Clinical Nurse Leader Role Research Articles

Retooling a Clinical Nurse Leader Curriculum in Response to the Nursing Faculty Shortage.

Our school had increased full-time and adjunct faculty vacancies. To deal with this crisis, we recruited our clinical nurse leader (CNL) graduates. Many reported not feeling prepared to teach. This article describes changes made in a CNL curriculum to better prepare graduates for positions in academic nursing education. While the CNL skill set was created for care of patient populations, it is also transferable to nursing education. Previously, our curriculum used only clinical experiences to teach aspects of CNL practice. We added academic educational experiences and content into our curriculum as another means of teaching the skill set. The size of our CNL program doubled. Students reported gaining confidence about the CNL role in both clinical and academic settings. This curricular change allows CNL students to "try on" the role of nurse educator. This exposure may increase their desire to pursue a career in academia. [J Nurs Educ. 2024;63(X):XXX-XXX.].

Master's Prepared Clinical Nurse Leaders: 2 to 10 Years Post-Graduation.

Because the Clinical Nurse Leader (CNL) role is relatively new, little is known about the success of CNL graduates. Our aim was to describe the career path of CNL graduates and to measure satisfaction 2 to 10 years after graduation. A cross-sectional survey design was used to assess career trajectory and self-reported satisfaction with work, life, and educational preparation in a sample of 109 CNL graduates from one university. Online data collection was used, resulting in participants from across the United States. Respondents were primarily Direct Entry CNL graduates. The majority (95%) were still working full- or part-time in nursing. Most (over 90%) were satisfied or extremely satisfied with their decision to become a nurse. Life satisfaction was high: the Satisfaction with Life Scale mean score was 24.9 (SD = 5.67). These results help describe CNL career trajectories and provide useful suggestions for education and practice. This information can help build the business case for the CNL.

Providing Quality Nursing Education: The Clinical Nurse Leader's Role.

Providing Quality Nursing Education: The Clinical Nurse Leader's Role.

Implementation of the Clinical Nurse Leader Role in the Veterans Health Administration.

The Veterans Health Administration (VHA) led implementation of the Clinical Nurse Leader (CNL) role nationally with the goal to meet system needs for strong clinical leadership across all settings. After a decade of CNL role implementation, the VHA supported this evaluation to determine the current state, the successes, the challenges, and the fidelity to the original intent of the role. The team used mixed methods to evaluate the state of the CNL initiative. Ten evaluation activities were undertaken including a facility survey directed toward chief nurse executives at all VHA facilities, and a second survey directed at registered nurses who completed a CNL graduate program, were certified as a CNL, or were currently enrolled in a CNL graduate program. The evaluation results suggest the CNL initiative had not yet accomplished the stated goals to improve cost and financial outcomes, increase patient satisfaction, increase staff satisfaction and retention, improve quality and internal processes, and facilitate practice model transformation including evidence-based practice and collaborative, interdisciplinary practice across the system. Observed CNL practices within the VHA could serve as exemplars for developing a care delivery model that could achieve these goals and offer potential paths to move this role forward.

Implementing Clinical Practice Guidelines for Replacing Peripheral Intravenous Catheters.

A community hospital policy of routinely replacing peripheral intravenous catheters (PIVCs) needed updating to the clinical practice guideline (CPG) of clinically indicated replacement. Guided by Lean principles, a clinical nurse leader (CNL) led a quality improvement small test of change on a 38-bed medical unit. The impact of the CPG was evaluated using quality, safety, and workflow measures. Nurses managed 469 inpatients, receiving 1033 PIVCs. Routine PIVC replacement declined from 34% to 3% (P < .001). PIVC dwell time ranged from 4 to 20 days and did not increase phlebitis (P = .41) or catheter-related bloodstream infections. Nurses attributed the improvements in workflow (P = .01) and the quality of patient care (94%) to the updated PIVC guideline. Clinically-indicated PIVC replacement reduced unnecessary catheter insertions, maintained patient safety, improved efficiency, and is being implemented hospital-wide. This project highlights and advances the CNL role in transforming healthcare.

Clarifying Role Expectations and Practice Standards Using a Clinical Nurse Leader Professional Practice Model Illustration.

Despite evidence of the positive impact of the clinical nurse leader (CNL) role, implementation of supplemental nursing roles has proven to be challenging due to unclear role explanations and organizational unfamiliarity. Nurses practice in a dynamic environment and need to cope with the rapid pace of change in practice roles. Outside of the preparation of the CNL, many nursing professionals are not educated or prepared on the essential aspects the CNL role. A graphic illustration was developed to facilitate discussion and provide insight into the CNL role, with the aim of creating consensus on the CNL role functions and expectations. Following the implementation of the CNL practice model illustration, participants reported a significant improvement in their understanding and importance of the CNL role. Professional practice model illustrations may be beneficial in developing a consensus of practice.

