CNL

2,795 views

Published on

Published in: Health & Medicine, Business
0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
2,795
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
33
Comments
0
Likes
2
Embeds 0
No embeds

No notes for slide
  • AACN’s White Paper on The Role of the Clinical Nurse Leader
  • CNL

    1. 1. Clinical Nurse LeaderClinical Nurse Leader An Emerging AdvanceAn Emerging Advance Practice RolePractice Role
    2. 2. Introduction • The Clinical Nurse Leader (CNL) is aThe Clinical Nurse Leader (CNL) is a new specialization in Nursingnew specialization in Nursing • There is a documented need for theThere is a documented need for the CNL role in assuring quality and costCNL role in assuring quality and cost effectiveness of nursing careeffectiveness of nursing care • There are differences of opinion onThere are differences of opinion on education and classificationeducation and classification
    3. 3. Origin of the Clinical NurseOrigin of the Clinical Nurse Leader (CNL) RoleLeader (CNL) Role “…“….unless nursing is able to create a.unless nursing is able to create a professional role that will attract theprofessional role that will attract the highest quality women and men intohighest quality women and men into nursing, we will not be able to fulfillnursing, we will not be able to fulfill our covenant with the public. Theour covenant with the public. The Clinical Nurse Leader (CNL)Clinical Nurse Leader (CNL) addresses the call for change.”addresses the call for change.” AACN (February 2007) White Paper on theAACN (February 2007) White Paper on the Education and Role of the Clinical Nurse LeaderEducation and Role of the Clinical Nurse Leader
    4. 4. Impetus for ChangeImpetus for Change • In 1999 the AACN Board of Directors identified aIn 1999 the AACN Board of Directors identified a number of primary concerns related to carenumber of primary concerns related to care delivery:delivery: – Declining enrollment in baccalaureate nursing programsDeclining enrollment in baccalaureate nursing programs – Lack of success in differentiating practice of RNs withLack of success in differentiating practice of RNs with different educational preparationdifferent educational preparation – Exponentially increased knowledge base for nurses(e.g.,Exponentially increased knowledge base for nurses(e.g., genetics, pharmacology), along with increasinglygenetics, pharmacology), along with increasingly complex delivery systemscomplex delivery systems – Numerous landmark studies reporting lack of high-Numerous landmark studies reporting lack of high- quality patient carequality patient care
    5. 5. Supporting StudiesSupporting Studies • IOM landmark reportIOM landmark report To Err is Human: Building a SaferTo Err is Human: Building a Safer Health SystemHealth System (2000) focused on increasingly high rate of(2000) focused on increasingly high rate of medical errorsmedical errors • JCAHOJCAHO Health Care at the Crossroads: Strategies forHealth Care at the Crossroads: Strategies for Addressing the Evolving Nursing CrisisAddressing the Evolving Nursing Crisis (2002)(2002) recommended proposals for providing financial incentivesrecommended proposals for providing financial incentives for health care organizations to invest in high qualityfor health care organizations to invest in high quality nursing carenursing care
    6. 6. Supporting StudiesSupporting Studies • RWJ’sRWJ’s Health Care’s Human Crisis: The American NursingHealth Care’s Human Crisis: The American Nursing ShortageShortage (2002) recommends “the reinvention of nursing(2002) recommends “the reinvention of nursing education and work environments to address and appeal toeducation and work environments to address and appeal to the needs and values of a new generation of nurses”.the needs and values of a new generation of nurses”. • IOMIOM Health Professions Education: A Bridge to QualityHealth Professions Education: A Bridge to Quality (2003): “(2003): “All health professionals should be educated toAll health professionals should be educated to deliver patient-centered care as members of andeliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-basedinterdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, andpractice, quality improvement approaches, and informaticsinformatics.”.”
