Clinical Nurse Leader

1
Clinical Nurse Leader

• An Emerging Advance Practice Role

2
Introduction

• The Clinical Nurse Leader (CNL) is a new
  specialization in Nursing
• There is a documented need for the CNL role in
  assuring quality and cost effectiveness of
  nursing care
• There are differences of opinion on education and
  classification

3
Origin of the Clinical Nurse Leader (CNL) Role

• .unless nursing is able to create a
  professional role that will attract the highest
  quality women and men into nursing, we will not
  be able to fulfill our covenant with the public.
  The Clinical Nurse Leader (CNL) addresses the
  call for change.
• AACN (February 2007) White Paper on the
• Education and Role of the Clinical Nurse Leader

4
Impetus for Change

•  In 1999 the AACN Board of Directors identified a
  number of primary concerns related to care
  delivery
• Declining enrollment in baccalaureate nursing
  programs
• Lack of success in differentiating practice of
  RNs with different educational preparation
• Exponentially increased knowledge base for
  nurses(e.g., genetics, pharmacology), along with
  increasingly complex delivery systems
• Numerous landmark studies reporting lack of
  high-quality patient care

5
Supporting Studies

• IOM landmark report To Err is Human Building a
  Safer Health System (2000) focused on
  increasingly high rate of medical errors
• JCAHO Health Care at the Crossroads  Strategies
  for Addressing the Evolving Nursing Crisis (2002)
  recommended proposals for providing financial
  incentives for health care organizations to
  invest in high quality nursing care

6
Supporting Studies

• RWJs Health Cares Human Crisis The American
  Nursing Shortage (2002) recommends the
  reinvention of nursing education and work
  environments to address and appeal to the needs
  and values of a new generation of nurses.
• IOM Health Professions Education A Bridge to
  Quality (2003) All health professionals should
  be educated to deliver patient-centered care as
  members of an interdisciplinary team, emphasizing
  evidence-based practice, quality improvement
  approaches, and informatics.

7
Development of the CNL

• 2002 an AACN task force created focused on needed
  nurse competencies
• Clinical leadership in all health care settings
• Implementation of outcomes-based practice and
  Quality Improvement strategies
• Ability of RNs to practice at their full scope of
  education and ability
• The creation and management of microsystems of
  care that will be responsive to the health care
  needs of individuals and families.
•  May 2003 Draft white paper The Role of the
  Clinical Nurse Leader
• February 2007 White Paper on the Education and
  Role of the Clinical Nurse Leader

8
Development cont.

•  
• .perhaps creating a powerful financial
  return-on-investment model based on higher
  quality of care, shorter length of stay, and
  improved clinical outcomes will more than justify
  the cost of such a role .
• (Drenkard, 2004)

9
Role Competencies

• The CNL functions as a Masters-prepared
  generalist providing and managing care at the
  point of care to patients, individuals, families,
  and communities.along with the authority,
  autonomy and initiative to design and implement
  care, the CNL is accountable for improving
  individual care outcomes and care processes in a
  quality, cost-effective manner.

10
Educational Competencies

• Critical thinking
• Communication
• Assessment
• Nursing technology and resource management
• Health promotion, risk reduction, and disease
  prevention
• Illness and Disease management
• Information and Health Care technologies
• Ethics
• Human Diversity
• Global Health Care
• Health Care Systems and Policy
• Provider/Manager/Coordinator of Care

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Fundamental Aspects of CNL

• Lateral integration of care for a specified
  group of patients
• Clinician
• may actively provide direct patient care in
  complex situations
• emphasis on health promotions and risk reduction
• Outcomes manager
• Responsibility for the ongoing assessment of the
  plan of care.
• Has the decision-making authority to change care
  plans if necessary
• Accountability for evaluation and improvement in
  point-of-care outcomes

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Fundamental Aspects of CNL

• Client and community advocate
• Educator
• Information manager
• Systems analyst/risk anticipator
• Team manager
• Collaboration with other health professional team
  members
• Member of a profession
• Lifelong learner

13
Real-World Example

• I was educated to use research to define and
  solve practice problems, to look beyond the
  obvious outcomes and to work to discover the true
  essence of practice problems. Through research, I
  learned to define problems on the unit by
  analyzing decreased patient satisfaction scores,
  the nurse turnover rate, staff morale, and
  increasing stress levels. I worked within the
  practice environment and studied how problems
  were being solved daily and how the flowthrough
  the GI lab was affected by other variables within
  the unit itself I evaluated how happy staff were
  with the way problems were being addressed by
  management and how their work performance was
  affected by their overall satisfaction with their
  work environment.
• Miller(2008)
•  

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Educational Preparation

• AACN holds the position that the CNL should be
  Masters prepared.
• CNL is an advanced generalist education.
• 65 schools in the U.S. offer a CNL program.

15
AACN Education Models for CNL

• Model A Masters degree program for BSN
  graduates that includes a post-BSN residency that
  awards masters credit.
• Model B Masters program designed for ADN
  graduates (RN-MSN).

