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Innovative Partnerships: the Clinical Nurse Leader Role in Diverse Clinical Settings

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Innovative Partnerships: the Clinical Nurse Leader Role in Diverse Clinical Settings ORIGINAL ARTICLES INNOVATIVE PARTNERSHIPS: THE CLINICAL NURSE LEADER ROLE IN DIVERSE CLINICAL SETTINGS CAROL ANN BARNETT LAMMON, PHD, RN, CNL,* MARIETTA P. STANTON, PHD, RN, C, CNAA, BC, CMAC, CCM, CNL,† AND JOHN L. BLAKNEY, RN, MSN‡ The American Association of Colleges of Nursing in collaboration with leaders in the health care arena has developed a new role in nursing, the clinical nurse leader (CNL). The CNL is a master's-prepared advanced nurse generalist, accountable for providing high-quality, cost- effective care for a cohort of patients in a specific microsystem. Although initial implementation of the CNL has been predominantly in urban acute care settings, the skill set of the CNL role is equally applicable to diverse clinical settings, such as smaller rural hospitals, home-based home care providers, long-term care facilities, schools, Veteran's Administration facilities, and public health settings. This article reports the strategies used and the progress made at The University of Alabama Capstone College of Nursing in the development of innovative partnerships to develop the role of the CNL in diverse clinical settings. With academia and practice working in partnership, the goal of transforming health care and improving patient outcomes can be achieved. (Index words: Clinical nurse leader; Settings; Partnerships) J Prof Nurs 26:258–263, 2010. © 2010 Elsevier Inc. All rights reserved. VER THE LAST decade, a series of reports by the complicated by chronic illnesses, and health disparities are O Institute of Medicine (2000, 2001, 2004), The Joint all too common. Responding to the call for change and the Commission (2002),theAmerican Hospital Association need to positively impact these issues, the American (2002), and the Robert Wood Johnson Foundation (2002) Association of Colleges of Nursing (AACN) in collabora- have described a health care system in crisis. The nursing tion with leaders in the health care arena developed a new shortage looms, medical errors are unacceptably high, role in nursing, the clinical nurse leader (CNL). implementation of evidence-based practice to achieve the The CNL is a master's-prepared nurse generalist, best outcomes lags years behind research, health care accountable for providing high-quality, cost-effective care waste and costs soar, delivery of care is fragmented, patient for a cohort of patients in a clinical microsystem. A clinical and family satisfaction is low, people are living longer lives microsystem is the place where patients and families and care teams meet (Nelson, Batalden, & Godfrey, 2007). A microsystem, although often interpreted as a hospital unit *Associate Professor and CNL Curriculum Coordinator, Capstone housing 15–20 patients, may also include any primary, College of Nursing, The University of Alabama, Tuscaloosa, AL. †Professor and Assistant Dean of the Graduate Program, Capstone secondary, or tertiary setting where care is delivered. Thus, College of Nursing, The University of Alabama, Tuscaloosa, AL. the CNL can function as a leader across all health care ‡Instructor and Faculty Mentoring Coordinator, Capstone College of settings; however, the implementation of the CNL role may Nursing, The University of Alabama, Tuscaloosa, AL. vary across settings (AACN, 2007). The CNL relies on Address correspondence to Dr. Stanton: Professor and Assistant Dean skills in patient care and requires in-depth knowledge in of the Graduate Program, Capstone College of Nursing, The University of Alabama, Tuscaloosa, Alabama, Box 870358, Tuscaloosa, Alabama quality management, nursing leadership, evidence-based 35487-0358. E-mail: [email protected] practice, risk appraisal, and outcomes analysis. This 8755-7223/10/$ - see front matter advanced nurse generalist coordinates care of a distinct 258 Journal of Professional Nursing, Vol 26, No. 5 (September/October), 2010: pp 258–263 doi:10.1016/j.profnurs.2010.06.004 © 2010 Elsevier Inc. All rights reserved. CNL IN DIVERSE CLINICAL SETTINGS 259 group of patients and has decision-making authority to placing high value on the lateral integrator role component. change care plans when necessary. The CNL is a resource All of the agencies believed that the CNL would enhance for clinical decision making and serves as lateral integrator quality patient care by supplying evidence to promote best of care. As an active member of the interdisciplinary health practices and would bring the needed skills for the care team, the CNL designs and directs cost-effective and development and evaluation of evidence-based care proto- evidence-based care within a microsystem. The CNL is cols. In many diverse care settings, health disparities are all accountable for clinical outcomes as well as influencing too common. The agencies valued the CNL educational work environments (AACN, 2007). focus of human diversity and cultural competence that the To date, implementation of the CNL role has been CNL could bring to the design of evidence-based health predominantly in