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Slide 1 - PLU - Pacific Lutheran University_ academically rigorous

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									Clinical Nurse Leader

  An Emerging Advance
      Practice Role
           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
 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
         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
          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
          Supporting Studies
• RWJ’s Health Care’s 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.”
     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
        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)
        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.”
    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
    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
    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
          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)
   Educational Preparation

• AACN holds the position that the CNL
  should be Master’s prepared.

• CNL is an advanced generalist
  education.

• 65 schools in the U.S. offer a CNL
  program.
AACN Education Models for
         CNL
• Model A: Master’s degree program
  for BSN graduates that includes a
  post-BSN residency that awards
  master’s credit.
• Model B: Master’s program designed
  for ADN graduates (RN-MSN).
    Education Models cont.
• Model C: Master’s Program designed
  for individuals with a baccalaureate
  degree in another discipline (second-
  degree program).
• Model D: Master’s degree program
  designed for BSN graduates.
• Model E: Post-master’s certificate
  program designed for individuals with a
  master’s degree in nursing in another
  area of study.
           CNL Certification
• AACN requires that the nurse meet
  the following criteria
  – Registered Nurse licensure
  – Graduation from an accredited CNL master's or post-
    master’s program

• CNL exam is web-based
 – Two-part process involving multiple choice and
   simulation questions
CNL Variations
          Graduate Level         CNL Role                           CNL Role Expectations
            Curriculum           Functions
             Elements
Nursing Leadership             Advocate          Keeps clients well informed
                                                 Includes clients in care planning
                                                 Advocates for the profession
                                                 Works with interdisciplinary team
                                                 Strives to achieve social justice within the microsystem

                               Member of a       Effects change in health care practice
                               Profession        Effects change in health outcomes
                                                 Effects change in the profession

Care Environment Management    Team Manager      Properly delegates and manages
                                                 Uses team resources effectively
                                                 Serves as leader/partner on interdisciplinary team

                               Information       Uses information systems/ technologies
                               Manager           Improves health care outcomes
                               Systems           Participates in system reviews
                               Analyst/Risk      Evaluates/anticipates client risks to improve patient safety
                               Anticipator
Clinical Outcomes Management   Clinician         Designs/coordinates/evaluates care
                                                 Delivers care in a timely, cost effective manner
                                                 Emphasizes health promotion/risk reduction
Clinical Outcomes Management   Outcomes          Uses data to change practice and improve outcomes.
                               Manager           Achieves optimal client outcomes
Clinical Outcomes Management   Educator          Uses teaching/learning principles/strategies
                                                 Uses current information/ materials/techniques
                                                 Facilitates clients learning, anticipating their health trajectory
                                                  needs.
                                                 Facilitates client care using evidence-based resources.
                                                 Facilitates group & other health professions’ learning and
                                                  professional development
      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)
Does CNL function in advanced
       practice role?
• The CNL is an advanced generalist, functions at
  the unit level, and isn’t 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.
 Is CNL educated for advanced
         practice role?
• Educated at the master’s 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 master’s
  level but is prepared at the advanced practice level with
  competencies as outlined in AACN’s (1996) Essentials of
  Master’s Education for Advanced Practice Nursing (AACN,
  2004c)
     Is CNL an MSN advanced
          practice role?
• AACN is proposing that we move our clinical
  master’s 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
 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.
             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
                        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? What’s in a Name? American Association of Critical Care
   Nurses.
   http://classic.aacn.org/AACN/aacnnews.nsf/ff1487bfe89b77df882565a600
   6cfc3f/2ae0e849ab5ec4e188256b5a007cd35e?OpenDocument#roles.
   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.
                           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. & O’Neill, E. (2002). Health care’s 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.

								
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