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and has 10 matching performance measures, These measures include monitoring of the annual and sick leave of their nursing staff, as well as completion of their annual performance reviews. Also, the CNL should “provide leadership, guidance and support to staff” (p. 3) with a separate accountability that refers to managing a cost centre. Eight performance measures match this one and include managing the clinical area budget within agreed parameters in conjunction with their manager. A further accountability refers to the provision of clinical support and guidance by the clinical nurse leader to the nursing staff. This sees performance measured against three criteria: provision of clinical support advice, guidance to ward/unit/team staff and provision of direct expert patient care (p. 4). There are in total 10 accountabilities with 69 matching performance measures, including but not limited to, the responsibility of the role to implement a ‘Continuous Quality Improvement’ programme, as well as an effective ‘Risk Management’ programme. There is also an expectation that the CNL will consult with the Director of Nursing on nursing matters of DHB significance.

Towards the end of the position description are four descriptors listed under the heading “problem complexity” (p. 8) of the role. Two of the four include that “the incumbent will be responsible and accountable for the clinical service delivery, staff and financial management of their clinical area” (p. 8). Secondly, there is the need to balance clinical expertise and mentoring of staff with the demands of a multidisciplinary service and budget. The role requires extensive use of problem solving skills and knowledge as well as intense interpersonal interactions with patients, family, the public, staff and management in often demanding situations.

Selection to the role is not entirely dependent on formal academic qualifications and ongoing professional development is individualised. Upon successful appointment, orientation differs widely both in content and duration. Opportunities to attend yearly education days are promoted and encouragement plus funding support may be accessed to commence or continue post registration qualifications. Regular forums are held to update changes to all facets of service delivery that may affect the areas the CNL leads. In addition to this situational context in or of the DHB, the CNL is also part of the


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