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Clinical Nurse Leader As Advocate

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Florence Nightingale may not have called herself a patient advocate, but her effort to promote the health and safety of wounded soldiers was a model for patient advocacy. As an advocate for her profession, Nightingale set standards for care, including education and training. Today, advocacy is a defining characteristic of the nursing profession.

Like Florence Nightingale, today’s Clinical Nurse Leaders (CNLs) advocate for both their patients and profession to improve patient safety and care outcomes. Registered Nurses (RNs) who aspire to this advanced leadership role can get started by earning a Master of Science in Nursing (MSN).

Like advanced practice nurses (APRNs), CNLs may specialize. For example, the online MSN – CNL program at the University of Louisiana Monroe (ULM) prepares graduates for adult gerontology care. However, CNLs can practice across the continuum and in any healthcare setting.

What Is a Clinical Nurse Leader?

The CNL role is relatively new to the nursing profession. Clinical Nurse Specialist (CNS) may be a more familiar leadership role in nursing. The CNL and CNS roles are distinctly different, but there are some similarities. For example, both a CNL and CNS are part of an interdisciplinary team. CNLs can expect to collaborate with CNSs, along with others on the healthcare team, to plan and implement care.

The creation of the CNL role was motivated in part by a national push to reduce preventable medical errors. The Institute of Medicine (IOM) — now the National Academy of Medicine — reported that preventable medical errors were causing more deaths than motor-vehicle accidents, breast cancer and AIDS. An essential goal of the CNL is to advocate for and improve patient safety and outcomes.

CNLs are described as “front-line innovators” and “information-flow managers.” CNLs provide team leadership at the point of care to improve patient outcomes, increase satisfaction and achieve cost savings. The American Association of Colleges of Nursing (AACN) identifies the following CNL areas of focus:

  • Care coordination at the microsystem level
  • Outcomes measurement
  • Transitions of care
  • Interprofessional communication
  • Team leadership
  • Risk assessment
  • Implementation of evidence-based practice
  • Quality improvement

How Do CNLs Advocate for Patients?

Nightingale believed that high-quality care was a human right. Her insistence on a clean environment, infection control and an educated nursing staff are all examples of advocacy. As healthcare leaders who oversee care coordination, CNLs integrate patient advocacy into everything they do.

Patient advocacy is such a crucial part of nursing that it is written into the Code of Ethics for Nursing. Provision 3 states that “the nurse promotes, advocates for, and protects the rights, health, and safety of the patient.”

A look at essential competencies for CNL practice shows the many ways advocacy is part of the CNL’s focus on optimizing patient outcomes. A few examples include:

  • Collaborating with the healthcare team on improvement opportunities
  • Evaluating patient handoffs to improve outcomes
  • Ensuring ethical decision-making
  • Incorporating appropriate patient-care technologies
  • Promoting interprofessional collaboration in patient-centered care
  • Using performance measures to improve the delivery of evidence-based practices
  • Evaluating medication reconciliation and administration processes to enhance the safe use of medications

Nightingale also advocated for patients at a policy level. In “The Voice of Florence Nightingale on Advocacy,” authors Louise C. Selanders, RN, EdD, FAAN and Patrick C. Crane, MSN, RN describe Nightingale’s frustration with a particular hospital policy. This policy limited hospital admission to those who were members of the Church of England. Nightingale eventually won the fight to admit patients regardless of their religious beliefs.

Advocating at the policy level is an important aspect of the CNL role as well. For example, CNL competencies include advocating for equitable health policies that “address healthcare disparities” and “leverage social change, promote wellness, improve care outcomes, and reduce costs.”

Education also relates to patient advocacy. Evidence links higher levels of nurse education to better patient outcomes. Nightingale, an early advocate of educated nurses, established the first professional nursing school. Today, the Code of Ethics for Nursing calls for “continuation of professional growth,” and “a commitment to lifelong learning.”

On this note, CNLs can advocate for patients by promoting clinical excellence through professional development. For example, continuing education courses can help nurses keep up to date on the latest medical technologies.

In The Future of Nursing, the IOM called on nurses to be “full partners, with physicians and other health professionals, in redesigning health care in the United States.” Earning an MSN – CNL can help nurses achieve this goal.

Some advanced nursing roles focus more on the administrative side of care, such as staffing and budgets. For RNs who want to remain actively involved with patients, the CNL role offers an innovative opportunity. As leaders on interdisciplinary teams, CNLs can advocate for both their patients and the nursing profession to achieve quality care.

Learn more about ULM’s online MSN – Clinical Nurse Leader Concentration program.


Institute of Medicine: To Err Is Human: Building a Safer Health System

NCBI: Clinical Leadership Development and Education for Nurses: Prospects and Opportunities

American Association of Colleges of Nursing: CNL Certification – History

American Association of Colleges of Nursing: Clinical Nurse Leader (CNL)

ANA: Code of Ethics for Nurses With Interpretive Statements

American Association of Colleges of Nursing: Competencies and Curricular Expectations for Clinical Nurse Leader Education and Practice

Online Journal of Issues in Nursing: The Voice of Florence Nightingale on Advocacy

RWJF: Building the Case for More Highly Educated Nurses

NCBI: The Future of Nursing: Leading Change, Advancing Health

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