Ninth Annual IBER & TLC Conference Proceedings 2009 Las Vegas, NV, USA
CNL: The Missing Piece
Of the Health Care Puzzle
Mary Hysell Lynd, Ph. D, R.N
College of Nursing & Health
Wright State University
Dayton, OH 45435
CNL; THE MISSING PIECE
OF THE HEALTH CARE PUZZLE
The health care crises is a leading topic in the USA. Health care professionals and legislators are struggling to
curtail the rising costs of health care. As is often the issue, solutions have been centered on the actual costs of
health care rather than the problems that have culminated into the rising costs. Most often the ‘health care problem
solvers’ are comprised of health care administrators and legislators rather than those health care professionals who
spend the ‘most time with patients’ and have their fingers on the pulse of the problems in health care—the nurse.
Consequently, health care costs continue to soar.
Over the past 3 decades, the delivery of nursing care has changed drastically but subsequent revision of the
leadership at the bedside has not changed. After the dramatic study by the Institute of Medicine (1999) reported
that approximately 90,000 individuals die yearly due to medical errors, professional nursing organizations were
eager to investigate these errors and to formulate their solution. The American Association of Colleges of Nursing
(AACN), a national accrediting agency for nursing curriculum in the USA, formulated 2 national task groups for
this purpose. As a result, the first new Master’s program in nursing, the Clinical Nurse Leader (CNL) was devised.
The CNL role would be to serve as expert clinical leader at the bedside of the patient. Since the head nurse,, who
was once considered the clinical nurse expert, had now taken on a more ‘organizational rather than unit role’—this
essential piece of the health care puzzle became a vital, missing piece of the health care puzzle. As a result, patient
care in health care facilities became fragmented and quality of care continued to decrease dramatically.
Since 2003, nearly 200 schools and universities in the USA have implemented a CNL program in their curricula.
Graduates of these programs take a national certification examination vy AACN to validate their expertise in
clinical leadership. Due to the short length of time since the graduation of the first CNLs, only minimal research
data is available to demonstrate significant results to attest to the rise in the quality of patient care. However, for
those studies completed, a definite rise in quality of care and in costs of health care have been demonstrated/ The
question is: ‘Once the CNL has been integrated as a normal role in the delivery of health care, will the role be the
missing piece of the health care puzzle’?
Key Words: health care crises, new master’s program in nursing, clinical nurse leader, quality of patient care,
decreased health care costs, AACN, Institute of Medicine