Unlocking clinical nurse leader potential: Diverse workspaces and elevating patient care

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In 2007, following the Institute of Medicine’s report titled “To Err Is Human,” the American Association of Colleges of Nursing (AACN) initiated the first new nursing role in over a quarter of a century: the clinical nurse leader (CNL).

Nurse leaders are the driving force behind quality care and staff morale. CNLs provide health maintenance and medical management at the point of service to care.

At the time, commentators remarked that the role of CNL was, in fact, not new and that it was a remodel of the role held by a ward sister or matron. Famous nurses who may have qualified as CNLs if the roles existed in their day are Mary Seacole, Dorothea Dix, Margaret Sanger-Slee and Florence Nightingale, the most famous CNL of them all.

Today, the initiative is designed for the role of a master’s-level nurse responsible for providing clinical leadership within a hospital unit or ward. The CNL takes charge of patient results by developing, applying and assessing strategies and processes and turning them into empirical-based actions.

Unlike other healthcare quality and risk assessment roles that monitor patient results across the entire system, the CNL focuses on the location or macrosystem where patient care offers leadership at a clinical, hands-on level.

Typically, CNLs positions are a mix of managerial, pastoral and mentorial leadership, taking on accountability for medical and clinical situations for patients and staff to provide the best possible EBC (evidence-based care) within the macro system.

Clinical nurse leaders lean on the proficiency that an online MSN CNL program provides to improve and sustain lead care delivery in the ever-changing world of science-based health protection. A degree program, such as the one offered by Cleveland State University, develops these leadership skills and insight into evidence-based care for future clinical nurse leaders in healthcare.

To further investigate the role, here are nine critical roles and duties a CNL will take on as part of their daily routine.

Clinical leadership or nurse lead

CNLs are leaders in clinical situations. Clinical leadership is exactly as it sounds – learned leadership at all times but especially in times of crisis or extreme stress, such as a pandemic, earthquake or other unexpected life-threatening situation.

The clinical nurse lead protects nursing standards, nurses and auxiliary staff by delivering proven clinical practice to enhance teamwork, always with patient welfare in mind. The CNL leads by example, observing, monitoring, implementing procedures and providing positive leadership while boosting morale.

Safety is uppermost in the CNL’s leadership responsibilities and includes coordination with medical stakeholders to include an evaluated plan for patient welfare, which encompasses all associated peripheries within the CNL’s reach.

A practical example is overseeing the placement of a cannula by a student nurse and mentoring during the procedure so that the patient receives the best care and the student nurses’ learning potential is boosted.

Risk assessments (RA)

The CNL’s role is that of a medical risk assessor, taking care of each patient by assessing clinical and medical risk (taken on advisement with consultants and others) and associated outcomes. Identifying risks means assessing nursing opportunities, threats, strengths and weaknesses of patients’ environments and the quality of care provided.

The CNL is responsible for methodizing changes in proven practice, and the nurse lead will always have safety control and improvement at the forefront of their day-to-day duties.

Active risk assessment is a suitable and sufficient assessment of a situation before delivering medicine or practical care of any sort. For example, should a patient receive community care, or should they become an inpatient?

Second-nature evidence-based practice (EBP) implementation

Evidence-based practice and care evolves with each patient. Each case generates evidence through researched practices, and assessing the quality of processes and care helps the practice improve on a patient-by-patient basis.

Identifying, assessing and evaluating quantitative and qualitative trends is fundamental in seamlessly delivering best practices and care. Care design is usually department-wide, led by the CNL and implemented at the staff level once all healthcare providers (consultants) or stakeholders agree.

Leadership collaboration fundamentals

For any medical service to work properly, teamwork is fundamental. The CNL works with other service teams and care providers to oversee that patients are looked after correctly, leading by example through collaboration.

The CNL models effective and ethical behavior for their team, encouraging teamwork and collaboration amongst staff and departments hospital-wide.

Teamwork means proper handovers are implemented and any information gleaned by caregivers is passed on to all relevant parties – it’s the CNL’s job to make sure handover procedures are followed.

Inciteful information application and management 

As part of successful collaboration, the CNL is expected to fully grasp all information technologies and use insightful information-gathering techniques to instill confidence and assurance within the team while promoting time and money-saving measures.

