Clinical Nurse Leader
The need for nurse leadership in clinical settings arose out of the clamor for better patient outcomes. With reports such as the Institute of Medicine’s (IOM; 2000) report indicating that up to half the deaths that occur in hospital result from medical errors, a need for better patient management arose. Such a need was reinforced by entry of Pay-for performance model for reimbursement under Medicare and Medicaid programs (Wilson et al., 2013). These changes called for a nursing role that would enable management of patient care to facilitate continuity of care even when clients were discharged. The clinical nurse leader program was introduced to meet such demands.
A clinical nurse leader (CNL), as Tornabeni and Miller (2008) define, “is a master’s prepared advanced generalist nurse who assumes accountability for health care outcomes of a specific group of clients within a patient care unit or setting” (p. 610). As buttressed by the American Association of Colleges of Nursing (AACN; 2013), a CNL minimum qualification is at the master’s level and comprises of three core aspects: a foundational content for all master students in nursing irrespective of specialization, content specialized for provision of advanced, direct patient care, and specialization-specific content developed by certification bodies and professional nursing organizations. In respect to roles, CNL roles include ensuring consistency and continuity of care for patients across different care settings, managing clinical outcomes such as decreasing length of inpatient stay, providing advocacy for clinicians and the health care institutions, and providing mentorship to nurses (Wilson et al., 2013; Tornabeni & Miller, 2008). The CNL is also involved in risk assessment, management of health information, and education of patients, healthcare professionals and other stakeholders (Tornabeni & Miller, 2008). Finally, as a member of a profession, the CNL in engaged in effecting change in practice and profession (Tornabeni & Miller, 2008).
An example of how a CNL influences direct care of patients is by establishing strong collaborations with patients’ families, other healthcare professionals and the community. As Wilson et al. (2013) observe, such collaboration creates a network to pre-empt and proactively respond to patient conditions before they worsen to unmanageable levels. Thus, by facilitating collaboration, the CNL is able to influence the healthcare system towards better management of the patient condition leading to better outcomes for patients.
The CNL role enables nurses to take a leadership role in patient management thus enabling them to establish procedures for better patient outcomes. Such leadership is developed through a training program that begins at the master’s level. Once trained, the CNL acts as a patient advocate, a change agent in the profession and practice, a risk anticipator, a mentor for other nurses, and a health information manager. Such competencies enable the CNL to form collaborations that can help to identify and address patient conditions before they advance to unmanageable levels.
American Association of Colleges of Nursing (2013). Competencies and curricular expectations for clinical nurse leader. Retrieved from http://www.aacn.nche.edu/cnl/CNL-Competencies-October-2013.pdf
Institute of Medicine (2000) To Err is human: Building a safer health system. National Academies Press, Washington, DC. Retrieved from http://www.iom.edu/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf
Tornabeni, J., & Miller, J. F. (2008). The power of partnership to shape the future of nursing: The evolution of the clinical nurse leader. Journal of Nursing Management, 16(5), 608-613. doi:10.1111/j.1365-2834.2008.00902.x.
Wilson, L., Orff, S., Gerry, T., Shirley, B. R., Tabor, D., Caiazzo, K., & Rouleau, D. (2013). Evolution of an innovative role: The clinical nurse leader. Journal of Nursing Management, 21(1), 175-181. doi 10.1111/j.1365-2834.2012.01454.x
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