Clinical Nurse Leader (CNL)

The Clinical Nurse Leader (CNL) role is designed to deliver clinical leadership in all health care settings and to respond to individuals and families within a micro-system of care. As of August 2007, over 80 VA Medical Centers (VAMC) sites have requested to participate in the CNL Initiative. The CNL is expected to address and improve the following:

• Cost/financial outcomes such as length of stay, patient flow, readmission rate and registered nurse (RN) turnover
• Patient satisfaction, staff satisfaction and retention
• Quality/internal process outcomes such as medication management, patient safety, and prevention of nosocomial infections
• Practice Model Transformation such as evidence-based and collaborative, interdisciplinary practice

This initiative is targeted towards RNs with a Master’s Degree in Nursing who desire to stay in the direct care setting but practice in an advanced generalist role with a broad scope of practice and more complex level of responsibility for a specific patient care unit.

The Clinical Nurse Leader Spread Plan Initiative

In the summer of 2011, ONS set a strategic goal of implementing a CNL at all points of care throughout the VHA system by fiscal year 2016. The CNL spread plan was developed to achieve this strategic goal, comprised of a portfolio of multi-year activities spanning from fiscal year 2011 through 2016.

The CNL Spread Plan Objectives:

• Overcome barriers to implement and sustain the CNL role
• Employ and fully integrate the CNL role into the patient care model
• Objectively embed quality, safety, and efficiency, into patient care delivery
• Enhance collaborative partnerships with affiliating schools of nursing and inter-professional teams

Key Initiatives in the CNL Spread Plan

Systems Redesign Academy for the Improvement of Microsystems

A team of CNLs which represented VA New Jersey Health Care System for the first AIM learning session cohort in Alexandria, VA in September 2011

In collaboration with the Mid-West Mountain VA Engineering Resource Center (VERC), ONS has developed an Academy for the Improvement of Microsystems (AIM) to foster the development of the CNL role through an inter-professional approach, emphasizing systems redesign and flow improvement.

The focus of the AIM is collaborative learning sessions which all VAMCs will participate in throughout the implementation of the spread plan. The VERC have developed a curriculum which includes one face to face meeting and a subsequent virtual collaborative which will guide facilities in implementing and readying the environment for setting up CNL programs, as well as equipping participants in Lean yellow belt, analytics, systems redesign, change management, and leadership development training.

  

Analytics Cohort

ONS plans to coordinate one cohort of CNLs each year until fiscal year 2016 to undergo the Healthcare Analytics Certificate Program, held by the VA Nebraska-Western Iowa HCS and University of Nebraska–Lincoln. The goal of developing CNL analytics course cohorts is to emphasize teamwork and utilize analytics-driven decisions for value, quality, access, and satisfaction. The first cohort of CNLs to participate in the certificate program was launched on Feb 29th, 2012.

CNL Implementation & Evaluation Service

The CNL Implementation & Evaluation service provides one-on-one consultation and assistance to VA Medical Centers, academic affiliates offering a CNL curriculum, and individual CNL students and preceptors. Specific offerings include guidance on:

• Readying environments for CNL role implementation and sustainment
• Exploring transformation of organizational structures, roles, and culture to fully integrate and implement the CNL role
• Fostering clinical and academic partnerships
• Developing CNL preceptors and mentors for the CNL clinical immersion
• Guiding the development and future analysis of metrics, outcomes, expectations related to the impact of the CNL role

For more information, please see the CNL brochure (pdf)

CNL Transition to Practice Program

A six month transition-to-practice program is under development to enhance CNL knowledge, skills, and abilities in domains aligned with the CNL academic curriculum. This transition-to-practice program uses facilitation and mentoring by a facility-based preceptor, residency coordinator/director, and optional academic affiliate advisor or CNL mentor during the guided experience. The program will enhance CNL knowledge, skills and abilities in coordinating care, applying evidence-based practices, delivering care in professional nursing practice, improving processes, demonstrating transformational leadership and translating informatics and analytics data to practice.

Important Dates:

• May 2012: Pilot launch of the CNL transition to practice program
• Fall 2012: Formal launch of CNL transition to practice program

Resources