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"It is evident that leadership in nursing is of supreme importance at this time. Nursing has faced many critical situations in its long history. What the outcome will be depends in large measure on the king of leadership the nursing profession can give in planning for the future and in solving stubborn and perplexing problems." (I.M. Stewart, The Education of Nurses, 1953).
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"Managed care movement in the 1990s created a downturn in the numbers of available CNSs because of the perception of a lack of value. This led to a lack of sufficient numbers of educationally prepared individuals who could manage patient safety and quality of care initiatives lead to poored quality care and a need fill the void." (Goudreau, 2008).
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"Nursing school enrollment and graduation rates have dropped. Since 1995, nursing baccalaureate-level graduation rates have dropped 23 percent, and associate level graduation rates have fallen 30 percent." (NLN).
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In 1998, hospitals began to experience the 2nd nursing shortage of the decade and did not resolve quickly. It has lingered and by 2002 it will enter its 5th consecutive year (Buerhaus, Staiger, Auerbach, 2003).
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"IOM reports in To Err is Human: Building a Safer Health System that somewhere between 44000 and 98000 Americans die each year as a result of medical errors. It also focused on the fragmented nature of the health care system." (AACN, White Paper for CNL, 2007).
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AACN board of directors engaged in extensive deliberations about the future of the nursing profession related to declining school of nursing enrollments. (Tornabeni, 2006).
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"AACN agreed that major and fundamental changes had to be made in education, practice, licensure, and credentialing if nursing was to be a career choice.
AACN board created 2 task forces:
1. Task Force on Education and Regulation for Professional Nursing Practice (TFER1)
2. Task Force on the Hallmarks of Professional Practice Environments." (Tornabeni, 2006). -
According to a study by Dr. Peter Buerhaus, the US will experience a 20% shortage in the number of nurses needed in our nation's health care system (AACN, White Paper on the Education and Role of the Clinical Nurse Leader, 2007).
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"The US healthcare system, fueled by the Medicare Act, is the most expensive in the world. For 25 years, US healthcare expenditures have experienced double digit growth, reaching $1.4 trillion." (Wiggins, 2006).
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"Aiken et al did a study and reported about the current nursing shortage, high hospital nurse job dissatisfaction, and uneven quality of hospital care. Nurses want more communication with management about the allocation of resources and the creation of an environment that is conduice to high-quality care." (Aiken et. al, 2001).
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"Discussion about the need for the CNL role began when AACN convened stakeholders to discuss what changes were needed in nursing education to prepare nurses with the competencies which they need to work in the current and future health care system (AACN, 2005).
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"Task Force on Education and Regulation for Professional Nursing Practice (TFER1) final report was released recommending that new educational models were needed to be developed as well as a new role for nursing competencies." (Tornabeni, 2006).
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"This report was commissioned by the Robert Wood Johnson Foundation to take a broad look at the underlying factors driving the nursing shortage. One of the key is the reinvention of nursing education and work environments to address and appeal to the needs and values of a new generation of nurses." (AACN, 2007).
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"Report calls for the creation of organizational cultures of retention, bolstering nursing educational infrastructures, and establishing financial incentives for nursing. Noted that 25% of sentinel events are nurse-related and predominant nurse factors in these events are competence and training of the nursing staff." (Bartels & Bednash, 2005).
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"Made a report and recommends that healthcare delivery systems make work design an organizational priority. A focus on competence, building interdisciplinary educational opportunities, diversifying the workforce, and capitalizing on parternships with the educational community." (Bartels and Bednash, 2005).
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Task Force on the Hallmarks of Professional Practice Environments held an external stakeholder panel that confirmed the new and compentencies needed for this new role...Clinical Nurse Leader. The Working Paper on the Role of the Clinical Nurse Leader was written. (Tornabeni, 2006).
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"Study done by Aiken et al in 1998 to 1999 showed that hospitals with higher proportions of nurses educated at the baccalureate level or higher, surgical patients experienced lower mortality and failure to rescue rates." (Aiken et al, 2003).
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AACN introduced the CNL pilot project. First time in more than 40 years that an attempt was made to introduce a new role to the nursing profession. Role was designed to address many challenges related to patient care in the current health care system (AACN, 2004). University Hospital a 551-bed nonprofit hospital located in Augusta, Georgia, launched a pilot of the unit based CNL role to support staff nurses and their patients. (Bowcott, Wall, Goolsby, 2006).
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"Dramatic changes in healthcare-an aging population, growing diversity, biomedical advances-all require nurses with more knowledge, more education, and more skills." (Bartels, 2005).
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"From January 2005 to April 2005, the CNL implementation task force held a series of 5 regional meetings to prepare for the major change envisioned. In March 2005, an evaluation committee was appointed with the charge of identifying the outcomes expected from the CNL initiative." (Tornabeni, 2006).
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AACN publishes the White Paper on the Education and Role of the Clinical Nurse Leader. The document delinates both entry-level competenies for all professional nurses and those competencies of the Clinical Nurse Leader.
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There are over 70 educational institutions in the United States that offer the CNL program. (AACN website)
