Clinical Nurse Leader: Moving Toward the Future

na340609.qxd 6/4/2004 10:47 AM Page 257 JONA Volume 34, Number 6, pp 257-260 ©2004, Lippincott Williams & Wilkins, Inc. PROFESSIONAL ISSUES Clinical Nurse Leader: Moving Toward the Future Karen Drenkard, MSN, RN, CNAA Elaine Cohen, EdD, RN, FAAN “Changing times are invitations for and 2) have been working since 2001 participants attended the meeting, participation.” to search for answers to the concerns furthering the white paper interpreta- –Anne Wilson Schaef 1 facing the discipline of nursing. Task tion. Force 1, which worked on develop- The AACN’s next steps5 include Professional nursing practice remains ing new educational models, deter- academic/practice partnerships to challenged by the multitude of issues mined that a new role was needed to pilot both the curriculum and the posed by a transforming healthcare differentiate scope of practice and role set of the clinical nurse leader system. Ensuring delivery of quality, create new licensure, rather than dif- role. In January 2004, the AACN effective patient care demands flexi- ferentiate current entry levels of board of directors passed several pol- bility and adaptability on the part of nursing.3 Task Force 2 began work in icy motions to guide the work of the nursing to fully participate in the 2002 and focused on nurse compe- association to “assure the highest many changes occurring in its envi- tencies that would be needed in the quality nursing workforce for our ronment. future. It was this task force that cre- nation’s healthcare needs.”5 These ated the role of the clinical nurse motions are included in Figure 1. In leader and published a draft of the June 2004, AACN will convene a TIME FOR TRANSITION white paper.3 conference between nurse educators In an attempt to create solutions for AACN held a stakeholder reac- and practice partners committed to the growing threat of the nursing tion panel before the release of the advancing the clinical nurse leader shortage and shape the future of white paper, to gather reactions and initiative. At this meeting, education- healthcare leadership and practice, critical feedback from the practice practice models and curriculum will the American Association of Colleges arena. One of the authors partici- be finalized, and an implementation of Nursing (AACN) developed a pated in the reaction panel (Ms timeline will be developed. AACN is- working paper describing a new role, Drenkard) and provided input into sued a request for proposals in April that of clinical nurse leader. Released the development of the role. The re- 2004 to identify education-practice in May 2003, the paper proposes the action panel included nurse execu- partners interested in piloting a clini- creation of a new role for profes- tives from major systems across the cal nurse leader program. sional nursing.2 country and provided the AACN Two AACN task forces (Task leadership with some reality testing, THE ROLE OF THE CLINICAL Force on Education and Regulation comments, and suggestions for NURSE LEADER for Professional Nursing Practice 1 change. Based on the feedback, addi- tional revisions were made to the The AACN white paper2 describes working draft. In October 2003, the various elements that are crucial to Authors’ affiliations: Chief Nurse Execu- AACN invited academic and practice the clinical nurse leader (CNL) role. tive (Ms Drenkard), Inova Health System, partners to participate in a meeting The CNL is characterized as a Falls Church, Va; Director, Case/Utilization of “thoughtful, collaborative, dia- “leader in the healthcare delivery Management, Quality and Outcomes, Asso- logue” between nurse educators and system, not just the acute care set- ciate Professor (Dr Cohen), University of practice partners about the education ting.”2 The white paper also says Colorado Hospital, Denver, Colo. Corresponding author: Ms Drenkard, Inova and practice of the nurse of the fu- the CNL “oversees the care coordi- Health System, 2990 Telestar Ct, Falls Church, ture, and to prepare an initial plan nation of a distinct group of pa- VA 22042 ([email protected]). for implementation.4 More than 200 tients and actively provides direct JONA • Vol. 34, No. 6 • June 2004 257 na340609.qxd 6/4/2004 10:47 AM Page 258 PROFESSIONAL ISSUES source for the clinical nursing These motions were acted upon in the aggregate and should not be considered team.”5 The CNL role will be imple- in isolation. mented across all care settings. Al- though not a management role, the • The AACN board of directors does not believe it is feasible and productive, at CNL will provide and manage care this point in time, to engage in efforts to differentiate the license for the cur- to individuals and populations with rent BSN and ADN graduates. diverse and complex health needs. • The AACN board does not believe that the set of expectations, as outlined in Serving as the clinical expert in a care the report of TFER2, can be achieved in a 4-year baccalaureate