|
Clinical Nurse Leader
An Emerging Role for Nursing in the 21st Century
The CNL was developed by the American Association
of Colleges of Nursing (AACN) in response to complexities of health
care environments, the need to ensure safety and high standards
at the point of service, as well as to meet diverse client and health
care environment needs. The CNL is prepared as a master's prepared
generalist accountable for clinical and health care environment
outcomes. The Clinical Nurse Leader (CNL) is a leader across all
settings at the microsystem level (patient unit, community zip code
area, school setting, nursing home specific area, etc). The CNL
oversees care coordination of a distinct group of patients, is a
resource for clinical decision making and serves as a lateral integrator
of care. This clinical leader puts evidence-based practice into
action to ensure that patients benefit from the latest innovations
in care delivery. The CNL collects and evaluates patient outcomes,
assesses cohort risk, and has the decision-making authority to change
care plans when necessary. This clinician functions as part of an
interdisciplinary team by communicating, planning, and implementing
care directly with other health care professionals, including physicians,
pharmacists, social workers, therapists, clinical nurse specialists,
and nurse practitioners. The CNL is a leader in the health care
delivery system across all settings in which health care is delivered,
not just the acute care setting. Implementation of this role will
vary across settings.
Competencies and clinical learning experiences for
CNL students are specified for each of the following CNL role components:
client advocate, member of a profession, team manager, information
manager, systems analyst/risk anticipator, clinician, outcomes manager,
educator, and life long learner. The CNL designs and directs care
within a microsystem ensuring best practices are brought to the
point of service and patients/clients receive timely cost efficient
care. Lateral integration of services is key. The CNL is accountable
for clinical and care environment outcomes as well as influencing
work environments so as to increase nurse retention. The framework
for the curriculum for the CNL includes the domains of leadership,
clinical outcomes management, and care environment management. The
curriculum guide can be accessed at www.aacn.nche.edu/CNL/pdf/draftcurriculumframework4-06.pdf.
The CNL role is fully described in AACN's Working
Paper on the Role of the Clinical Nurse Leader (2004).
Incorporating the CNL requires a transformation in
practice. Specifics of the process of this transformation may be
unique to each institution. Resistance is inherent in any major
change so patience and perseverance are key leadership attributes
in implementing this new role. Kotter (1996) suggests that the first
four steps in the transformation process help defrost a hardened
status quo. Phases five to seven introduce new practices. The last
stage grounds the changes; makes them "stick."
|