Clinical Nurse Leader: Evolution of the Role in Oncology Care.

The clinical nurse leader (CNL) role has evolved since the American Association of Colleges of Nursing published a white paper on the role in 2007. Since then, various publications have evaluated the role of CNLs in enhancing quality outcomes for patients. The introduction of the CNL role in the oncology setting, although occurring with variability across the United States, provides a unique opportunity to explore the benefits of this role in cancer care outcomes.

Applying the PDSA Framework to Examine the Use of the Clinical Nurse Leader to Evaluate Pressure Ulcer Reporting

The clinical nurse leader (CNL) role has been cited as an effective strategy for improving care at the microsystem level. The purpose of this article is to describe the use of the CNL role in an academic medical center for evaluating pressure ulcer reporting. The Plan-Do-Study-Act cycle was used as the methodological framework for the study. The CNL assessment of pressure ulcers resulted in a 21% to 50% decrease in the number of hospital-acquired pressure ulcers reported in a 3-month time period. The CNL role has potential for improving the validity and reliability of pressure ulcer reporting.

Implementing the Clinical Nurse Leader Role in a Large Hospital Network

In 2011, the Institute of Medicine (IOM) provided statistics regarding the future of health care based on legislative changes during 2010. According to the IOM's report, 1 an additional 32 million Americans would receive health care benefits by 2012. Additionally, it is estimated that by the year 2025, health care will face a shortage of more than 350,000 nurses. 2,3 The influx of new lives in America requiring medical care and the estimated lack of resources provide multiple challenges for hospitals, including organizing new models of care at the bedside to improve care coordination and to enhance interprofessional collaboration. 4,5

A Clinical Nurse Leader (CNL) practice development model to support integration of the CNL role into microsystem care delivery.

The Veterans Health Administration (VHA) Office of Nursing Services (ONS) was an early adopter of Clinical Nurse Leader (CNL) practice, generating some of the earliest pilot data of CNL practice effectiveness. In 2011 the VHA ONS CNL Implementation & Evaluation Service (CNL I&E) piloted a curriculum to facilitate CNL transition to effective practice at local VHA settings. In 2015, the CNL I&E and local VHA setting stakeholders collaborated to refine the program, based on lessons learned at the national and local level. The workgroup reviewed the literature to identify theoretical frameworks for CNL practice and practice development. The workgroup selected Benner et al.'s Novice-to-Expert model as the defining framework for CNL practice development, and Bender et al.'s CNL Practice Model as the defining framework for CNL practice integration. The selected frameworks were cross-walked against existing curriculum elements to identify and clarify additional practice development needs. The work generated key insights into: core stages of transition to effective practice; CNL progress and expectations for each stage; and organizational support structures necessary for CNL success at each stage. The refined CNL development model is a robust tool that can be applied to support consistent and effective integration of CNL practice into care delivery.

The Certified Clinical Nurse Leader in Critical Care.

Challenges of the current health system in the United States call for collaboration of health care professionals, careful utilization of resources, and greater efficiency of system processes. Innovations to the delivery of care include the introduction of the clinical nurse leader role to provide leadership at the point of care, where it is needed most. Clinical nurse leaders have demonstrated their ability to address needed changes and implement improvements in processes that impact the efficiency and quality of patient care across the continuum and in a variety of settings, including critical care. This article describes the role of the certified clinical nurse leader, their education and skill set, and outlines outcomes that have been realized by their efforts. Specific examples of how clinical nurse leaders impact critical care nursing are discussed.

Variations in Clinical Nurse Leaders confidence with performing the core role functions

Background Clinical nurse leader (CNL) practice, by definition, requires individuals to make career transitions. CNLs must adjust to their new work role and responsibilities and doing so also entails individual adjustment. Prior work has not examined the role of individual-level factors in effective CNL role transition. This study contributes to CNL implementation efforts by developing understanding of personal and contextual factors that explain variation in individuals' levels of self-confidence with performing the key functions of the CNL role. Data were gathered using a cross-sectional survey from a national sample of registered nurses (RNs) certified as CNLs. Respondents' perceptions of their confidence in performing CNL role competencies were measured with the Clinical Nurse Leader Self-Efficacy Scale (CNLSES; Gilmartin MJ, Nokes, K. (in press). The Clinical Nurse Leader Self Efficacy Scale: Results of a pilot study. Nursing Economic$ ). The CNLSES is a 35-item state-specific self-efficacy scale with established measurement properties that assesses nurses' perceptions of their ability to function effectively as a CNL. Demographic data were also collected. Data were analyzed using a general linear regression model. One hundred forty-seven certified CNLs participated in the survey. Results indicate that respondents vary in their confidence with performing the nine role competencies associated with CNL practice. Results from regression analyses also show that respondents' confidence in their abilities to carry out the core functions associated with the CNL role varied significantly across geographic region, organizational type, and by CNL graduate program model. The results of this study show important differences in CNLs' levels of self-confidence with the core competencies of their role. As a result, it may be important to develop targeted career transition interventions to gain the full benefit of CNL practice.

