Clinical Nurse Leaders as Agents of Change

New role could help redesign health care delivery.

    • February 26, 2009

The nascent Clinical Nurse Leader (CNL) role shows “enormous promise” in redesigning the way health care is delivered, according to Robert Wood Johnson Foundation Senior Adviser for Nursing Susan Hassmiller, Ph.D., R.N., F.A.A.N.

In a January 29 keynote speech at the Second Annual Clinical Nurse Leader Summit in New Orleans, Hassmiller called the role a “marvelous experiment that places decision-making in the hands of people who work at the bedside and know how patient care is delivered.”

The CNL role was created earlier this decade by the American Association of Colleges of Nursing and practice leaders in an effort to improve patient safety and the practice environment for nurses.

The clinical nurse leader is a master’s-prepared, advanced-generalist registered nurse (R.N.) who provides and coordinates care to individuals and patient groups on individual medical surgical floors.

The CNL plays a key role in collaborating with interdisciplinary teams. Together, these teams identify risk-analysis strategies and resources needed to ensure the safe delivery of care. In making decisions, the clinical nurse leader relies on patient-centered, evidence-based practice and performance data.

During her speech, Hassmiller discussed the need for policy-makers and nurse leaders to redesign the way health care is delivered, given the droves of nurses who are expected to retire in the next 10–20 years. Current estimates predict the United States will face a shortage of 500,000 nurses by 2025.

Calling the knowledge loss in the profession “unprecedented,” Hassmiller said that “new nurses are going to have far fewer mentors than in the past.”

She noted that clinical nurse leaders can help fill the knowledge gap in several ways: by acting as a resource for staff, patients and families; by implementing evidence-based practices and performance and improvement initiatives; and by coordinating patient care.

However, Hassmiller encouraged the CNL community to generate more data showing how clinical nurse leaders are improving patient care. Because the role is relatively new, most of the currently available information about CNLs is anecdotal or a series of case studies.

She said robust evidence about the effectiveness of clinical nurse leaders will be necessary to win grants and to convince hospital CEOs that their positions have merit in a difficult economic climate.

“You need to demonstrate how CNLs improve patient care and save the hospital money,” Hassmiller said.

She noted that research by Rose Sherman, Ed.D., R.N., C.N.A.A., an RWJF Executive Nurse Fellow (2006–2009) and director of the Nursing Leadership Institute at Florida Atlantic University in Boca Raton, Fla., will help clinical nurse leaders build their case.

Sherman has interviewed 71 CNLs and is analyzing their experiences and organizational support, their thoughts about where they add value, and their concerns about the future. She has also interviewed chief nursing officers to determine the factors that influence organizational leaders to use clinical nurse leaders.

Hassmiller encouraged CNLs to publicize their role to physicians and health care providers and to clarify how their role differs from that of advanced practice nurses, nurse managers and clinical nurse specialists.

Once clinical nurse leaders develop a cogent business case, Hassmiller urged them to advocate their role to schools of nursing, hospitals, physician practices and home health agencies.

“Don’t be shy about spreading this innovation and bringing it to all systems of care,” she said. “Be sure to highlight it in health care boardrooms across the country.”

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