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Clinical Nurse Leaders: Filling a Need with RNs and Patients


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By Susan Kreimer, MS, contributor

Newspaper articles and medical reports remind Sally Gerard, DNP, RN, CNL, that patients can incur harm in hospitals, and that nurses have a lot of responsibility riding on their shoulders.

“The current system is complex and often dangerous,” said Gerard, an assistant professor of nursing at Fairfield University in Fairfield, Connecticut, and a certified diabetes educator at nearby Stamford Hospital.  These factors have led to the need for clinical nurse leaders (CNLs), according to Gerard.

Clinical nurse leaders are a relatively new phenomenon. They translate research into action, ensuring that bedside nurses can offer patients the latest advances.

“The role of the CNL was developed not as a manager, central educator or disease-specific practitioner,” said Gerard, a 23-year veteran of nursing who teaches in Fairfield’s CNL graduate program. “The right CNL is a bedside leader, educator, advocate and clinical expert. Our overwhelmed staff nurses need this support to properly care for their patients.”

After several years of discussion, the American Association of Colleges of Nursing (AACN) created this role in 2006 in collaboration with a variety of leaders from the practice environment. Their goals: to upgrade the quality of patient care and to better prepare nurses for success in the present and future health care system.

The association details the CNL’s functions to include collecting and evaluating patient outcomes, assessing cohort risk, and exercising the authority to alter care plans when necessary. As part of a team, the CNL coordinates with physicians, pharmacists, social workers, clinical nurse specialists and nurse practitioners, working in all health care settings, not only acute care.

He or she has a master’s degree in nursing with a curriculum focused on leadership at the point of care, operating at the microsystem level and acting as a liaison between the patient and other health care providers.

“The CNL focuses on improving patient outcomes and facilitating the patient’s progress through a complicated and often chaotic health care environment. The role was designed to make the patient’s experience more seamless,” said Patricia Boylan, MSN, RN, CCRN, CNL, assistant manager of the cardiovascular and thoracic intensive care unit at Loyola University Health System in Maywood, Ill.

Surveys help a CNL measure patient, family and physician satisfaction, end-of-life care and staff retention, she said. Other initiatives involve reducing the length of hospital stays, infections acquired during these times, patient falls, near-misses and medical errors.

A CNL also initiates meetings with health care providers, the patient and family, facilitating continuity of care, better discharge planning, and more involvement among loved ones in making major decisions, Boylan said.

In December 2008, Boylan graduated from Saint Xavier University in Chicago with the qualifications required to take the CNL exam. A nurse for 22 years, she became certified as a CNL in May.

“The role is new and accredited programs in the area are few,” she said. “I expect we will see more and more nurses prepared for this role, as hospital administrators begin to see positive results from implementation of the role.”

According to AACN records, more than 700 CNLs have become certified to date, and more than 80 schools of nursing offer the CNL program.

Providence Health & Services funded scholarships for 10 nurses in Oregon to complete the CNL program. In addition, a system grant is funding a pilot study of the CNL role on a medical telemetry unit, said Elaine Ritchey, a clinical nurse leader at Providence Medford Medical Center in Medford, Ore.

“The beauty of the CNL education is that we are prepared to step into any work setting and practice as a clinical nurse leader – inpatient, outpatient, community health and more,” said Ritchey, a nurse for 12 years.

Patients stand to benefit from such a liaison. “With 12-hour shifts and part-time staff, one patient in a three-day hospitalization could have as many as nine different RNs and nine different nursing assistants,” she said. “The CNL is the continuous thread that assures congruence with the nursing plan of care, the medical plan of care and the patient’s needs and wishes.”

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