Clinical Nurse Leader: A Role for the 21st Century.

A clinical nurse leader (CNL) is an advanced generalist prepared at the master’s degree level to oversee the lateral integration of care for a specific group of patients (American Association of Colleges of Nursing [AACN], 2013). According to Reid and Dennison (2011), the intended purpose of the CNL was to provide clinical leadership directly at the point of care to ensure safe, evidence-based, high-quality care delivery that produces optimal patient outcomes. The AACN’s White Paper on the Education and Role of the Clinical Nurse Leader (2007) explained the CNL role encompassed such roles as clinician, outcomes manager, client advocate, educator, information manager, systems analyst, risk anticipator, team manager, member of a profession, and lifelong learner. The CNL role is unique to the nursing profession because, similar to an attending physician with resident physicians, it returns graduate-prepared clinicians to the bedside to coach and mentor nursing staff to provide patient-centered care that will improve patient results. As identified by Nelson, Batalden, Godfrey, and Lazar (2011), the immediate need of health care should be to focus attention prophylactically on frontline processes, where direct patient care is accomplished, and provide a concentrated opportunity for making pinpoint corrections that could avoid fatal medical errors. Because the CNL is a registered nurse, the provision of direct patient care, assistance during rapid response situations or resuscitation, and clinical assistance during the clinical nurse’s shift are just a few of the benefits for any unit with an assigned CNL. The CNL is considered the protector of nursing care because he or she provides leadership while combining evidence-based research, hands-on instruction, and clinical assistance at the bedside (AACN, 2007). Harris, Roussel, and Thomas (2014) noted the CNL was created to be an expert clinician equipped with graduate-level competencies in illness and disease management, to think critically as well as interpret and analyze clinical interventions. An experienced nurse with this knowledge set is bound to be a vital resource for the entire health care team in the care of medically unstable patients. The CNL is not intended to accept a patient assignment similar to a clinical nurse. The CNL is not an admission discharge nurse or extra nurse in staffing. Additionally, the CNL should not perform routinely the duties associated with the clinical nurse’s role, such as administering daily medications, performing dressing changes, or completing routine patient care tasks. The CNL’s purpose is to assess psychosocial issues, provide service recovery, anticipate risks related to patient outcomes, and identify commonly missed patient signs known to increase the hospital length of stay, jeopardize healing, foster readmissions, and increase health care costs. According to Stachowiak and Bugel (2013), the CNL has the ability to use “advanced clinical assessment to evaluate each patient within the cohort, while evaluating quality of care and patient safety metrics for the entire cohort and comparing current care practices to the best evidence available” (p. 59). Because the CNL possesses this knowledge of the microsystem, he or she easily serves as a reinforcement for the nursing team, available for patient-related questions and concerns nurses may hesitate to ask other health care team members.