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August 2012, Volume 42 Number 8 , p 54 - 58


  • Michelle Sheets MSN, RN, CNL
  • Barbara Bonnah MSN, RN, CNL
  • Jennifer Kareivis MSN, RN, CNL
  • Pamela Abraham MSN, RN, CNL
  • Marianne Sweeney MSN, RN, CNL
  • Judd Strauss MSN, RN, CNL


IN THE EVER-CHANGING U.S. healthcare system, poor outcomes, increased length of stay (LOS), and increased costs continue to be critical concerns. To address some of these issues, the American Association of Colleges of Nursing (AACN) created the role of the clinical nurse leader (CNL), launching the national CNL pilot program in 2004.The CNL is a catalyst for change. This master's-prepared nurse works collaboratively with the entire healthcare team, including the nursing staff, healthcare providers, patient-care managers, and social workers, to ensure high-quality, safe patient care at the microsystem level. They help transform suggestions by the frontline team-the nursing staff-into action.This article describes the role of CNLs in one facility and the positive results they've achieved. Start by looking at their history at Hunterdon Medical Center (HMC) in Flemington, N.J., a 178-bed community hospital.According to the AACN White Paper on the Education and Role of the Clinical Nurse Leader, improving outcomes in a cohort of patients is one aspect of the CNL role that can be used as a metric of performance.1In 2007, when they were near the completion of a master's program in the CNL role and CNL certification, two CNL students met with the CNO of HMC to define the job description and identify specific quality indicators that would be used to measure their success. LOS was chosen as an indicator because it reflects the quality of care within the organization.In September 2007, the CNL students completed their master's degrees, became certified CNLs, and transitioned into their role as CNLs at the facility, one in the medical-specialty unit and one in the intermediate care unit. By September 2008, HMC was committed to its CNL program: it had five full-time CNLs, three in a 48-bed medical-specialty unit and two in the 29-bed intermediate care unit. The CNLs at HMC set out to implement several interventions that would directly impact LOS.The AACN recommends a CNL-to-patient

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