The CNL must promote a trusting care culture among fellow nurses and healthcare givers. Guiding staff toward meeting objectives and goals with creative solutions reduces paperwork and improves communication with the long-term goal of promoting well-needed downtime.

The CNL’s staff engagement objective

Staff engagement is a vital role that the CNL undertakes to ensure the smooth daily management of clinical environments.

The CNL must maintain strong relationships with all clinicians. As master’s-educated nurses who may not always directly oversee staff, they must serve as mentors and role models for junior staff while using direct management to ensure effective staff engagement.

Often CNLs reinforce best clinical practices as it happens while staff nurses provide patient care. CNLs integrate their role within delivery systems and communicate the value of their contributions to healthcare team members to promote a diverse nursing culture that benefits overall healthcare.

Positive staff engagement is closely tied to an effective workplace culture that promotes safe practices. Work environments that fail to prioritize the safety of stakeholders may experience high employee turnover, care fatigue and, in the worst-case scenario, burnout or stress syndrome.

Supporting staff education and development (E&D)

Much like a human resources manager, the CNL may educate staff or point them in the right educational direction, helping clinicians develop scientific and evidence-based approaches that support a culture of excellence in patient care while always learning.

Educational development may be as simple as creating a mentor-mentee relationship or providing support and information to all staff whenever needed.

Another vital role is offering meaningful staff recognition and development. All CNLs know that efficiency doesn’t occur without teamwork. CNLs must provide the necessary support to ensure staff are regularly recognized for their efforts, praised for success and supported during failure or oversight.

The role consists of managing and utilizing human, environmental and material resources effectively – simply put, the role of a CNL is all about the effective use of resources. Resources are a reserve of funds, materials, staff and assets, such as medical machinery, that an individual or organization can access for efficient workplace function.

Advocating for patients, communities and healthcare teams

A large part of any clinical nurse leader’s role is advocacy, championing the needs of patients, communities, healthcare teams, medical operatives and anyone who comes under the care umbrella within the CNLs role.

The CNL will always prioritize patient-centered care by advocating for elevated outcomes – CNLs must be willing to fight for resources (such as funding and staffing) deemed necessary to ensure quality care.

At the same time, CNLs must recognize when additional resources are unnecessary and might even cause harm. They must champion the needs of communities by advocating for improved access to services and resources inside and outside of the hospital setting or medical environment.

The role of the clinical nurse leader is a complex one, and it should be taken seriously. It is a rewarding career that quite rightly commands respect and evaluated remuneration. Opportunities to diversify are promoted, but in what setting can a CNL practice their vocation?

Where can clinical nurse leaders work?

Hospital settings

Nurse leaders are most commonly found in hospitals wherein CNLs collaborate with other healthcare providers to provide direct patient care and services across various acute, chronic and special care settings.

In a hospital or clinical environment, the CNL works with medical staff, including physicians and other practitioners, as well as nursing staff and assistants, to ensure optimum, seamless health care is provided at all times.

CNLs work in surgery wards, neonatal or intensive care units, emergency departments, oncology divisions, psychiatric wards and anywhere that requires professional leaders.

In a surgery situation, the CNL will work with specialist nurses and consultants to maintain high clinical standards. Neonatal or intensive care units require more family-based support nursing, and the A&E department relies on the clinical lead nurse for nursing cohesion to ensure a swift and positive outcome.

Oncology departments use CNLs to demonstrate leadership in a formal role as the head nurse or informally as a backup to the clinical leadership team members. Psychiatric wards also require leadership to meet the physical needs of their patients but also the pastoral needs of the friends and family of the inpatient.

These settings are an example of the areas that require the skill and leadership of a clinical lead nurse, but there are many more situations where a CNL can practice.

Nursing education settings

The CNL’s advanced training and experience can also be used in nursing education departments. As master’s degree-educated professionals, CNLs can impart their knowledge and experience to the next generation of healthcare providers, helping them prepare for a career in healthcare.

In this setting, if the leader doesn’t want a hands-on career, the CNL is often responsible for developing courses, maintaining the curriculum and providing students with guidance when needed. Some CNLs take on further learning to become professors in the field of healthcare education and study.

Patients are at the forefront of any nursing career, and the combination of critical aspects in clinical nurse-led practice is how patient care can be improved on a practical, day-to-day level in each work environment.

How can CNLs improve patient welfare in any environment?

