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Miami Valley Hospital in Dayton, Ohio, is one of nearly 200 health care institutions across the country to employ a new member of the health care team — the clinical nurse leader — to elevate patient care.

The American Association of Colleges of Nursing (AACN) first proposed this nursing role in 2004 to alleviate some of the pressures placed on the bedside nurse by providing care coordination and integration of care for more complex patients. It is now a trademarked role with certification available through AACN.

To prepare for the role, clinical nurse leaders (CNLs) must complete a master's education program that focuses on clinical and organizational skills. The curriculum includes training in specific competencies, such as risk assessment, quality improvement, implementation of evidence-based practice, lateral integration of care and inter-professional communication skills.

"The bedside nurse must spend so much time completing tasks for patients that they often don't have the time or expertise to step back and see the big care picture," says Joan Stanley, PhD, CRNP, FAAN, senior director of education policy at AACN.

At Miami Valley Hospital (MVH), the CNL's role includes conducting a detailed interview of the patient and family, reviewing the patient's plan of care, developing a discharge plan and changing care plans when necessary. The CNL also evaluates individual patient outcomes, assesses cohort risk and applies evidence-based practice to ensure patients benefit from the latest knowledge and innovations in care.

CNL offers guidance, aids bedside care

The CNL fills the gaps between shifts and is the leader on the floor, says Rick Kelley, RN, MA, nurse manager at MVH, which employs two CNLs — one on the medical-surgical unit and one on the neurosurgical unit. "She could dedicate her entire day to coaching and mentoring staff and could deal with issues before or as they were happening instead of after the fact," he says.

About 70 percent of new hires at the hospital are recent graduates, so the CNL provides much-needed mentoring and oversight of patient care, Kelley says. "New nurses are very task-oriented," he says. "The CNL gets the bedside nurse to problem-solve, think more critically and think on a broader level, in terms of an overall patient plan."

Karen Findley, RN, MS, a clinical nurse leader at MVH, says her nursing experience combined with the additional training she obtained in the CNL master's program, provided her with skills to be a mentor and leader of quality and patient safety. "I consider myself an adjunct caregiver to the bedside nurse," says Findley. "The nurses really appreciate having me available as a resource. It makes them feel more comfortable and confident."

"We found the CNL to be that person who could help maintain the integrity of the patient story," says Jayne Gmeiner, RN, MS, CNAA, BC, director of the Center for Nursing Excellence at the hospital. "She provides continuity of care, so the patient's story isn't lost during hand-offs."

Early outcomes show CNL boosts care

While data is not yet complete, Stanley says preliminary outcomes collected from participating health care institutions on the CNL's influence on patient care have been positive. Early results show decreases in patient re-admission rates, infection rates, falls, and post-surgical infection rates. Positive outcomes include a rise in critical thinking skills and level of care among nursing staff, high physician and employee satisfaction scores and cost savings derived from quality improvement projects.

MVH has seen similar results. "Since the implementation of the first CNL at MVH, the medical-surgical unit became more focused on providing a total team effort to improve its patient care outcomes and the work environment," says Deb Mals, RN, MS, CNAA, BC, chief nursing officer.

As a result, MVH documented several improved outcomes in 2007 — a 2.2-point improvement in patient satisfaction with regard to nursing, the greatest increase on the unit in five years; 50% reduction in the nurse vacancy rate; a 4-point improvement in nurse satisfaction and a 20-point improvement in teamwork between May 2006 and May 2007 on the National Database of Nursing Quality Indicators (NDNQI) RN satisfaction score; a 10 percent improvement in consistency of overall chart documentation in 2007; and an 11 percent improvement in screening for pneumovax in one year.

"With today's increasing focus on quality improvement and patient safety, we believe that when our outcome data is released from this first wave of CNLs, this role will become the trend of the future," says Stanley.

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Susan Meyers is a freelance writer for Gannett Healthcare Group. To comment, e-mail editorMW@nurseweek.com.

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