Why is AACN developing new role " Clinical Nurse Leader"????

[NRSKarenRN]

the clinical nurse leader

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the clinical nurse leader or cnl

is a new nursing role being developed by the american association of colleges of nursing (aacn) in collaboration with leaders from the education and practice arenas. aacn is advancing the cnl to improve the quality of patient care and to better prepare nurses to thrive in the health care system. the cnl role emerged following research and discussion with stakeholder groups as a way to engage highly skilled clinicians in outcomes-based practice and quality improvement.

in practice, the cnl oversees the care coordination of a distinct group of patients and actively provides direct patient care in complex situations. this master's degree-prepared clinician puts evidence-based practice into action to ensure that patients benefit from the latest innovations in care delivery. the cnl evaluates patient outcomes, assesses cohort risk, and has the decision-making authority to change care plans when necessary. the cnl is a leader in the health care delivery system, and the implementation of this role will vary across settings.

http://www.aacn.nche.edu/cnl/about.htm

gee, i thought this was the cns role in a hospital facility...why the need for another practioner.....i must be getting old.

[elkpark]

I have my own cynical "conspiracy theory" about the CNL "role," which I have arrived at from reading lots of other posts on this site.

We all know there are all these second-career people looking to switch to nursing, who already have a baccalaureate degree in something else. Well, they want to go back to school for nursing, and they want to be able to get federal financial aid/student loans to do it -- BUT, apparently, you can't get federal aid for a second baccalaureate degree, so they're all looking at direct-entry MSN programs, because they can get federal aid for those. Fortunately (the one bright spot in all of this mess for me ), a lot of these people don't want to start out as APNs, so -- ta-dah!! -- schools are now developing these new MSN programs to prepare basic bedside, entry-level RNs. BUT, since there's no rationale whatsoever to justify preparing bedside nurses at the Master's level to do the same things that ADN and BSN grads do, they've gussied the programs up with some extra stats, systems, research, etc., courses and dubbed them "CNL" programs. Problem solved ... :chuckle

In my heart of hearts :), I can't believe this is about anything but money. And, if there has been any great outcry from the clinical world for MSN-prepared nurses at the bedside, that has certainly escaped my notice ... I think (again, JMHO) the AACN needs to get back on its medication ... :icon_roll

[swampkitty421]

Ok, not trying to step on any toes here, but the AACN is developing the role to complement The CNS role. CNS=specialist. CNL= generalist... that's my take on it.

The other thing is the stinging hostility toward nurses trying to find a way into a field they see as promising or fulfilling. Unfortunately, unlike many of you, I NEVER knew I wanted to be a nurse until I worked with some at a children's hospital. The RNs i worked with were the cream of the crop! They inspired me to do SOMETHING with my life. that something is nursing. (I have a BA in sociology, btw...)

Also, please understand that these "new" roles (ASN, CNL, etc) are created to fill a need! How many times do you find your unit short-staffed?? Additionally, it's not a shortcut for many of us!!!!!! (I wish i could really emphasize that) I am insanely PAINED that I did not choose the traditional BSN route when I was in college the FIRST TIME for my BSN. I would love to see the hostility taken out of nursing and an embrasing that may invite more people into the field....

[ukstudent]

Also, please understand that these "new" roles (ASN, CNL, etc) are created to fill a need!

Please understand that the "need" you talk about is NOT coming from hospitals, or from working nurses. There is NO NEED for a CNL. The need you are talking about is the ability to obtain funding so that people can become nurses if they already have a BA, BS.

I have seen no anger directed at anyone becoming a CNL. I think most of us wish them well. The anger is directed at the universities that are cashing in on people's desire to become nurses, getting them to pay master level credits and not fully inform students of the limited possibilities of work after graduation. Are they being informed that as a new grad you will get the same pay rate as all other new grads?

[Asherah, BSN, RN]

Are they being informed that as a new grad you will get the same pay rate as all other new grads?

The DEMSN programs I checked into went into detail regarding the pay expectation and the fact that the DEMSN (generalist) prepared new grad would be recieving the same pay as other new grads. The did however talk about how easy it would be to get jobs (getting recruited prior to graduation at top teaching facilities in the area) and further education (post-master's education) if students went the DEMSN route, which of course is the school blowing sunshine up someone's you-know-what to get them to enroll there. (This was the mantra of UCLA and CSUF)

[merellis2009]

I can tell you that a recent CNL graduate, we experience tons of anger, resentment, and criticism from nurses such as many of you who don't see a need for the CNL role. One reason that many of you do not see a need for the role is because you do not have a complete understanding in the role and how it plays into providing optimal patient care. For those individuals, I refer you to the AACN website which contains the "CNL white papers", the official description of the role:

http://www.aacn.nche.edu/Publications/WhitePapers/ClinicalNurseLeader.htm

For those of you who recognize that you don't have a 100% understanding of the role, you are not alone. There is much confusion regarding the role and unfortunately the "Nurses Eat Their Young" also applies here in addition to the fact that many people do not like change whether it's good or bad. I just ask that you try and not listen to those who lack an understanding as well. Look to the AACN and ask those who are CNL's, are teaching at a school in the CNL program, or are recent graduates of the CNL programs.

