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The Many Roles of a Clinical Nurse Leader

The Many Roles of a Clinical Nurse Leader

The Clinical Nurse Leader (CNL) is an emerging role developed by the American Association of Colleges of Nursing (AACN) in collaboration with leaders in the nursing practice environment. A CNL makes it his or her mission to identify how to improve the quality of patient care and prepares other nurses with the skills needed to thrive in the current and future healthcare system.

Quality care begins at the bedside and while nursing leadership is known to go beyond to the managerial or administrative level, the Clinical Nurse Leader plays an integral leadership role at the bedside, holding patient care at its core. This position is not one of administration but of action, consistently evaluating patient outcomes, assessing cohort risk, and making leadership decisions to change care plans when necessary. CNL’s have many responsibilities.

Taking on Leadership

Learning to become an effective leader is a significant skill to be developed throughout nursing education. Unlike a staff nurse, the CNL has a hand in many things. Responsibilities involve drafting healthcare plans for patients, leading processes and teams, utilizing data to design and implement evidence-based practice, and anticipating problems with colleagues or patient care. CNLs work toward bettering the care of the patient population, making recommendations as necessary based off of data they’ve collected and analyzed.

They can also be agents of change for a healthcare facility or organization. Many facilities need a transformative leader to change nurses’ thought processes. The CNL is a master at many styles of leadership to effectively get their employees to perform at a level of excellence. Two leadership styles include:

Democratic - allowing team members a say in critical decision-making, with the final decision resting with the leader.

Affiliative - putting the team members first and ensure their needs are met on a project.

To ensure quality of care is at its optimum state, the nursing culture in the organization has to have leaders that promote autonomy, integrity and ongoing performance and care improvement. Helpful key behaviors include that leaders do the following:

  • Encourage followers to be actively involved in the quality control process
  • Clearly communicate expected standards of care
  • Encourage high standards to maximize quality instead of setting minimum safety standards.
  • Embrace quality improvement as an ongoing process
  • Use control as a method of determining why goals were not met
  • Distinguish between clinical standards and resource utilization standards, ensuring that patients receive at least minimally acceptable levels of quality of care
  • Support and actively participate in research efforts to identify and measure nursing sensitive patient outcomes1

Improving Patient Care

The CNL focuses on the safety of patients and families entrusted into his or her care. There are seven important subcultures CNLs need to maintain a culture of safety: leadership, teamwork, evidence-based care, communication, learning, justice and patient-centeredness.

By acquiring a master’s nursing degree, the potential CNL will quickly learn the importance of creating effective patient care plans. A large part of the job involves managing patient care and coming up with the best plan or course of action.

Nurses studying to become a CNL will learn how to research new surgery techniques, assess new equipment and relevant details. CNLs are also prepared to address change by learning about risk anticipation, risk reduction failure modes analysis techniques, as well as conducting root cause analyses. CNL students learn how to collaborate not just with doctors and nurses, but also with pharmacists, the patient’s family, physical therapists and social workers.

As technology increases, teamwork and interdisciplinary collaboration grow more essential to safe care delivery. The CNL education preparation includes a specific focus on communication skills targeted towards the teamwork, lateral integration of care, and conflict management needed to advocate for patient-centered, evidence-based care.

One of the early examples of the CNLs ability to provide strong evidence-based point-of-care clinical leadership was the 12-bed hospital project at Baptist Hospital in Miami, Florida. Implementation of the CNL role resulted in a 67% reduction in the fall with injury rate and a sustained pressure ulcer prevalence rate of zero for the full year. Additionally, one-year findings included increase in patient satisfaction and a decrease in staff turnover.

Another example of CNL role implementation in an acute care setting comes from a hospital in northeastern Florida. There were improvements in nurse satisfaction and retention, patient satisfaction, and physician. The presence of the point-of-care clinical leader led to a 38% reduction in restraint use, fewer falls, and a significantly reduced incidence of failure to rescue.2

The Joint Commission recognizes the CNL as an important contribution towards helping to solve healthcare’s safety problems and implementation of the CNL role now occurs in several major healthcare systems across the nation.3

Collaborating with Colleagues & Patients

As the bridge between numerous individuals and departments, it is important for the CNL to build strong relationships with colleagues. From the newest certified nursing assistant, to the most tenured doctor, the CNL must maintain clear communication with all stakeholders.

One of the biggest challenges in our complex, healthcare settings is that of effective and timely communication among multiple healthcare providers, including physicians, nurses, therapists, and consultants. Without this communication, care can become fragmented for the patient and family, increasing their risk of harm. A CNL role insures that patient and family needs are not only assessed, but also properly communicated with all members of the healthcare team for effective, quality care.

Part of the position also involves listening to everyone's concerns and ideas as they can play a role in determining an ideal course of action for a given patient. CNLs keep up on the latest technology and treatments and assess the risks and advantages with the patient’s nurses and doctors. This helps in identifying the best plan of action.

Coordination of care between settings, or ‘lateral integration,’ enables the CNL to serve as the patient advocate/care navigator, and as the stop-gap professional. This coordination ultimately helps reduce fragmentation and lapses in patient care and safety.

Motivating Your Team

A CNL must be a mentor for his or her team. As a leader, constant communication is critical, as is the ability to listen to problems and ideas from others with an open mind.

To become a leader and expert, it is important to specialize in an area of focus in healthcare. The CNL career path is ideal for established nurses who strive to be the best patient caregiver. A Master of Science in Nursing with a Clinical Nurse Leader track is the ideal path for nurses to achieve this career goal, as it is designed to prepare nurses for the CNL certification exam. Nurses wishing to work as a CNL are required to hold a master’s degree and have the potential of earning an annual salary that is almost $20,000 higher than RNs without master’s degrees.2

Sacred Heart University offers a Master of Science in Nursing with a specialization of Clinical Nurse Leader (CNL), preparing students to sit for the American Association of Colleges of Nursing CNL Certificate Exam through coursework and over 348 hours of role immersion. The university’s CNL track offers seasoned RNs the needed skillset to create, implement and gauge a patient’s care, along with the management and collaboration skills for working with other healthcare professionals.

1Marquis & Huston (2009), http://rnjournal.com/journal-of-nursing/clinical-nurse-leadership-and-performance-improvement-on-surgical-unit

2 (Smith, Manfredi, Hagos, Drummond-Huth, & Moore, 2006).

3The Department of Veteran’s Affairs aspires to implement CNL roles in all of its facilities by 2016.