urban acute care settings; however, care practices and protocols. All the agencies embraced the the skill set of the CNL is equally applicable to diverse CNL as a person that would be accountable for the clinical settings. Smaller rural hospitals, home-based outcomes and clinical indicators appropriate for the setting. home care providers, long-term care facilities, schools, The ability to use and manipulate databases for outcomes Veteran's Administration facilities, and public health assessment was viewed as a valuable skill the CNL would settings all can benefit from the impact of the CNL on bring to the clinical agency. evidence-based, cost-effective, and outcomes-focused Lay the Groundwork for the CNL Program health care. This article reports the strategies used and the progress made at The University of Alabama Starting a CNL program in a school of nursing requires Capstone College of Nursing (CCN) in the development clinical partners, an understanding of the contribution of of innovative partnerships and the successful integra- the academic and clinical partner to the CNL program, tion of the CNL role across diverse clinical settings. curriculum development, funding, and students. Initially, four clinical agencies in our area committed to partnering Introduce the CNL Role to Potential with the CCN to develop a program to educate CNLs: Clinical Partners • DCH Regional Medical Center, a regional acute care The CNL role is the first new role in nursing since the facility serving 11 predominantly rural counties in development of the Clinical Nurse Specialist. Our initial West Alabama. We later added the smaller rural response to the CNL role as described in the Working hospitals in the DCH Health System. White Paper on the Role of the Clinical Nurse Leader • Alacare Home Health and Hospice, providing home- (American Association of Colleges of Nursing, 2003) was care services statewide. to approach our local regional medical center to • Tuscaloosa Veteran's Administration Hospital, pro- determine the level of interest in partnering to educate viding primary, long-term, and mental health care and employ CNLs. A meeting was held to discuss the services for veterans. CNL role and this new educational opportunity. Repre- • Alabama Department of Public Health, providing sentatives from a variety of local community health care public health services statewide. agencies were invited to attend. As the CNL role was presented, many of the community agencies expressed A Memorandum of Agreement for the CNL partner- interest in the CNL role, citing potential benefits to their ship, delineating the responsibilities of each partner, was agency and the clients they serve. negotiated and signed by the Dean of the academic The CNL role components that are of particular interest partner and the Chief Nursing Officer of each clinical to these diverse clinical groups included development of a partner. This was an effective strategy in delineating the point of care provider that could provide clinical leader- basics of the partnership and later proved to be useful ship, care coordination within and across health care when we expanded our partnerships beyond the original settings, outcomes management, and staff education and four clinical partners. mentorship. Although it was envisioned that implementa- The CNL role was integrated into the existing Master tion of the CNL role would vary across these diverse clinical of Science in Nursing (MSN) program at the CCN in June settings, all potential partners agreed that several of the core 2006. Nursing faculty, along with contributions from competencies of the CNL were standard across all agencies: adjunct faculty from the partnering clinical agencies, promotion of patient-centered care, promotion of effective made revisions in courses for the CNL track in the interdisciplinary teamwork, employment of evidence- existing MSN program. The CNL program was supported based practice, application of quality improvement, and in part by a 3-year grant from the Health Resources and increased utilization of informatics. All of the diverse Services Administration (HRSA)1, which provided funds clinical agencies viewed the role of the CNL to be one of to support personnel and materials necessary for program leading and managing the staff to promote patient-centered care rather than provider of care to a caseload or patient 1 This project was supported in part by funds from the Division of assignment. All agencies employ a variety of health care Nursing (DN), Bureau of Health Professions (BHPr), HRSA, Depart- providers and viewed the CNL as an integral part of the ment of Health and Human Services (DHHS) under Grant DO9HP07455 and title VIII for $978,000. The information or content multidisciplinary health care team, working to improve the and conclusions are those of the authors and should not be construed quality and coordination of care. In fact, most agencies as the official position or policy of, nor should be any endorsements be viewed the CNL as the hub of the multidisciplinary team, inferred by the DN, BHPr, HRSA, DHHS, or the U.S. government. 260 LAMMON ET AL expansion. Students were recruited from each of the four annual CNL summits.
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