    7. 7. Development of the CNLDevelopment of the CNL • 2002 an AACN task force created focused on2002 an AACN task force created focused on needed nurse competenciesneeded nurse competencies – Clinical leadership in all health care settingsClinical leadership in all health care settings – Implementation of outcomes-based practice and QualityImplementation of outcomes-based practice and Quality Improvement strategiesImprovement strategies – Ability of RNs to practice at their full scope of educationAbility of RNs to practice at their full scope of education and abilityand ability – The creation and management of “microsystems” ofThe creation and management of “microsystems” of care that will be responsive to the health care needs ofcare that will be responsive to the health care needs of individuals and families.individuals and families. • May 2003: Draft white paperMay 2003: Draft white paper The Role of theThe Role of the Clinical Nurse LeaderClinical Nurse Leader • February 2007:February 2007: White Paper on the EducationWhite Paper on the Education and Role of the Clinical Nurse Leaderand Role of the Clinical Nurse Leader
    8. 8. DevelopmentDevelopment cont.cont. “…“….perhaps creating a powerful financial.perhaps creating a powerful financial return-on-investment model based onreturn-on-investment model based on higher quality of care, shorter length ofhigher quality of care, shorter length of stay, and improved clinical outcomes willstay, and improved clinical outcomes will more than justify the cost ofmore than justify the cost of such a role” .such a role” . (Drenkard, 2004)(Drenkard, 2004)
    9. 9. Role CompetenciesRole Competencies • ““The CNL functions as a Masters-preparedThe CNL functions as a Masters-prepared generalist providing and managing care at thegeneralist providing and managing care at the point of care to patients, individuals, families, andpoint of care to patients, individuals, families, and communities…….along with the authority,communities…….along with the authority, autonomy and initiative to design and implementautonomy and initiative to design and implement care, the CNL is accountable for improvingcare, the CNL is accountable for improving individual care outcomes and care processes in aindividual care outcomes and care processes in a quality, cost-effective manner.”quality, cost-effective manner.”
    10. 10. Educational CompetenciesEducational Competencies • Critical thinkingCritical thinking • CommunicationCommunication • AssessmentAssessment • Nursing technology and resource managementNursing technology and resource management • Health promotion, risk reduction, and disease preventionHealth promotion, risk reduction, and disease prevention • Illness and Disease managementIllness and Disease management • Information and Health Care technologiesInformation and Health Care technologies • EthicsEthics • Human DiversityHuman Diversity • Global Health CareGlobal Health Care • Health Care Systems and PolicyHealth Care Systems and Policy • Provider/Manager/Coordinator of CareProvider/Manager/Coordinator of Care
    11. 11. Fundamental Aspects ofFundamental Aspects of CNLCNL ““Lateral integration of care for a specified group ofLateral integration of care for a specified group of patients”patients” • ClinicianClinician – may actively provide direct patient care in complexmay actively provide direct patient care in complex situationssituations – emphasis on health promotions and risk reductionemphasis on health promotions and risk reduction • Outcomes managerOutcomes manager – Responsibility for the ongoing assessment of the plan ofResponsibility for the ongoing assessment of the plan of care.care. – Has the decision-making authority to change care plansHas the decision-making authority to change care plans if necessaryif necessary – Accountability for evaluation and improvement in point-Accountability for evaluation and improvement in point- of-care outcomesof-care outcomes
    12. 12. Fundamental Aspects ofFundamental Aspects of CNLCNL • Client and community advocateClient and community advocate • EducatorEducator • Information managerInformation manager • Systems analyst/risk anticipatorSystems analyst/risk anticipator • Team managerTeam manager • Collaboration with other health professional teamCollaboration with other health professional team membersmembers • Member of a professionMember of a profession • Lifelong learnerLifelong learner
    13. 13. Real-World ExampleReal-World Example ““I was educated to use research to define and solve practiceI was educated to use research to define and solve practice problems, to look beyond the obvious outcomes and to work toproblems, to look beyond the obvious outcomes and to work to discover the true essence of practice problems. Through research,discover the true essence of practice problems. Through research, I learned to define problems on the unit by analyzing decreasedI learned to define problems on the unit by analyzing decreased patient satisfaction scores, the nurse turnover rate, staff morale,patient satisfaction scores, the nurse turnover rate, staff morale, and increasing stress levels. I worked within the practiceand increasing stress levels. I worked within the practice environment and studied how problems were being solved dailyenvironment and studied how problems were being solved daily and how the flowthrough the GI lab was affected by otherand how the flowthrough the GI lab was affected by other variables within the unit itself I evaluated how happy staff werevariables within the unit itself I evaluated how happy staff were with the way problems were being addressed by management andwith the way problems were being addressed by management and how their work performance was affected by their overallhow their work performance was affected by their overall satisfaction with their work environment.”satisfaction with their work environment.” Miller(2008)Miller(2008)   
    14. 14. Educational PreparationEducational Preparation • AACN holds the position that the CNLAACN holds the position that the CNL should be Master’s prepared.should be Master’s prepared. • CNL is an advanced generalistCNL is an advanced generalist education.education. • 65 schools in the U.S. offer a CNL65 schools in the U.S. offer a CNL program.program.
