The CNL Difference

"If you had to describe in one word the difference that the CNL brings to their patients – what would that word be?”

Our patients deserve the very best care, this is why we all became nurses. Patients under our care have lost their control of a situation and now must rely and trust the healthcare system once they come through our hospital doors. The first healthcare provider they usually meet in the ED is the RN. Next, upon admission to the unit, they meet another RN. If it is a change of shift, they will experience another RN who will be their nurse for the next eight hours. Each of these RNs will provide empathy, compassion, and knowledge to their patients and gain their patient’s trust. What happens after the RN admits the patient to the unit? The RN works on making them comfortable, decreasing their anxiety, explaining expectations and what may be ahead, and most importantly helps relieve some of their fear of the unknown. Often, the very next day, that same nurse has been rescheduled, rotated, or has a day off. Now this patient is introduced to another nurse and maybe another depending on length of stay. This can be very unnerving for some patients, especially those with more complex cases. Their anxiety and stress levels can begin to acerbate thinking “what if this new nurse does not know all the nurse before her knew. Now the “What If” starts. 

Let’s use this same scenario but add to it the CNL position. This is where the CNL finds their strength! The CNL does not have rotating patients on an 8-hour rotating basis. The unique difference is that the CNL is assigned a particular cohort of patients that do not change from day to day. In doing so, the master prepared CNL has the ability to be ever mindful of those subtle changes that may go unnoticed by the staff nurse scheduling changes. 

"I wish all of the patients could witness and have that extra quality care and eyes a CNL brings to their patient healthcare team by laying a safer foundation for their hospitalization experience”. It is difficult to express into words as it is more so a “feeling”. The added healthcare education that comes with being a CNL makes me feel good about myself as a nurse as I have obtained that extra knowledge and have a position that provides that constant extra pair of eyes for today’s more complex patients that are admitted into the hospitals under our care. 

As I witness patients who cross through our doors, each has demonstrated that mislaid emotion of not knowing what to expect, scared because they have lost control of a situation, afraid of the unknown, and each and every one of them all have those “what if” questions running in circles through their minds. They all try to be brave as they pass those doors, all hoping for help and concerned they may not be understood or listened to carefully enough, or what is going to happen to them, and what should they expect. They need to know they will never be judged once through those doors. Whether they walk through our doors under their own esteem, push themselves in a wheelchair or walk through alone without any loved ones – they all have a new burden now - fear. 

For many they may be first timers, readmissions, surgical, accidents, and some just coming because they have nowhere else to turn, whereas others are terminal and arrive in the ER as a last hope and end of life and sadly may never leave. Yet, they are all the same, they are all in need of that one nurse who has that extra piece of knowledge and expertise that could possibly save their life, or at least make their end of life peaceful. Such a nurse is the CNL who has been master prepared trained academically to look for the complex patient that may have a subtle change that may be missed during changing rotation of nurses. 

To me, the one word I would use to describe a CNL is the word "constant" - it gives the CNL its strength and provides that “safety net” that makes the CNL different. The CNL brings to our patients that one healthcare person that can touch base with all the interdisciplinary disciplines, always investigating using evidence, sharing information and resources, searching best current data, identifying and recommending changes in care through best practice and protecting patient under their care from falling through the cracks.

-Lorraine Kaack, MS, RN-BC, CNL