Someone earlier was referring to the CNL role stating that it isn't needed because it's just something else to add to the fragmentation of healthcare. Breaking down the fragmentation of healthcare is what the heart of the CNL is all about! Have you ever worked on a hospital floor where there's all kinds of disciplines involved in a particular patients care and it seems like NONE of them are communicating?! The cardiologist is doing this and that, and the nephrologist is doing something else, and the dietician is trying to educate about the new onset Diabetes, and the respiratory therapists are doing their thing, and you as the nurse (in addition to the patients who are at the core of it all) think that NONE of these disciplines are communicating?! Each group is doing its own thing and who knows WHAT the patient thinks about how to take care of themself upon discharge?!

Enter the CNL.... First of all he/she evaluates current practice on the floor to ensure that hospital policy and current practice on the floor is in alignment of what is found to be BEST for the patient based on evidence based practice (not just because Dr. Smith "has always done it this way so we just keep on doing it that way). Next, the CNL evaluates the care of the patient using his/her critical thinking to ensure optimal patient outcomes. The CNL is the gatekeeper of the interdisciplinary team and meets with all interdisciplinary team members regularly to ensure that patients are 1) improving 2) all disciplines are communicating 3) The LOS is as short or as long as it needs to be and 4) the floor or unit's data is then compared to local/state/national benchmarks in addition to ensuring that customer service scores are where they need to be. In addition to doing all those things, the CNL ensures that core measures are met, and spends other time reviewing the latest research and practice in an effort to see if there are things that his/her unit/floor could do better.

The Staff RN does not have time to do this.

The charge RN does not have time to do this.

The case manager does not have time to do this.

The MD certainly does not have time to do this.

Who WOULDNT want a smooth environment where everyone is on the same page for the patients care?!

If you're cynical (and that's ok if you are) then look at the research itself and what it says about the CNL. Customer satisfaction scores improve and Staff morale/satisfaction improves with the use of a CNL. If you don't believe me, look it up! :)

We have 2 CNL's at my hospital. The one that works closest to me is amazing. She oversees care for 38 patients and does a tremendous job. Patient satisfaction scores are higher than they've ever been, and the RN's truly love their jobs there. Morale is great. Patients are receiving the BEST care possible, and it's all based in evidence. I am so proud to work in an environment like this where all the RN's truly support the CNL and the CNL vision.

Sorry this is so long, but I just ask that if you don't know about the role and already have a negative attitude about it, please don't talk about what you don't know for a fact. If you have questions, ASK someone who does know. Spreading negativity regarding a new role that could improve outcomes for patients is NOT what the nursing profession needs today. Nurses need to support one another and STOP eating their young (and rejecting change --because not all change is bad!)

And before I forget:

1. No I didnt get my MSN/CNL degree because of financial aid. I could've gotten another Bachelors degree but I would have been crazy to pass up this kind of oppportunity! I didn't want to just get another Bachelors. I wanted to move up to the next level. Maybe that's not for everyone-but that's just how I operate-always moving forward.

2. No the CNL is not in any way, shape, or form trying to get rid of the CNS. Actually, the CNS and CNL roles complement each other very well as the CNS is a specialist and the CNL is a generalist. In practice it's a very nice mix.

3. At most places you DO get paid a little more (not as much as advanced practice but it is a little more)

[Altra, BSN, RN]

You said it was "OK" to be cynical so I'll go ahead ...

Enter the CNL.... First of all he/she evaluates current practice on the floor to ensure that hospital policy and current practice on the floor is in alignment of what is found to be BEST for the patient based on evidence based practice (not just because Dr. Smith "has always done it this way so we just keep on doing it that way).

Are you saying that you believe that hospitals will employ CNLs to dictate best clinical practice to MDs who bring business to the hospital? And MDs will change orders for individual patients if a CNL points out that the orders are not in line with best clinical practice according to ... whom, exactly?

Next, the CNL evaluates the care of the patient using his/her critical thinking to ensure optimal patient outcomes. The CNL is the gatekeeper of the interdisciplinary team and meets with all interdisciplinary team members regularly to ensure that patients are 1) improving 2) all disciplines are communicating

In this theoretical hospital there are interdisciplinary team meetings on all patients? In practice, the vast majority of communication between disciplines during a typical inpatient LOS of

3) The LOS is as short or as long as it needs to be

The LOS is as long or as short as the insurance company will pay for. Period. Trust me on this one.

