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Copyright 2007 by the American Association of Colleges of Nursing. All rights reserved No part of this document may be reproduced in print. or by photostatic means or in any other manner without the express. written permission of the publisher, AACN February 2007 White Paper on the Education and Role of the Clinical Nurse LeaderTM 2. This document delineates both the entry level competencies for all professional nurses. Essentials of Baccalaureate Education for Professional Nursing Practice 1998 and those. competencies of the Clinical Nurse Leader TM an advanced generalist role The competencies. deemed necessary for the CNL role originally were delineated by the AACN Task Force on. Education Regulation II TFERII in the Working Paper on the Clinical Nurse Leader and. accepted by the AACN Board 2003 Therefore the competencies delineated here include. all of the competencies deemed necessary for all graduates of a CNL education program. In addition to the CNL graduate competencies the Curriculum Framework which includes. required curricular components required clinical experiences and overarching end of. program competencies are included These components provide the basis for the design and. implementation of a master s or post master s CNL education program and prepare the. graduate to sit for the AACN CNL Certification Examination. INTRODUCTION, Nursing education and the profession have an unparalleled opportunity and capability to. address the critical issues that face the nation s current health care system The American. Association of Colleges of Nursing AACN representing baccalaureate and graduate. schools of nursing in collaboration with other health care organizations and disciplines. proposes a new Clinical Nurse Leader CNL role to address the ardent call for change being. heard in today s health care system, It is evident that leadership in nursing is of supreme importance at this time Nursing. has faced many critical situations in its long history but probably none more critical than. the situation it is now in and none in which the possibilities both of serious loss and of. substantial advance are greater What the outcome will be depends in large measure on the. kind of leadership the nursing profession can give in planning for the future and in solving. stubborn and perplexing problems if past experience is any criterion little constructive. action will be taken without intelligent and courageous leadership 1. Isabel Maitland Stewart wrote those words over fifty years ago in her petition for education. reform in nursing Perhaps their most staggering revelation is that despite all of nursing s. progress in recent decades as a profession nursing remains at the same critical juncture where. it was at the end of World War II Despite the promise of university based education for. professional nursing the health care system is in yet another nursing shortage with yet another. call for intelligent and creative leadership, The good news is that nursing has the answers to the predominant health care dilemmas of the. future including, the problems associated with normal human development particularly aging.
chronic illness management in all ages, AACN February 2007 White Paper on the Education and Role of the Clinical Nurse LeaderTM 3. health disparities associated with socioeconomic dislocations such as global migration. classism sexism and, strategies for health promotion and disease prevention. Each of these prevailing health problems is suited to the nursing paradigm Their amelioration is. what nursing students are educated to do The advancement of medical science and technology. has changed the landscape of health and illness Not only are people living much longer they are. living with chronic illnesses that would have been fatal twenty years ago This is true in adults. and children resulting in the need for providers who can manage the on going health needs of. persons of all ages The necessity for practitioners who focus on the promotion of health and. wellness and the prevention of disease has emerged as not only a good and wholesome thing to. do in our society but also as a means of addressing escalating medical costs Whether working. with older adults children refugees ethnic minorities persons with chronic illness or whole. communities the predominant theme is the promotion and maintenance of health and the. improvement of health care outcomes,BACKGROUND, In November 1999 the Institute of Medicine IOM issued the comprehensive report on medical. errors To Err is Human Building a Safer Health System The report extrapolating data from. two previous studies estimates that somewhere between 44 000 and 98 000 Americans die each. year as a result of medical errors 2 These numbers even at the lower levels exceed the number. of people that die from motor vehicle accidents breast cancer or AIDs Total national costs of. preventable adverse events medical errors resulting in injury were estimated to be between 17. billion and 29 billion of which health care costs represented over one half 3 In addition. medication related and other errors that do not result in actual harm are not only extremely. costly as well but have a significant impact on the quality of care and health care outcomes The. IOM report also focused on the fragmented nature of the health care delivery system and the. context in which health care is purchased as being major contributors to the high and inexcusable. error rate, In addition to the growing concern over health care outcomes the United States is in the midst of. a nursing shortage that is expected to intensify as baby boomers age and the need for health care. grows According to a study by Dr Peter Buerhaus 4 and colleagues published in the Journal of. the American Medical Association the U S will experience a 20 shortage in the number of. nurses needed in our nation s health care system by the year 2020 This translates into a shortage. of more than 400 000 RNs nationwide The fall 2002 survey by the American Association of. Colleges of Nursing AACN showed that enrollment in entry level baccalaureate programs in. nursing increased by 8 nationwide since fall 2001 This represents an increase of 5 316. enrollees and only 559 more graduates than the previous year And despite these modest. increases enrollment is still down by almost 10 or 11 584 students from 1995 5. Several recent landmark reports focus on the nursing shortage the crisis in the health care. system and proposed strategies for addressing these critical issues The IOM report Crossing the. Quality Chasm 2001 stresses that the health care system as currently structured does not as a. whole make the best use of its resources The aging population and increased client demand for. new services technologies and drugs contribute to the increase in health care expenditures but. AACN February 2007 White Paper on the Education and Role of the Clinical Nurse LeaderTM 4. also to the waste of resources Recommendation two in the report calls on all health care. organizations and professional groups to promote health care that is safe effective client. centered timely efficient and equitable p 6 6, In a follow up report Health Professions Education A Bridge to Quality the Institute of.
