Continued from Page 1

“We need a new model of school nursing that will address the volume and acuity of students and meet their needs and those of the nurses,” says Anne L. Hedges, RN, MSN, NCSN, school health administrator, Health Care District of Palm Beach County, West Palm Beach. The district administers the school health program in Palm Beach County’s public schools.

With more than 170,000 students in 260 schools, Palm Beach is the only county in Florida with a full-time nurse in every public school. Hedges believes CNLs will be assets — clinical experts who can pull it all together. Rather than supervise, CNLs will work with and support RNs as clinical backup, problem solvers, and resources and will report to nursing supervisors.

“Where nurse practitioners act as medical providers who work in collaboration with physicians, CNLs assist nurse managers and staff in the provision of ‘bedside’ care,” says Hedges.

Liberty Health Service, a Jersey City, N.J., multihospital and health service system, plans to bring CNLs into its acute care, home care, ambulatory care, and rehabilitation facilities.

“As the AACN suggests, rather than superimposing the new role on what facilities already have, the partnerships redesign care around the CNL role. Typically, schools of nursing and health care systems work in tandem,” says Rita Smith, RN, senior vice president patient care at Jersey City Medical Center. “Our partnership with UMDNJ SON is driving the curriculum, determining what works and doesn’t in clinical practice.”

Bring in the new

What health care is doing isn’t working, says Joan Roche, APRN, PhD, BC, clinical assistant professor at the University of Massachusetts School of Nursing, Amherst. “Research shows that RNs at the bedside are task-driven, devoid of resources, working at a staccato pace with little time to invest in second-order problem solving,” she says. Instead of helping nurses get around the system to care for their patients, CNLs will help RNs work through system problems and make the system work better, ultimately for better patient care.

This is not a remake of the old team leader role, though pieces of responsibilities may seem recognizable, says Susan Salmond, RN, EdD, associate dean for administration and planning, University of Medicine and Dentistry New Jersey School of Nursing. The CNL is a new role brought together in a new fashion with the education and skill sets needed to response to today’s complex health care demands. “Rather than rigidly predefine it and cause it to fail,” she says, “we must allow enough flexibility for the new role to evolve.”

Though it’s to be determined, CNLs’ patient assignments need to be flexible, ideally using the definition of “bedside patient care” to mean facilitating care, handling complex problems, mentoring, and teaching.

“It’s a redefinition to include how CNLs operationalize care to accomplish it more effectively and efficiently,” says Salmond. CNLs will be patient advocates who never let go, aware of how to use the system and get patients through it.

In their quest to define future patient care delivery models and the nurse who will be providing care in the future, the American Organization of Nurse Executives (AONE) has developed guiding principles that members who are predominantly in the practice community can use as they look to define care delivery models on particular units. The guidelines encourage dramatic change, revolutionary thinking, and experimentation.

“There’s a huge synergy between our work and the CNL project that looks at educational reform, the nursing role, and work nurses will be doing in the future,” says Karen Haase Herrick, RN, MN, executive director of Northwest Organization of Nurse Executives and AONE past president. For AONE to participate in this partnership to explore one possible role for the future, is a natural fit, she says.

Lorraine Steefel, RN, MSN, CTN, is a senior staff writer for Nursing Spectrum.