Promoting a Strategic Approach to Clinical Nurse Leader Practice Integration.

The Office of Nursing Services of the Department of Veterans Affairs (VA) piloted implementation of the clinical nurse leader (CNL) into the care delivery model and established a strategic goal in 2011 to implement the CNL role across the VA health care system. The VA Office of Nursing Services CNL Implementation and Evaluation (CNL I&E) Service was created as one mechanism to facilitate that goal in response to a need identified by facility nurse executives for consultative support for CNL practice integration. This article discusses strategies employed by the CNL I&E consultative team to help facility-level nursing leadership integrate CNLs into practice. Measures of success include steady growth in CNL practice capacity as well as positive feedback from nurse executives about the value of consultative engagement. Future steps to better integrate CNL practice into the VA include consolidation of lessons learned, collaboration to strengthen the evidence base for CNL practice, and further exploration of the transformational potential of CNL practice across the care continuum.

Implementing the Clinical Nurse Leader Role: A Care Model Centered on Innovation, Efficiency, and Excellence

Nurses must become full partners with other healthcare disciplines to become involved and take responsibility for identifying system problems. Nurses devise and implement improvement plans, track improvements over time, and make necessary adjustments as leaders who implement change and help improve the healthcare system. 1 Institute of Medicine The Future of Nursing: Leading Change, Advancing Health. National Academies Press, Washington, DC2011 Google Scholar We are facing the dilemma of fragmented healthcare that can only be improved through “new innovative care delivery models…that address patient needs and wants, span sites of care, result in more efficient use of resources, and demonstrate measurable improvement in patient satisfaction and quality outcomes over time.” 2 Kimball B Joynt J Cherner D O'Neil E The quest for new innovative care delivery models. J Nurs Adm. 2007; 37: 392-398 Crossref PubMed Scopus (37) Google Scholar With the implementation of the clinical nurse leader (CNL) role, the innovation unit as developed at Rush Oak Park Hospital (ROPH) addresses current healthcare system concerns, such as the creation of more effective interdisciplinary care, point-of-care coordination, and the implementation of evidence-based practice findings. 3 Buerhaus P Ulrich B Donelan K DesRoches C Registered nurses' perspectives on health care and the 2008 presidential election. Nurs Econ. 2008; 26: 227-235 PubMed Google Scholar Nurses must become full partners with other healthcare disciplines to become involved and take responsibility for identifying system problems. Nurses devise and implement improvement plans, track improvements over time, and make necessary adjustments as leaders who implement change and help improve the healthcare system. 1 Institute of Medicine The Future of Nursing: Leading Change, Advancing Health. National Academies Press, Washington, DC2011 Google Scholar We are facing the dilemma of fragmented healthcare that can only be improved through “new innovative care delivery models…that address patient needs and wants, span sites of care, result in more efficient use of resources, and demonstrate measurable improvement in patient satisfaction and quality outcomes over time.” 2 Kimball B Joynt J Cherner D O'Neil E The quest for new innovative care delivery models. J Nurs Adm. 2007; 37: 392-398 Crossref PubMed Scopus (37) Google Scholar With the implementation of the clinical nurse leader (CNL) role, the innovation unit as developed at Rush Oak Park Hospital (ROPH) addresses current healthcare system concerns, such as the creation of more effective interdisciplinary care, point-of-care coordination, and the implementation of evidence-based practice findings. 3 Buerhaus P Ulrich B Donelan K DesRoches C Registered nurses' perspectives on health care and the 2008 presidential election. Nurs Econ. 2008; 26: 227-235 PubMed Google Scholar

Are personality characteristics of Clinical Nurse Leader graduate nursing students related to culturally competent nursing care?