Medicine 7 Committee on the Health Professions Education states All health professionals. should be educated to deliver patient centered care as members of an interdisciplinary team. emphasizing evidence based practice quality improvement approaches and informatics p 3. The Joint Commission on Accreditation of Healthcare Organizations JCAHO in Health Care at. the Crossroads Strategies for Addressing the Evolving Nursing Crisis 8 urges that the shortage. of registered nurses has the potential to impact the very health and security of our society. Recommendations include proposals for transforming the workplace aligning nursing education. and clinical experience and providing financial incentives for health care organizations to invest. in high quality nursing care, The American Hospital Association AHA Commission on Workforce for Hospitals and Health. Systems report In Our Hands How Hospital Leaders Can Build a Thriving Workforce 2002 9. highlights the immediate and long term critical workforce shortages facing hospitals Five key. recommendations include the need to foster meaningful work by designing health care to center. on clients and the need to collaborate with professional associations and educational institutions. to attract and prepare new health professions, The Robert Wood Johnson Foundation in its commissioned 2002 report Health Care s Human. Crisis The American Nursing Shortage 10 takes a broad look at the underlying factors driving the. nursing shortage One of the key recommendations made is for the reinvention of nursing. education and work environments to address and appeal to the needs and values of a new. generation of nurses, While there is ample evidence for the need to produce many more nurses to meet the pressing. health care needs of society this is not just a matter of increasing the volume of the nursing. workforce The nursing profession must produce quality graduates who. Are prepared for clinical leadership in all health care settings. Are prepared to implement outcomes based practice and quality improvement. strategies, Will remain in and contribute to the profession practicing at their full scope of. education and ability and, Will create and manage microsystems of care that will be responsive to the health.
care needs of individuals and families 11 12, In addition unless nursing is able to create a professional role that will attract the highest quality. women and men into nursing we will not be able to fulfill our covenant with the public The. Clinical Nurse Leader CNL addresses the call for change. The realities of a global society expanding technologies and an increasingly diverse population. require nurses to master complex information to coordinate a variety of care experiences to use. technology for health care delivery and evaluation of nursing outcomes and to assist clients with. AACN February 2007 White Paper on the Education and Role of the Clinical Nurse LeaderTM 5. managing an increasingly complex system of care The extraordinary explosion of knowledge in. all fields also requires an increased emphasis on lifelong learning Nursing education must keep. pace with these changes and prepare individuals to meet these challenges Change however. cannot occur in isolation Nursing education must collaborate and work in tandem with the. health care delivery system to design and test models for education and practice that are truly. client centered generate quality outcomes and are cost effective Significant changes must. occur in both education and the practice setting to produce the delivery system desired by all. constituents New ways of educating health professionals including inter professional education. and practice and new practice models must be developed that better use available resources and. address the health care needs of a rapidly growing diverse population. EDUCATING THE CLINICAL NURSE LEADER, In response to client care needs and to the health care delivery environment the American. Association of Colleges of Nursing AACN proposes the Clinical Nurse Leader CNL role. The design of this role has been done in collaboration with constituents from a broad array of. expertise and leadership roles within the health care system Participants at the Stakeholders. Reaction Panel Meeting 2003 confirmed that this role has emerged and is being further. developed on an ad hoc basis Individuals to fill this role are being recruited opportunistically. based on available clinicians with appropriate experience personal characteristics and self. selection Stakeholders affirmed the need to produce these clinicians through a formal degree. granting program of education, 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 The implementation of the CNL role however will. vary across settings The CNL role is not one of administration or management The CNL. functions within a microsystem and assumes accountability for healthcare outcomes for a. specific group of clients within a unit or setting through the assimilation and application of. research based information to design implement and evaluate client plans of care The CNL is a. provider and a manager of care at the point of care to individuals and cohorts The CNL designs. implements and evaluates client care by coordinating delegating and supervising the care. provided by the health care team including licensed nurses technicians and other health. professionals, Ten Assumptions for Preparing Clinical Nurse Leaders. Assumption 1 Practice is at the microsystems level. In addition to being direct care providers the CNL is accountable for the care outcomes of. clinical populations or a specified group of clients in a healthcare system As clinical decision. maker and care manager the CNL coordinates the direct care activities of other nursing staff and. health professionals The CNL provides lateral integration of care services within a microsystem. of care to effect quality client care outcomes To prepare students for the CNL role there must. be a deliberate and integrated inclusion of leadership education and socialization that begins on

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