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Clinical Nurse Leader Tool Kit

Examples of the kinds of materials you will find in each section are listed under the section headers below. These lists are not all-inclusive of the materials available in the toolkit.

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The Eight-Stage Process to Creating Major Change: 

Clinical Nurse LeaderSM
An Emerging Role for Nursing in the 21st Century


The CNL was developed by the American Association of Colleges of Nursing (AACN) in response to complexities of health care environments, the need to ensure safety and high standards at the point of service, as well as to meet diverse client and health care environment needs. The CNL is prepared as a master's prepared generalist accountable for clinical and health care environment outcomes. The Clinical Nurse Leader (CNL) is a leader across all settings at the microsystem level (patient unit, community zip code area, school setting, nursing home specific area, etc). The CNL oversees care coordination of a distinct group of patients, is a resource for clinical decision making and serves as a lateral integrator of care. This clinical leader puts evidence-based practice into action to ensure that patients benefit from the latest innovations in care delivery. The CNL collects and evaluates patient outcomes, assesses cohort risk, and has the decision-making authority to change care plans when necessary. This clinician functions as part of an interdisciplinary team by communicating, planning, and implementing care directly with other health care professionals, including physicians, pharmacists, social workers, therapists, clinical nurse specialists, and nurse practitioners. The CNL is a leader in the health care delivery system across all settings in which health care is delivered, not just the acute care setting. Implementation of this role will vary across settings. 

Competencies and clinical learning experiences for CNL students are specified for each of the following CNL role components: client advocate, member of a profession, team manager, information manager, systems analyst/risk anticipator, clinician, outcomes manager, educator, and life long learner. The CNL designs and directs care within a microsystem ensuring best practices are brought to the point of service and patients/clients receive timely cost efficient care. Lateral integration of services is key. The CNL is accountable for clinical and care environment outcomes as well as influencing work environments so as to increase nurse retention. The framework for the curriculum for the CNL includes the domains of leadership, clinical outcomes management, and care environment management. The curriculum guide can be accessed here. The CNL role is fully described in AACN's determination on the role of the Clinical Nurse Leader (2004). 

Incorporating the CNL requires a transformation in practice. Specifics of the process of this transformation may be unique to each institution. Resistance is inherent in any major change so patience and perseverance are key leadership attributes in implementing this new role. Kotter (1996) suggests that the first four steps in the transformation process help defrost a hardened status quo. Phases five to seven introduce new practices. The last stage grounds the changes; makes them "stick."

Stage I. Establishing a Sense of Urgency

  • Institute of Medicine (IOM) Articles (1999-2004)
  • Institute for Healthcare Improvement (IHI)
  • Leapfrog Group for Patient Safety
  • Agency for Healthcare Research & Quality (AHRQ) 

Stage II. Creating the Guiding Coalition

  • End of Program Competencies
  • Tornabeni, J., et al articles (2006)

Stage III. Developing a Vision and Strategy

  • AACN National and Regional Meetings
  • Plexus Institute Complexity Workshops
  • Curriculum/Preceptor Workshops 

Stage IV. Communicating the Change Vision

  • VA Video
  • AACN FAQ Sheets

Stage V. Empowering Board-Based Action

  • CNL/CNS Comparison Paper (2004)
  • Job Description
  • Performance Evaluation Tool for Practice Setting
  • End of Program Competencies
  • Comparison of CNL and Nurse Manager Roles
  • Preceptor Role Guidelines
  • Curriculum Development Framework
  • Template for CNL Implementation in the Practice Setting
  • AONE Guiding Principles / AACN Core Competencies 

Stage VI. Generating Short-Term Wins

  • Clark, J. et al, Developing the CNL Role in the 12 Bed Hospital Model
  • AACN CNL Pilot Project Evaluation Indicators
  • The CNL Role: A Pilot Evaluation by an Early Adopter 

Stage VII. Consolidating Gains and Producing More Change

  • Role of the Team Coordinator: INOVA haealth System
  • Evaluation Framework and Cover Letter

Stage VIII. Anchoring New Approaches in the Culture

  • Certification of CNL's
  • CCNE Accreditation of CNL programs
  • Master's Essentials