What you're proposing here is impractical for most garden-variety adult admissions that comprise the bread & butter of hospital business. Case managers and coordinators sometimes have responsibilities such as you describe in some specialized services with patient populations which have a longer length of stay, i.e. trauma, burn, oncology and specialized disease care.

4) the floor or unit's data is then compared to local/state/national benchmarks in addition to ensuring that customer service scores are where they need to be.

In addition to doing all those things, the CNL ensures that core measures are met, and spends other time reviewing the latest research and practice in an effort to see if there are things that his/her unit/floor could do better.

The Staff RN does not have time to do this.

The charge RN does not have time to do this.

The case manager does not have time to do this.

The MD certainly does not have time to do this.

Who WOULDNT want a smooth environment where everyone is on the same page for the patients care?!

The second half of your post proposes that CNL responsibilities include functions of nursing education, risk management, nursing administration and facility administration. I'm not saying it's impossible, but don't expect non-clinical administrators to willingly give up turf to nurses.

AACN can "develop new roles" for nurses and academic institutions can develop new degree programs. That in no way shape or form guarantees that there will be any meaningful impact on the day-to-day running of the hospital business.

[herring_RN, ASN, BSN]

I am glad this was posted.

At first I was afraid there was something new I had missed that the American Association of Critical Care Nurses, also AACN, was working on.

I'll have to learn more. With the emphasis on budget I admit to being sceptical too.

One concern is the need for direct care experience in our leaders.

If you've read Patricia Benners "From Novice to Expert" or have provided direct care for several years you understand what I mean.

Also related to the budget is the loss of too many clinical nurse specialists.

And will they teuly be allowed to use critical thinking skills? T learn from the direct care nurses who assess and observe the patient?

Or will they be limited to an algorithm?

Lots of things for me to find out before having sufficient data to formulate an opinion.

[MIA-RN]

Not all CNL programs are direct entry...

The one I am looking into requires three years clinical experience as an RN before entering the program.

[imenid37]

To be a leader... you need some experience. I am okay w/ someone who has experience getting an advanced degree and assuming this role. Otherwise, it doesn't mean a lot. I hate to say it I also agree, just a way created for universities to get $ for second degree students. It is great that you can direct care and look at how congruent policy and practice are, but really can you do it effectively w/o experience? What do peers think or are they w/ years of experience subordinates to this leader??? Maybe it is a poor choice of titles for the direct entry practitioner??? Maybe w/ the nursing shortage, the govt. needs to pay for BSN's for folks who already have BS degrees. We need more nurses at the bedside to care for patients, not more nurses in lab coats w/ clipboards. I say this w/ my bad knees, after 21 years, and yes I am in school for an MSN in nursing education. We need to educate nurses at the entry level to do what nurses do, provide quality direct patient care. Then, let them gain expertise and move into other roles, if they choose. If they stay at the bedside, reward them heartily. They (not academics or those who spend their days sitting in an office)are truly the gems of our profession who lend their expertise and support to "bring up" the coming generations of nurses. I, obviously, value education. I also greatly value experience and plan to spend time regularly at the bedside to keep myself currrent with skills and practice AND so I still know what it feels like to be a bedside caregiver. Education is great, it augments but doesn't replace expertise gained through time and experience.

[RNperdiem, RN]

Interesting development in nursing. I will watch to see what happens.

Most of the real leadership in most units I have been in comes from a small core of hardworking senior nurses. If they aren't in charge, they are precepting, taking the most complex assignments(so new grads and floats can take lighter assignments), and being a resource to everyone there.

These mentors have earned their (often unoffficial) status, and have the skills and "street cred" to back it up.

I think that we already have unofficial CNL's.

Senior nurses, I salute you.

[herring_RN, ASN, BSN]

imenid37

With you experience and commitment to bedside nursing you will be an awesome professor.

[llg, PhD, RN]

Education is great, it augments but doesn't replace expertise gained through time and experience.

Yep. Some students enter CNL (and other) programs thinking they are going to leapfrog over the typical entry-level jobs and move right into leadership positions with no practical experience as a working nurse. For those students, there will be many frustrations and disappointments ahead.

To be a leader ... the staff has to be willing to follow you ... and few experienced staff nurses are going to follow a self-proclaimed leader who has little idea of what it is actually like at the bedside.

It's sad that our profession is doing this to itself. By creating all these new role, titles, and degrees, we are creating a confusing mess that will need to be sorted out eventually. That sorting out will be messy.