Future for nurses discussion 5

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Please respond to the discussion and respond to the peer discussions


Identify the educational preparation and role(s) of the clinical nurse leader (CNL) designation. Give an example of how the CNL influences direct patient care whether in a hospital or out in the community.


Identify advocacy strategies that you can use to create change in your current workplace.

Peer discussion 1

To obtain your CNL you first must have
your master’s in nursing and then take a certification exam
hosted by the AACN. Currently what is happening in the career field
of nursing is that there is a mixed reception with the CNL position.
This is primarily do because there is a lack of understanding of how
to transfer the role and its purpose into practice. Stated in an
article by Heather Monaghan (2011) states, “CNLs provide
education to all the different professional groups they work with as
they integrate evidence-based practice and change at the
point of care”.
So, while in the hospital it is their
job and role to help organize a plan of care. They delegate and work
along since clinical nurse educators as well as staff nurses to help
adjust based on evidence-based practice to patient care.

In their Transforming Practice,
Transforming Care™ model for the clinician at the point of
care, Monaghan and Swihart identified six elements of the CNL role,
all of which are inter-related and need to be mastered:

Leadership and change,
Interdisciplinary relationship, Knowledge transfer, Outcomes
management, Clinician at the point of care, and Professional development.

Based on these roles CNLs work with a
cohort of patients to help provide care, even though it may not be
directly hands on care while in the hospital setting. Whether it be
in the hospital or in the community CNLs are a co-coordinator of
care and will use these strategies as well as their knowledge and
access to the latest evidence-based practice to influence patient
care outcomes.


Monaghan, H. M. (2011). Clarifying the
clinical nurse leader role: Guardian of care. American Nurses Today, 6(4).

Peer discussion 2

The American Association of Colleges of nursing (ANC) developed
the Clinical Nurse Leader role in 2007. “The AACN (2007)
emphasized the CNL role addresses the call for changes that are
necessary for the country to address challenges faced in health
care” (Sotomayer & Rankin, 2017, p. 2). Organizations,
universities and hospitals quickly began to utilize CNL’s in
their practices. A CNL acts as a navigator to
high risk patients, coach and mentor to all. (Sotomayer &
Rankin, 2017). The role of the CNL is still being developed but
holds great promise to the practice of nursing in the upcoming years
(Sotomayer & Rankin, 2017). A Master’s degree is required
to sit for CNL certification. “CNLs oversee care coordination,
provide direct patient care in complex situations, put
evidence-based practice into action, ensure patients benefit from
the latest innovations in care delivery, evaluate patient outcomes
and assesses cohort risk and have the decision-making authority to
change care plans when necessary.” (AACN, 2018, P.1).

Lorraine Kaack is a CNL. She paints a direct picture of her role
through this quote, “The CNL does not have rotating patients
on an 8-hour rotating basis, and 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 CNL has the ability to be mindful
of those subtle changes that may go unnoticed by the staff nurse
scheduling changes” (Kaack,2018, p.1). This means the CNL is a
very important member of a patient’s healthcare team. The
CNL’s role is consistent whereas a registered nurses role is
everchanging. A CNL is like an investigator in they are trained to
pick up what others may inadvertently miss. Nevertheless, the CNL is
an asset to the practice of nursing and the CNL is a role that is
being devised to improve healthcare and nursing practices across

American Association of Colleges of Nursing. Clinical Nurse
Leader. (2018). Retrieved from: https://www.aacnnursing.org/CNL-Certification

Sotomayer, G.., & Rankin, V. (2017). Clinical Nurse Leaders:
Fulfilling the Promise of the Role. Retrieved from: http://eds.b.ebscohost.com.lopes.idm.oclc.org/ehos…

Lorraine Kaack, MS, RN-BC, CNL
. Retrieved from:

Peer discussion 3

Mistakes are inevitable as we are all human and humans make mistakes.
When working with patients, mistakes can cost someone their life and,
in an effort, to help build a safer health system the position of
clinical nurse leader was developed to help address some of these concerns.

In order to become a clinical nurse leader, you have to have a
master’s degree in nursing because you will have a higher level
of clinical competence and knowledge that you can bring to the
position (Graduatenursingedu. 2018). The CNL position is a
certification that requires a minimum of 400 clinical hours within the
CNL education program and 300 clinical immersion hours which can be
included in the 400 total hours needed (Graduatenursingedu. 2018).

The clinical nurse leader plays an important role and has a great
impact on direct patient care. Their position requires them to work in
the clinical setting and within their scope of practice they
facilitate collaborative care for patients, provide mentoring for
staff, oversee a healthy working environment, collect patient risk,
outcomes and care plans, coordinate direct care activities among
nursing staff and provide lateral integration of healthcare services
(Graduatenursingedu. 2018). All of these roles help improve patient
care and ensure each and every patient is cared for properly with the
highest level of safety and care.