  1. CNLs are expected to lead by example, demonstrating professional behavior and encouraging a culture of trust among stakeholders.
  2. Clinical leads advocate for EBP and use their skills to ensure that processes are correctly enforced in the clinical setting.
  3. They are dedicated to improving quality care at all times. CNLs strive to ensure that the highest care is provided for every patient while maintaining high nursing standards.
  4. Enhancing clinical problem-solving is a fundamental attribute of a CNL. 
  5. Clinical nurse leaders help expand interprofessional collaboration. Working alongside other caregivers and medical professionals is a major part of the CNL’s job description.
  6. CNLs must be able to proactively think critically in any circumstance.
  7. They act as a middle person between physicians, consultants, junior doctors, nurses and other professionals.
  8. CNLs identify risks accurately, considering the physical and emotional elements associated with a patient’s condition and that of their families and others who support convalescence.
  9. Clinical nurse leaders are expected to be patient advocates no matter how disagreeable that might appear to others.

The future of nursing

The evolving healthcare environment on various continents and the world’s diverse population demands a foundational and locational shift toward patient-centered care. 

The future of nursing includes focusing on first-hand or primary care rather than specialty care. Delivering care within communities instead of in acute care settings fosters seamless care transition, allowing healthcare professionals to fully utilize their skills and promote interprofessional collaboration for better prognosis.

Community care, in theory, means healthcare systems can improve care quality, reduce errors and enhance safety in one place, such as in the home, care homes or the community center. Nurses and CNLs are well-equipped to address these needs due to their numbers, scientific knowledge and adaptability.

Patients increasingly request a community-based system that means normal life can remain relatively uninterrupted. Expect to see more small clinics and holistic services rather than a one-method that fits all healthcare system.

Technology in the future of nursing

Nursing will be less hands-on than ever. Technology means that the internet of medical things (IoMT) or Meditech can reduce human error and increase efficiency.

From autonomous robots to artificial intelligence (AI) systems, nurses already have access to many innovations that can monitor multiple patients simultaneously, such as telemonitoring, remote patient monitoring (RPM) and other systems within telehealth that free up valuable time to allow more direct patient care.

As technology progresses, it’s likely that more processes will be automated, such as record-keeping and filing notes, while healthcare professionals will focus their attention on practical holistic care.

Introducing virtual reality and augmented realities can enhance training for all levels of nurses, from students to CNLs to surgeons and general doctors or physicians.

Practical help comes in the form of electric beds that turn patients and reduce the risk of bedsores. The clinical lead nurse will show others how to safely operate the bed and ensure that patients in most need are placed in the available electric beds.

Clinical leads will promote the use of robotic structures to help lift patients in and out of bed, petitioning bursars for more or less equipment as required. Other vital areas for progression include automated pill dispensers and computerized documentation systems that leave less room for error and more time for essential hands-on nursing.

By advocating for more technology, not less, the clinical lead nurse can maximize its impact on time management and patient care, taking the optimistic lead in promoting technology through the ranks of professionals who might otherwise dismiss the beneficial opportunities that automation in specific areas can provide. 

Digital healthcare in action

It’s possible to give student nurses experience without entering the ward. Digital clinical experience (DCE) offers virtual patient care duplication designed to promote clinical reasoning practices and skills.

The DCE system is designed for virtual diagnosis and is automatized with 3D graphics, real speech elements and understanding questions with the ability to answer just as a real patient would.

Nursing education is in the midst of a revolution. As emerging technologies such as augmented reality (AR) and virtual reality (VR) continue to evolve at pace, they will provide nurse educators with numerous contemporary and potential future educating applications, ranging from disaster simulations to emergency flight experiences.

This article cannot possibly cover all options, but it aims to highlight some key technologies for educators and administrators to consider when integrating new simulation tools into their nursing programs.

The healthcare climate is changing, and nurses, particularly CNLs, must be ready to meet the demands of a new era. Clinical nurse leaders have the potential to change healthcare forever with their expertise in evidence-based practice, interprofessional communication, problem solving and critical thinking.

Nursing education should equip our future CNLs with all the tools they need to succeed. Technological advances and virtual simulations can help ensure that nurses are well-prepared for whatever the future of nursing may bring.

By being aware of the latest technology and trends, clinical nurse leaders can move their practice forward and continue to provide essential patient care in diverse workspaces. With a solid foundation and an online MSN in nursing, CNLs can continue to elevate patient care while unlocking their full potential.

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