After three decades of nursing, Nan Trump, RN, BSN, was eager to advance her career by earning a master’s degree, but she was torn. Most master’s-prepared nurses left the bedside to work as administrators, nurse practitioners or educators, yet Trump wanted to stay involved in bedside patient care.

Then a friend suggested she investigate becoming a clinical nurse leader (CNL), a new role being developed by the American Association of Colleges of Nursing (AACN). The AACN envisioned a nurse who oversees a subset of nurses, yet is not an administrator. Instead, the idea is that this master’s-prepared nurse will have the time to identify and solve problems on the unit. A CNL would also stay abreast of patient status in case physicians, nurses or patients need quick answers to questions.

“When I read about the CNL, it was everything I wanted to be as a nurse,” Trump says. “It was a patient advocate role, but also supported the staff and the families. It also looked at outcomes. I’d be able to assess the patient population and find out the areas where individuals really wanted changes that could improve patient and staff outcomes.”

Evolution of the Clinical Nurse Leader

The need for nursing leaders at the bedside arose after several organizations released reports about the high level of medical errors. One Institute of Medicine report suggested that medical errors were usually the result of poor systems and processes in the healthcare setting, not human recklessness.

In response to these concerns, the AACN formed a taskforce to identify the skills a future nurse leader would need to improve faulty hospital systems. Once the AACN had defined this new breed of nurse, the organization began calling for hospitals and nursing schools to partner on designing the curriculum and job sites for future clinical nurse leaders. Now, more than 100 nursing schools and 188 healthcare institutions nationwide are collaborating to educate, train and employ CNLs.

To enter one of the country's 100+ CNL programs, students can be RNs or hold a bachelor’s degree in another field. Programs vary in length, but in general take about two years for RNs to complete and two to three years for non-RNs.

Trump started her CNL program in January 2005 at the University of Portland. Throughout the program, she worked full-time as an RN in a neonatal intensive-care unit within the Providence Health System, which partnered with the University of Portland to implement the CNL role. Providence paid Trump’s tuition and hired her as a CNL once she graduated.

As a CNL, Trump won’t have patient assignments, but she will stay up-to-date by performing rounds on her specific patient population and talking to the different disciplines providing bedside care. Unlike staff nurses, Trump will work Monday through Friday during normal business hours to decrease the fragmentation of care that results from shift work. She will be available to answer questions from hospital staff, patients and relatives. She also will evaluate her patient population through research and discussion with staff members to identify which methods of providing care need improvement and will work with other caregivers to make needed changes.

CNLs as Problem Solvers

Tamela Garcia, RN, MS, CNL-BC, is a new clinical nurse leader with Morton Plant Mease Health Care in Florida.

Working in the remote telemetry unit at Mease Countryside Hospital, Garcia put her CNL training into practice when she noticed that nurses had difficulty knowing who to call when patient monitors signaled a problem. In response, she placed laminated emergency phone cards in each patient room so nurses could quickly identify the correct contact, one of several changes Garcia made to help nurses do their jobs more effectively.

“The quality of care has definitely improved,” she says. “There are fewer patient falls, fewer skin issues, patient education needs are being met and discharge is being done in advance.”

Not only do the patients benefit, but Garcia also finds her job more satisfying. Rather than rushing to finish her duties each day, Garcia enjoys having time to talk to patients about their concerns, educational needs and health history.

“The pace isn’t as hectic,” she says. “I’m still busy, but I have a little more freedom to explore the patient needs. I can see a problem and fix it before it becomes a problem, and as a nurse, that is very rewarding.”