Graduatenursingedu. (2018). Clinical Nurse Leader (CNL) Job
Description. Retrieved from: https://www.graduatenursingedu.org/clinical-nurse-…

Discussion 4

The American Association of Colleges of Nursing (AACN) white paper in
2007 proposed a new role in nursing: Clinical Nurse Leader (CNL) to
improve the health care outcomes (Sotomayor, 2017). The aim of the CNL
is to utilize a master prepared nurse to practice across the continuum
of care within diverse healthcare setting in today’s changing
healthcare environment (AACN, 2013).

According to the AACN (2013, pg. 4-5), “the foundation of
aspects of CNL practice include:

1.Clinical leadership for patient-care practices and delivery,
including the design,

coordination, and evaluation of care for individuals, families,
groups, and populations.

2.Participation in the identification and collection of care outcomes.

3.Accountability for evaluation and improvement of point-of-care
outcomes, including the synthesis of data and other evidence to
evaluate and achieve optimal outcomes.

4.Risk anticipation for individuals and cohorts of patients.

5.Lateral integration of care for individuals and cohorts of patients.

6.Design and implementation of evidence-based practice(s).

7.Team leadership, management, and collaboration with other health
professional team Members.

8.Information management or the use of information systems and
technologies to improve healthcare outcomes.

9.Stewardship and leveraging of human, environmental, and material resources.

10.Advocacy for patients, communities, and the health professional team”.

In the Sotomayor’s report (2017), from 2010 to 2015, CNLs led
substantial improvement in the incidence of patient falls,
catheter-associated urinary tract infection, central line-associated
blood stream infection, and hospital-acquired pressure ulcer on
medical-surgical units. The CNLs are able to detect issues of the
environment, cooperate with other health professionals, lead the
health care team and comply with the trend in providing quality care
and changes to improve the care in the diverse healthcare settings.


AACN. (2013). Competencies and Curricular Expectations for Clinical
Nurse Leader Education and Practice. Retrieved from http://www.aacn.nche.edu/cnl/CNL-Competencies-October-2013.pdf.

Sotomayor, G (2017). CNE SERIES. Clinical Nurse Leaders: Fulfilling
the Promise of the Role. MEDSURG Nursing, 26(1), 21-32. Retrieved from http://eds.a.ebscohost.com.lopes.idm.oclc.org/eds/pdfviewer/pdfviewer?sid=415d8048-5d08-41df-945e-e66ab320dffc%40sessionmgr4006&vid=4&hid=4205.

Peer discussion 5

In healthcare there is constant stress
of the phrase “Patient care advocate” meaning that as a
healthcare worker you are the voice of your patient and want to do
what is the safest and right by them with their thoughts in mind.
With that said there is a lot of confusion on ways to be a better
advocate. Also, within healthcare it is lost that you must also be
an advocate for your fellow healthcare workers and look after one
another. Some of these advocacy strategies that can be implemented
in the workplace are: organizational plans, environmental analysis,
stakeholder analysis, risk analysis, drafting goal objectives, and
creating an action plan.

Taking a step back and analyzing the
situation is the best thing that can be done to be a better
advocate. To open your eyes and identify a problem and analyze it
and then develop a plan of how to address the issue is the
foundation of utilizing your advocacy strategies. Also, realizing
what tools you have at your disposal within your work place; that
being policy and leadership can also help when developing an action
plan in order to help advocate for changes you wish to be seen.


What is advocacy strategy? (2017).
Retrieved September 10, 2018, from Worldanimal website: http://worldanimal.net/our-programs/strategic-advo…

Peer discussion 6

Identifying innovative strategies to create workplace change can
reduce the fear and anxiety that comes with changing work
“Change can scare a lot of people, but in today’s
workplace managing change is what keeps people relevant and being
held accountable for managing change and making things better in
your workplace is the new normal” (Llopis,2012, p.1).
Change is a natural occurrence in life as well as work. Change
can be terrifying but there are strategies that we can use to
advocate for change minimize the negative effects of these changes.

I am active in Shared Governance and this is a great tool I
utilize to make effective changes that enhance our nursing
practices. For example, my unit specializes in palliative care.
Through Shared Governance we devised a plan to make our palliative
patients and their families feel more safe and secure on the unit.
We created Palliative Care bags. The bags include medication
literature, flameless candles, Lavender patches, pen and paper,
palliative literature and a warm hand-crafted blanket. The soft
feeling of the blanket and the gentle scent of lavender has made all
the difference to these patients making our bags a success. Through
Shared Governance I can create changes that benefit not only my
patients but their families and my coworkers as well.

I am also a member of the Violence committee and our fight for
change has enforced security efforts and helped minimize the risk of
violence towards nurses. Your voice is your greatest strategy to
advocate for change in the workplace! If you speak loud enough, you
can make certain your voice is heard. Sometimes we must speak more
than once to be heard, but if we give up we will never see what
difference we could have made if we just kept trying. Your voice can
save lives! Your voice is the greatest strategy you can use to
create change in your workplace.

Llopis, G. (2012) Five Effective ways to Sale Change. Retrieved
from: https://www.forbes.com/sites/glennllopis/2012/11/0…

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