Revisiting the Role of Clinical Nurse Leaders in the Age of Healthcare Reform

With a major focus on reducing hospital readmissions and improving patient satisfaction, clinical nurse leaders (CNLs) play an increasingly important role in the healthcare industry. A relatively new position in the field, CNLs continue to provide high-level care in a constantly changing healthcare system.

What Is a CNL?

Introduced in 2003 by the American Association of Colleges of Nursing (AACN), a CNL is a master’s-prepared advanced generalist who works as an integrator for the healthcare team, facilitating, coordinating and overseeing care across multiple disciplines. As issues such as patient safety and outcomes, quality of care and medical errors became more prevalent in healthcare, the CNL role was designed to meet these needs.

In the article “Clarifying the clinical nurse leader role: guardian of care” the author states that CNLs “work with the clinical staff who are involved in the care of the patients; provide support and assessment of patients who have complex healthcare, discharge, and rehabilitation needs; provide direction and delegation to care delivery for this group; make referrals when necessary; round with the medical and interdisciplinary teams; and coach and support the direct caregivers in their unit or environment of care.”

What Are a CNL’s Responsibilities?

According to the Clinical Nurse Leader Association, CNLs practice at the point of care, focusing on evidence-based practice, safety, quality, risk reduction and cost containment. Often compared to an air traffic controller for patient care, CNLs work with all patient populations in all practice settings.

CNLs are responsible for helping to coordinate interdisciplinary rounds and working with the nursing staff, physicians, social services, physical therapy and other members of the care team. They also help staff plan for difficult discharges so patients are educated appropriately and medications are reconciled correctly, making the process a smoother one.

In addition, CNLs may assist with post-discharge care, such as making the patient’s appointment with the physician for a follow-up, or, if the patient does not have a physician, helping to find one.

6 Key Elements of CNL Role

Six key elements of a CNL role were identified by Monaghan and Swihart in their Transforming Practice, Transforming Care model:

  • Leadership and change
  • Interdisciplinary relationships
  • Knowledge transfer
  • Outcomes management
  • Clinician at the point of care
  • Professional development

How Does a CNL Differ from Other Nursing Roles?

Because clinical nurse leaders wear a variety of hats, so to speak, their role is sometimes confused with other nursing positions in healthcare, such as that of the clinical nurse specialist and case manager. Often an unclear role in healthcare, the key distinction between a CNL and other nursing roles is that a CNL does not primarily act as a direct caregiver, but rather as a facilitator of direct care.

CNL vs. Case Manager (CM)

In general, the CM will coordinate the patient’s discharge plan, and deal with Medicaid/Medicare and other insurance requirements. A CNL coordinates with the healthcare team regarding the patient’s plan of care. Like a CM, the CNL is typically involved in discharge procedures, but the scope of the position usually involves other responsibilities the CM is not involved with, such as patient or staff education. The roles of CNL and CM complement each other in that they both help the patient move through the hospital admission as smoothly and efficiently as possible, though they both fulfill specific needs in the process.

CNL vs. Clinical Nurse Specialist (CNS)

While a clinical nurse specialist (CNS) is an advanced practice specialist with a focus on the macrosystem, a CNL is an advanced generalist with a microsystem focus—working within a particular unit or type of facility. Further, CNSs focus on a specific patient group, such as cardiology or oncology patients, whereas CNLs have a caseload that includes overseeing all patients in their units, which may encompass a wide range of ages, diseases, surgeries, etc. These two roles work in collaboration with one another to promote best practices for patient care.

A Tool for Improving Outcomes?

Baptist Health in northeast Florida has long included CNLs in their clinical force, and they are seeing the value in expanding this role across their hospitals, according to an article in HealthLeaders Media. “When we were looking for ways to improve the patient’s experience, to improve care coordination and meet our quality measures, that role reemerged in our discussion,” said Diane Raines, DNP, RN, NEA-BC, senior vice president and chief nursing officer.

As a means of coordinating the care of complex patients, “They’re kind of the glue that keeps the care moving forward,” Raines said.

Is your healthcare system employing clinical nurse leaders? Feel free to share your experiences in the Comments section below.

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