The Clinical Nurse Leader: An Emerging Role for Nursing in the 21st Century

Mary Lou Wesley, senior vice president and chief nurse executive

The Clinical Nurse Leader (CNL) role was developed by the American Association of Colleges of Nursing (AACN) in response to the increasing complexities of healthcare environments, the need to ensure safety and high standards at the point of service (the bedside), as well as to meet diverse client and healthcare environment needs.  It is the newest role in nursing since the Nurse Practitioner role was introduced 40 years ago. The CNL is prepared at the master’s level as a nurse generalist, accountable for clinical and healthcare environment outcomes.  The CNL oversees the coordination of care of a distinct group of patients at the unit level, is a resource for clinical decision-making and serves as a lateral integrator of care.  The CNL puts evidence-based practice into action to ensure that patients benefit from the latest innovations in care delivery.  The CNL mentors and guides other registered nurses in their care of patients and serves as a patient advocate, facilitating the optimal patient experience, while helping the patient and family navigate through the healthcare system.  The recent Institute of Medicine report, “The Future of Nursing: Leading Change, Advancing Health,” lists the establishment of the CNL role as an important strategy to effectively respond to the increasing acuity of patients and complexity of the healthcare system.

In the Fall of 2010, a partnership with the University of West Georgia was established to bring the Master of Science in Nursing CNL program to WellStar Health System. It is a full-time, four-semester program (36 credit hours). At the completion of the program, graduates must successfully pass the CNL certification exam in order to practice as a CNL. The first cohort of 16 CNLs graduated in April 2013 and sat for the certification exam on May 15. The CNLs are part of the staffing model at the bedside, placed strategically on units where they can have the greatest impact on outcomes related to quality, cost, coordination and satisfaction.  A second cohort began in Fall 2012 and will graduate in Spring 2014. For more information on the CNL role, go to Clinical Nurse Leader at http://www.aacn.nche.edu/cnl.

We already started seeing positive outcomes of the CNL role while they were in school. These outcomes included:
•            Decreased fragmentation of care
•            Improved effectiveness and efficiency of multidisciplinary rounds and hand-offs
•            Improved clinical workflows and processes
•            Reduction in hospital-acquired conditions and infections
•            Improved core measure compliance
•            Improved patient and family satisfaction
•            Improved physician satisfaction

REFERENCES
Hartranft, S. R., Garcia, T., & Adams, N. (2007). Realizing the anticipated effects of the clinical nurse leader. Journal of Nursing Administration, 37(6), 261-263.
Harris, J. L., Tornabeni, J., & Walters, S. E. (2006). The clinical nurse leader: A valued member of the healthcare team. Journal of Nursing Administration, 36(10), 446-449.
Porter-O’Grady, T., Clark, J. S., & Wiggins, M.S. (2010). The Case for CNLs: Guiding Nursing Practice into the 21st Century. Nurse Leader 8(1), 37-41. DOI:10.1016/j.mnl.2009.11.002.