16
Education Models cont.

• Model C Masters Program designed for
  individuals with a baccalaureate degree in
  another discipline (second-degree program).
• Model D Masters degree program designed for BSN
  graduates.
• Model E Post-masters certificate program
  designed for individuals with a masters degree
  in nursing in another area of study.

17
CNL Certification

• AACN requires that the nurse meet the following
  criteria
• Registered Nurse licensure
• Graduation from an accredited CNL master's or
  post-masters program
• CNL exam is web-based
• Two-part process involving multiple choice and
  simulation questions

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CNL Variations
19
(No Transcript)
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Is CNL by definition an advanced practice role?

• Advance practice registered nurse (APRN) is not
  defined in Washington Nurse Practice Guide (WDOH,
  2005)
• The CNL is not prepared as an advanced registered
  nurse practitioner (ARNP) as the ARNP is
  currently defined (WDOH, 2005)
• APRN is a generic, umbrella term that encompasses
  ARNPs, CNSs, nurse anesthetists and nurse
  midwives. (APRN-JDC, 2008)

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Does CNL function in advanced practice role?

• The CNL is an advanced generalist, functions at
  the unit level, and isnt a patient population
  expert in contrast with the specialized focus of
  the practice by CNS and ARNP.
• CNS and ARNP is prepared in a specialty
  curriculum which includes those clinical and
  didactic learning experiences identified and
  defined by the specialty nursing organization for
  the particular area of advanced clinical practice.

22
Is CNL educated for advanced practice role?

• Educated at the masters degree, the CNL is
  prepared with nursing competencies as outlined in
  the AACN (1998) Essentials of Baccalaureate
  Education for Professional Nursing Practice and
  additional competencies as outlined in the
  Working Paper on the Role of the Clinical Nurse
  Leader (AACN, 2004a).
• In comparison, the CNS is also prepared at the
  masters level but is prepared at the advanced
  practice level with competencies as outlined in
  AACNs (1996) Essentials of Masters Education
  for Advanced Practice Nursing (AACN, 2004c)

23
Is CNL an MSN advanced practice role?

• AACN is proposing that we move our clinical
  masters advanced practice nursing degrees (CNS,
  NP, CRNA and CNM) toward the practice doctorate.
• The CNL will be a Masters prepared nurse
• The CNL will serve in a unit-based role in the
  place of a unit-based CNS and ideally in
  conjunction with a DNP

24
Is CNL an emerging advanced practice role?

• CNL is an emerging nursing role developed by the
  American Association of Colleges of Nursing
  (AACN) in 2003
• The expectations for the CNL seem formidable with
  the many responsibilities identified
• CNL role clearly overlaps with the CNS role in
  many areas.
• Both the CNL and CNS manage care that is
  responsive to the health care needs of
  individuals and families.
• The CNL and CNS design and provide health
  promotion and risk reduction services for
  patients.

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Summary

• The CNL is a unique and valuable nursing role
• The verdict is still out on recognition of CNL as
  an advance practice role
• Standardization and legislation for title
  recognition and educational requirements is
  needed to formalize the role

26
Reference

• AACN, 2008. CNL Frequently Asked Questions.
  American Association of Colleges of Nursing.
  http//www.aacn.nche.edu/CNL/FAQ.htm Accessed
  9-29-08.
• American Association of Critical Care Nurses,
  2008. Advanced Practice Roles CNS or NP? Whats
  in a Name? American Association of Critical Care
  Nurses. http//classic.aacn.org/AACN/aacnnews.nsf
  /ff1487bfe89b77df882565a6006cfc3f/2ae0e849ab5ec4e1
  88256b5a007cd35e?OpenDocumentroles. Accessed
  9-29-08.
• APRN-JDC, 2008. Consensus Model for APRN
  Regulation Licensure, Accreditation,
  Certification Education. APRN Consensus Work
  Group the National Council of State Boards of
  Nursing APRN Advisory Committee. July, 2008.
• Grindel C. (2005). AACN Presents the Clinical
  Nurse Leader and the Doctor In Nursing practice
  Roles A Benefit or a Misfortune? MEDSURG
  Nursing, Vol. 14/No.4, pg 209-210.

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Reference

• Institute of Medicine. (2003). Health professions
  education A bridge to quality. Washington, DC
  The National Academies Press.
• Joint Commission on Accreditation of Healthcare
  Organizations. (2002). Health care at the
  crossroads, Strategies for addressing the
  evolving nursing crisis. Chicago.
• Kimball, B. ONeill, E. (2002). Health cares
  human crisis The American nursing shortage.
  Princeton, NJ The Robert Wood Johnson
  Foundation.
• Spross J, Hamric A, Hall G, et al. Working
  statement comparing the clinical nurse leader and
  clinical nurse specialist roles similarities,
  differences, and complementarities. Washington,
  DC American Association of Colleges of Nursing
  2004.
• WDOH, 2005. Nursing Practice Guide. Washington
  State Department of Health, Nursing Care Quality
  Assurance Commission. December 2005
• Institute of Medicine. (2000). To Err is Human
  Building a Safer HealthSystem. Washington, DC
  National Academy Press.