    15. 15. AACN Education Models forAACN Education Models for CNLCNL • Model A:Model A: Master’s degree programMaster’s degree program for BSN graduates that includes afor BSN graduates that includes a post-BSN residency that awardspost-BSN residency that awards master’s credit.master’s credit. • Model B:Model B: Master’s program designedMaster’s program designed for ADN graduates (RN-MSN).for ADN graduates (RN-MSN).
    16. 16. Education ModelsEducation Models cont.cont. • Model C:Model C: Master’s Program designedMaster’s Program designed for individuals with a baccalaureatefor individuals with a baccalaureate degree in another discipline (second-degree in another discipline (second- degree program).degree program). • Model D:Model D: Master’s degree programMaster’s degree program designed for BSN graduates.designed for BSN graduates. • Model E:Model E: Post-master’s certificatePost-master’s certificate program designed for individuals with aprogram designed for individuals with a master’s degree in nursing in anothermaster’s degree in nursing in another area of study.area of study.
    17. 17. CNL CertificationCNL Certification • AACN requires that the nurse meetAACN requires that the nurse meet the following criteriathe following criteria – Registered Nurse licensureRegistered Nurse licensure – Graduation from an accredited CNL master's or post-Graduation from an accredited CNL master's or post- master’s programmaster’s program • CNL exam is wCNL exam is web-basedeb-based – Two-part process involving multiple choice andTwo-part process involving multiple choice and simulation questionssimulation questions
    18. 18. CNL Variations
    19. 19. Graduate Level Curriculum Elements CNL Role Functions CNL Role Expectations 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 Profession • Effects change in health care practice • 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 Manager • Uses information systems/ technologies • Improves health care outcomes Systems Analyst/Risk Anticipator • Participates in system reviews • Evaluates/anticipates client risks to improve patient safety 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 Manager • Uses data to change practice and improve outcomes. • 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
    20. 20. Is CNL by definition anIs CNL by definition an advanced practice role?advanced practice role? • Advance practice registered nurse (APRN) is notAdvance practice registered nurse (APRN) is not defined in Washington Nurse Practice Guidedefined in Washington Nurse Practice Guide (WDOH, 2005)(WDOH, 2005) • The CNL is not prepared as an advancedThe CNL is not prepared as an advanced registered nurse practitioner (ARNP) as the ARNPregistered nurse practitioner (ARNP) as the ARNP is currently defined (WDOH, 2005)is currently defined (WDOH, 2005) • APRN is a generic, umbrella term thatAPRN is a generic, umbrella term that encompasses ARNPs, CNSs, nurse anesthetistsencompasses ARNPs, CNSs, nurse anesthetists and nurse midwives. (APRN-JDC, 2008)and nurse midwives. (APRN-JDC, 2008)
    21. 21. Does CNL function in advancedDoes CNL function in advanced practice role?practice role? • The CNL is an advanced generalist, functions atThe CNL is an advanced generalist, functions at the unit level, and isn’t a patient populationthe unit level, and isn’t a patient population expert in contrast with the specialized focus ofexpert in contrast with the specialized focus of the practice by CNS and ARNP.the practice by CNS and ARNP. • CNS and ARNP is prepared in a specialtyCNS and ARNP is prepared in a specialty curriculum which includes those clinical andcurriculum which includes those clinical and didactic learning experiences identified anddidactic learning experiences identified and defined by the specialty nursing organization fordefined by the specialty nursing organization for the particular area of advanced clinical practice.the particular area of advanced clinical practice.