nursing ex- setting, the CNL will coordinate and perience. evaluate nursing care at the point of service. • The Board of Directors supports continuation of baccalaureate nursing education, at a minimum, as the entry level for the professional registered nurse. EVOLVING CHALLENGES • The Board of Directors accepts the draft White Paper on the Role of the Clini- cal Nurse Leader, May 2003, as a working paper. As the conceptual framework of the task force moves into our practice • AACN will continue to provide leadership and invest resources in the creation settings, challenges and issues arise and evaluation of a new model, or models, of nursing practice and nursing that will need to be addressed. The education at the master’s degree in nursing level that results in a new nursing CNL role holds much promise, albeit professional (CNL). with many unanswered questions. • The new models to be created and evaluated will result in a new nursing pro- The role of the nurse executive will fessional for generalist practice, as described in the CNL paper, who is pre- be to serve as a leader of the change pared at the master’s level. process, helping resolve the unanswered questions, participating ac- • The Board of Directors approved models as a starting point for model devel- tively in the dialogue with their acad- opment. emic partners, and leading the way • AACN will assume leadership and engage appropriate stakeholders to en- by experimenting and implementing sure development of a new legal scope of practice and credential for the new new models of care. As nurse execu- nursing professional as described in the CNL working paper. tives direct the path to implementation, several areas of inquiry require exploration. Figure 1. Motions passed by the American Association of Colleges of Nursing (AACN) Board of Directors. (From AACN. Talking points: AACN board deci- sions regarding the clinical nurse leader initiative. Available at: DO WE NEED A NEW ROLE? www.aacn.nche.edu/NewNurse/TalkingPoints.htm. Accessed March 10, 2004. It appears ironic amid our current Reprinted with permission.) nursing shortage, a situation in which we do not have enough staff to patient care in complex situations. • prepared for clinical leader- fill existing positions, that we are dis- This clinician puts evidence-based ship, cussing the creation of another nurs- practice into action to ensure that pa- • accountable for outcomes, ing role. However, there are those tients benefit from the latest innova- • willing to remain in the pro- who would emphatically state that it tions in care delivery. The CNL col- fession, and is exactly the convergence of these lects and evaluates patient • capable of managing complex and other internal and external fac- outcomes, assesses cohort risk, and systems of care. tors that provide an opportune time has the decision making authority for the development of a new to change care plans when neces- At the meeting in January 2004, provider of nursing care. sary. This clinician functions as part the AACN board confirmed “sup- Nurse executives face daily of an interdisciplinary team by com- port for the creation of a new nurse struggles in their attempts to staff municating, planning, and imple- role to enhance care delivery titled clinical units with competent, quali- menting care directly with other the Clinical Nurse Leader (CNL). fied registered nurses who are ac- healthcare professionals.”5 Core The CNL is a generalist clinician countable for a full range of patient competencies, knowledge, and role with education at the master’s degree interventions and associated practice development for the CNL have been level. This nurse leader must be pre- outcomes. Our current work envi- identified and are presented in Fig- pared to bring a high level of clinical ronments are fraught with numerous ure 2. The CNL role aspires to pro- competence and knowledge to the challenges that affect the quality, vide nurses who are point of care and to serve as a re- safety, and effectiveness of patient 258 JONA • Vol. 34, No. 6 • June 2004 na340609.qxd 6/4/2004 10:47 AM Page 259 PROFESSIONAL ISSUES the CNL role may not be perfected provides nurse leaders with an op- Core Competencies yet, it offers the opportunity for di- portunity to design new models of Critical thinking alogue among our colleagues in nursing care in a cost-effective man- Communication academia and service—a dialogue ner. It is unlikely that current cost in- Assessment that is critical to its successful im- frastructures could support the addi- Nursing technology and resource plementation. tional role set of the CNL as an management The CNL role creates an op- “add-on” position. Models will need Core Knowledge portunity for new care models and to be developed that completely Health promotion, risk reduction, care team configurations in every recreate the care team using the CNL and disease prevention delivery setting.

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