Health policies increasingly address the need to eliminate disparities in healthcare and it is imperative that nurses identify how they contribute to achievement of that goal. The purpose of this descriptive, cross-sectional research was to identify if there is relationship between a core personality trait, core self-evaluations, and confidence in the ability of beginning graduate nursing students (N = 71) in a Clinical Nurse Leader (CNL) track to deliver culturally competent nursing care. A partial correlation, controlling for age, pre-licensure nursing education program, race, and satisfaction with current nursing position, found that core self-evaluations were significantly related to the three subscales on the transcultural self-efficacy scale, specifically: cognitive ( r = .417, p = .001); affective ( r = .479, p = .000); and practical ( r = .521, p = .000) self-efficacy. The relatively low core self-evaluations for this group of nurses in the early phases of graduate education for the CNL role compared to other samples is less than desirable for persons who are embracing a new nursing role that requires leadership skills to inspire followers. Although core self-evaluations are a relatively stable personality characteristic, educational programs could incorporate strategies to improve core self-evaluations in order to assist professionals to appraise their workplace challenges in a more positive framework.

Joan Shinkus Clark, DNP, RN, NEA-BC, CENP, FACHE, FAAN

Dr. Joan Shinkus Clark is the senior vice president and system chief nursing officer for Texas Health Resources (THR) headquartered in Arlington, Texas. Dr. Clark joined the THR leadership team in 2008, assuming overall responsibility for the nursing enterprise across the THR system. THR has 25 acute care and short-stay hospitals that are owned, operated, joint-ventured, or affiliated with the system, representing more than 3,800 licensed beds. THR has more than 21,100 employees at fully owned and operated facilities plus 1,400 employees of consolidated joint ventures and more than 5,500 physicians with active staff privileges. In her system role, Dr. Clark has responsibility for advancing strategic nursing initiatives and represents nursing at the senior executive level. Dr. Clark has also been a member of AONE for 25 years and has served AONE and chapter affiliates in Texas, Florida, and Georgia on numerous committees and in multiple elected positions, including 2 terms: 1 as Region 4 and as Region 7 AONE board director.

Healthcare Reform—A New Role for Changing Times: Embracing the Clinical Nurse Leader Role—A Strategic Partnership to Drive Outcomes

Healthcare Reform—A New Role for Changing Times: Embracing the Clinical Nurse Leader Role—A Strategic Partnership to Drive Outcomes

The Clinical Nurse Leader in the Perioperative Setting: A Preceptor Experience

The US Veterans Administration (VA) has implemented the clinical nurse leader (CNL) role nationwide. Nursing leaders at the Malcolm Randall VA Medical Center in Gainesville, Florida, implemented the development of the CNL role in the perioperative setting during the summer of 2012. The perioperative department developed the position in partnership with the University of Florida College of Nursing, Gainesville, Florida. The team developed a description of the roles and experiences of the preceptors, the clinical nurse leader resident, and the University of Florida faculty member. The clinical nurse leader resident's successes and the positive outcomes, such as improved patient outcomes, experienced by the perioperative department demonstrated the importance of the CNL role.

The Current Evidence Base for the Clinical Nurse Leader: A Narrative Review of the Literature

The clinical nurse leader (CNL) is a relatively new nursing role, introduced in 2003 through the American Association of Colleges of Nursing (AACN). A narrative review of the extant CNL literature was conducted with the aim of comprehensively summarizing the broad and methodologically diverse CNL evidence base. The review included 25 implementation reports, 1 CNL job analysis, 7 qualitative and/or survey studies, and 3 quantitative studies. All CNL implementation reports and studies described improved care quality outcomes after introduction of the role into a care delivery microsystem. Despite preliminary evidence supporting the CNL as an innovative new nursing role capable of consistently improving care quality wherever it is implemented, CNLs are still struggling to define the role to themselves and to the health care spectrum at large. Although the AACN CNL White Paper provides a concise model for CNL educational curriculum and end competencies, there is a compelling need for further research to substantively delineate the CNL role in practice, define care delivery structures and processes that influence CNL integration, and develop indicators capable of capturing CNL-specific contributions to improved care quality.

Driving Change from the Middle: An Exploration of the Complementary Roles and Leadership Behaviors of Clinical Nurse Leaders and Engineers in Healthcare Process Improvement

:The healthcare system presents challenges and opportunities for those looking to drive process improvement. Engineering managers can improve the probability of successfully implementing initiatives by partnering with a clinical nurse leader (CNL), since a key CNL role is designing and implementing changes to improve patient outcomes. Similar to project managers and engineers, CNLs drive change from the middle of the organization by successfully balancing the needs of upper management with frontline demands. Case studies of change efforts in healthcare are used to illustrate behaviors required of successful middle leaders to both lead and serve as “courageous followers” when improving healthcare outcomes.