    22. 22. Is CNL educated for advancedIs CNL educated for advanced practice role?practice role? • Educated at the master’s degree, the CNL is prepared withEducated at the master’s degree, the CNL is prepared with nursing competencies as outlined in the AACN (1998)nursing competencies as outlined in the AACN (1998) Essentials of Baccalaureate Education for ProfessionalEssentials of Baccalaureate Education for Professional Nursing PracticeNursing Practice and additional competencies as outlined inand additional competencies as outlined in thethe Working Paper on the Role of the Clinical Nurse LeaderWorking Paper on the Role of the Clinical Nurse Leader (AACN, 2004a).(AACN, 2004a). • In comparison, the CNS is also prepared at the master’sIn comparison, the CNS is also prepared at the master’s level but is prepared at the advanced practice level withlevel but is prepared at the advanced practice level with competencies as outlined in AACN’s (1996)competencies as outlined in AACN’s (1996) Essentials ofEssentials of Master’s Education for Advanced Practice NursingMaster’s Education for Advanced Practice Nursing (AACN,(AACN, 2004c)2004c)
    23. 23. Is CNL an MSN advancedIs CNL an MSN advanced practice role?practice role? • AACN is proposing that we move our clinicalAACN is proposing that we move our clinical master’s advanced practice nursing degreesmaster’s advanced practice nursing degrees (CNS, NP, CRNA and CNM) toward the practice(CNS, NP, CRNA and CNM) toward the practice doctorate.doctorate. • The CNL will be a Masters prepared nurseThe CNL will be a Masters prepared nurse • The CNL will serve in a unit-based role in theThe CNL will serve in a unit-based role in the place of a unit-based CNS and ideally inplace of a unit-based CNS and ideally in conjunction with a DNPconjunction with a DNP
    24. 24. Is CNL an emerging advancedIs CNL an emerging advanced practice role?practice role? • CNL is an emerging nursing role developed by theCNL is an emerging nursing role developed by the American Association of Colleges of NursingAmerican Association of Colleges of Nursing (AACN) in 2003(AACN) in 2003 • The expectations for the CNL seem formidableThe expectations for the CNL seem formidable with the many responsibilities identifiedwith the many responsibilities identified • CNL role clearly overlaps with the CNS role inCNL role clearly overlaps with the CNS role in many areas.many areas. – Both the CNL and CNS manage care that is responsiveBoth the CNL and CNS manage care that is responsive to the health care needs of individuals and families.to the health care needs of individuals and families. – The CNL and CNS design and provide health promotionThe CNL and CNS design and provide health promotion and risk reduction services for patients.and risk reduction services for patients.
    25. 25. SummarySummary • The CNL is a unique and valuableThe CNL is a unique and valuable nursing rolenursing role • The verdict is still out on recognitionThe verdict is still out on recognition of CNL as an “advance practice” roleof CNL as an “advance practice” role • Standardization and legislation forStandardization and legislation for title recognition and educationaltitle recognition and educational requirements is needed to formalizerequirements is needed to formalize the rolethe role
    26. 26. ReferenceReference 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/ff1487bfe89b77df882565a6006cfc3f/ . 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.
    27. 27. ReferenceReference 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.

    ×