Office of Nursing Services (ONS)
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 December 2013, over 70 VA Medical Center (VAMC) sites are participating 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
The Clinical Nurse Leader role was developed by the American Association of Colleges of Nursing (AACN) through collaboration between academic and practice leaders in response to quality and safety issues identified by The Institute of Medicine (IOM) reports in 2000. The role is designed to address gaps in care delivery related to the growing complexity and fragmentation of healthcare. The Clinical Nurse Leader helps nurses practice more effectively and efficiently.
Frequently Asked Questions about the CNL Role
What is a Clinical Nurse Leader (CNL)? Show content
- Master’s prepared generalist nurse from a Commission on Collegiate Nursing Education (CCNE) accredited CNL program of study
- Certified as a CNL by the Commission on Nurse Certification (CNC)
- Point of care clinical leader focused on the delivery of quality, safe, efficient, veteran-centered care
- Prepared to practice in any clinical area
What is the focus of the CNL role? Show content
- Point of care
- Patient outcomes in assigned microsystem
- Safety, effectiveness, timeliness, efficiency, quality, and the degree to which we are veteran centered
- Variations in clinical outcomes
- Critical evaluation and mitigation of risk
- Patterns of need and tailoring of interventions
How does the CNL role add value? Show content
- Role is incorporated into the care delivery model
- Role imbeds advanced skillset in the microsystem at the point of care
- Role assesses and addresses issues in real time and within context of microsystem reality
- Role observes and evaluates patterns impacting practice and outcomes
- Role partners with nurse manager
- Role supports direct care staff directly
- Role influences point of care and organizational culture
How do CNLs influence care for veterans? Show content
- Facilitate evidence-based practice as a way of practice
- Embed quality and safety as everyday functions
- Promote practice and practice change driven by outcomes
- Foster inter-professional team environments
- Partner to create learning and problem solving communities
How is the CNL role different from other nursing roles? Show content
- Generalist rather than specialist
- Clinical leadership rather than administrative leadership
- Point of care role rather than macro focused role
- The CNL works collaboratively with macrosystem focused roles such as nurse educator and nurse case manager. Collaborations serve to develop microsystem priorities that reflect macrosystem strategic initiatives designed to improve care and services for veterans.
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
Academy for the Improvement of Microsystems Show content
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 Midwest Mountain Veterans 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.
Each AIM cohort provides opportunity for microsystem teams from multiple VA facilities to learn and work together in a virtual collaborative. Facility participants include the Nurse Executive, Nurse Manager, Clinical Nurse Leader (CNL) or high performing RN with interest in micro-system improvements from the same unit as the Nurse Manager, and other interested healthcare professionals. The VERC team has developed a curriculum designed to guide facilities in creating conditions that promote high performing microsystems and to assist participants in applying VA-TAMMCS methodology to microsystem process improvement activities. Completion of curricular modules and a micro-system improvement project will assist interested participants in meeting partial fulfillment of Yellow Belt certification requirements.
CNL Transition to Practice Curriculum Show content
A six month transition-to-practice curriculum is under development to enhance CNL knowledge, skills, and abilities in domains aligned with the CNL academic curriculum. This transition-to-practice curriculum uses facilitation and mentoring to guide new CNLs as they integrate their role and establish effective practice in the microsystem of assignment. Content builds on the academic training received in a CNL program of study with focus on application to the care of veterans in the VA system. The curriculum 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.
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