Clinical Nurse Leader
EVOLUTION OF A REVOLUTION
generalist, while CNSs are pre- pared for specialty practice. The CNL primarily operates on the clinical microsystem level involving small, functional frontline units, while the CNS is engaged not only within the microsystem, but also at the macrosystem level within 3 spheres of influence: client, person- nel, and organizational systems. The CNL coordinates and imple- ments client care, while the CNS designs and evaluates patient- specific and population-based programs. The CNL evaluates and implements evidenced-based practices, while the CNS has the added responsibility of generat- ing new evidence.^ 3
The Experience The CNL and CNS roles are dis- tinct in preparation yet complimen- tary in the mission to improve
patient outcomes. Throughout the development and implementation of this role, the CNL and CNS, who serve a cardiac population of patients within the University Health Care System, a commu- nity hospital, have worked to- gether to develop a collaborative relationship that benefits both staff and patients. Roles have been differentiated to include ex- pectations, functions, and out- comes (Table 1). In making patient care decisions, role simi- larities and overlap do occur such as working with the multidisci- plinary team, using advanced nursing skills for patient assess- ment, making complex problem analysis, and supporting bedside staff. Both roles use nursing theo- retical frameworks such as the Synergy model3 for problem solv- ing and patient care decisions.
Despite these similarities, there are several key distinctions that reinforce the need for separate roles. The CNL role specifically is aimed at managing a distinct population group through day- by-day management of clinical issues and decisions. The primary focus is on evaluating and sup- porting evidence-based decisions to ensure best possible outcomes for clinical goals. The CNS role specifically is aimed at helping the staff deal with disease processes and treatments at a macrosystem level with focus on an entire grouping of illnesses such as care of patients with cardiac diagno- ses and solving problems at the macrosystem level, such as imple- menting an approach to diabetic education and management. The CNLs more directly assist staff to implement evidence-based or
Table 1. Comparison of the CNL and CNS Roles
Clinical Nurse Leader
Clinical Nurse Specialist
Scope is a 40-bed cardiac progressive care unit Responsible for coordination and implementation of patient care on a daily basis, working with staff, physicians, and patient to ensure best patient outcomes Uses evidenced-based practice in caring for patients and ensures that staff are following these guidelines (ie, acute myocardial infarction and cardiac heart failure core measures) Provides education to staff and patients at the identified point of need, either informally at the bedside or one-on-one Focuses on developing and refining specific outcome goals for the individual cardiac patient through monitoring specific measures on the unit as defined by the Joint Commission on Accreditation of Healthcare Organizations’ core measures Works with the multidisciplinary team to ensure that planning, implementation, and coordination of care for high-risk patients are provided through daily updates as well as biweekly team meetings Serves as a resource for obtaining advanced healthcare information through degree obtained, references, Internet or consultation with other healthcare providers
Scope includes a 40-bed cardiac progressive care unit, 13-bed coronary care unit, 10-bed postYopen heart surgery unit, and a 128-unit centralized telemetry monitoring station Responsible for designing and evaluating cardiac programs of care for staff and patient as needs are identified Provides education and training for implementation of these guidelines as well as updates. Also has the added responsibility of participating in research projects to generate new evidence through research and promoting new practice guidelines when available Provides broad-based education including new employee orientation, general skills, and procedures for identified deficiencies in the unit in a formal classroom setting and usually in a group. Also provides one-on-one education to new employees who show a deficit in skills and procedures Focuses on developing and refining overall hospital goals and education to staff related to updates and changes made to the guidelines as needed Serves as a resource and consultant for identified high-risk, low- volume, rarely seen therapeutic interventions (ie, continuous Foley catheter irrigation, patient-controlled analgesia infusions, tracheotomy care family education and training, etc) Serves as a resource for obtaining information about advanced technology, research, and clinical trials. Serves on the product evaluation committee and keeps staff updated on product, policy, and procedures and changes
Vol. 37, No. 10
Copyright @ Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.