of care delivered to patients.