The Many Roles of a Clinical Nurse Leader
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What is a Clinical Nurse Leader (CNL)?
The Clinical nurse leader (CNL) is a master’s educated nurse ready to practice within any healthcare setting. The CNL role was developed by the American Association of Colleges of Nursing (AACN) in collaboration with leaders in the nursing practice environment. A CNL makes it their mission to identify how to improve the quality of patient care and prepare 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 CNL plays an integral leadership role with 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. Because of this, CNLs have many responsibilities.
Taking on Leadership
Learning to become an effective clinical lead nurse 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. Clinical nurse leaders work toward bettering the care of the patient population, making recommendations as necessary based on data they’ve collected and analyzed.
They can also be agents of change for a healthcare facility or organization. Many facilities need a transformative clinical lead nurse 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.
Clinical lead nurses can take on many styles of leadership, including:
- 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 ensuring their needs are met on a project.
- Strategic – supporting the company’s objectives while ensuring optimal working conditions for various types of employees.
- Transformational – pushing team members outside of their comfort zone and towards growth.
- Visionary – driving change by inspiring team members and earning their trust.
To ensure the quality of care is at its optimum state, the nursing culture in an organization has to have leaders that promote autonomy, integrity and ongoing performance and care improvement. This must be true no matter which leadership style they employ. Helpful key behaviors of clinical lead nurses include:
- 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 to their care. According to The Online Journal of Issues in Nursing, there are seven important subcultures that clinical nurse leaders should focus on to maintain a culture of safety:
- Evidence-based care
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 clinical nurse leaders will learn how to research new surgery techniques and 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.
Employing CNLs is shown to have a positive impact on patient care. The Online Journal of Issues in Nursing states, “One of the early examples of the CNL’s ability to provide strong evidence-based 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 [an] increase in patient satisfaction and a decrease in staff turnover.”
This is just one of many examples of the way a CNL has improved patient care within major healthcare systems. The position focuses on care coordination, outcomes, transitions, communication and the implementation of best practices, safeguarding the patient in an increasingly interconnected healthcare structure.
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.
Teamwork and interdisciplinary collaboration are essential to safe care delivery, and the responsibility for its effectiveness falls to those in leadership roles. A CNL ensures 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 being a clinical lead nurse 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.
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. 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. The CNL education preparation includes a specific focus on communication skills targeted toward teamwork, lateral integration of care and conflict management.
Motivating Your Team
A clinical nurse leader must be a mentor for their 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 in 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 online MSN –Clinical Nurse Leader specialization 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.
- (Smith, Manfredi, Hagos, Drummond-Huth, & Moore, 2006).
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