Monday, November 5, 2007

This presentation is part of : Leadership in Healthcare Organizations
Leadership Innovations in Practice: Implementing the Clinical Nurse Leader (CNL) Role
K. Sue Haddock, RN, PhD, Research, WJB Dorn VAMC, Columbia, SC, USA and Andrea Marshall, RN, MSN, Acute Care, WJB Dorn VA Medical Center, Columbia, SC, USA.
Learning Objective #1: Describe the development and implementation of a new leadership role in clinical practice.
Learning Objective #2: Discuss outcomes associated with a program implemented as a pilot across 58 hospitals in the VA.

Program Description

The VA has partnered with the American Association of Colleges of Nursing (AACN) to develop a Clinical Nurse Leader (CNL), a leadership role for practice.  The CNL works with staff to put evidence-based practice into action at the patient care unit/area level.   The CNL is expected to evaluate patient outcomes and assess risk while improving the overall coordination and delivery of care for an individual/group of patients.  The CNL role addresses and improves the lateral integration of patient care delivery.  The CNL works with the staff to provide expert consultation about patient care issues and to facilitate implementation of evidence-based practice on the unit.  The role differs from Clinical Nurse Specialist in that it does not solely address any one specific disease or clinical condition.


Formative and summative evaluation are essential components of implementation.  The framework that is being used to guide the evaluation includes four general domains: financial, satisfaction, quality, and innovation.  A feasibility study was done to define specific indicators and ease of electronic data collection.  Data collected as part of the feasibility study indicated reduced length of stay, surgical infection rates and falls. Locally, we have outcomes related to quality and innovation and both are demonstrating the positive impact of the CNL.  The national evaluation of this program has been initiated with the identification of twelve VA sites.  They will begin reporting data in 2007 with another 20 sites joining the sample by 2008. 



Implementation of the Clinical Nurse Leader role has great potential for improving the patient outcomes through support of staff nurses involved in direct patient care.  Initial findings indicate that the role is indeed improving outcomes.  The links with academia are important and have yet to be realized in all practice sites.  Evaluation and academic linkage will be the main focus for 2007.