Diffusion of a Nurse-led Healthcare Innovation: Describing Certified Clinical Nurse Leader Integration Into Care Delivery.

JONA Volume 46, Number 7/8, pp 400-407 Copyright B 2016 Wolters Kluwer Health, Inc. All rights reserved. THE JOURNAL OF NURSING ADMINISTRATION Diffusion of a Nurse-led Healthcare Innovation Describing Certified Clinical Nurse Leader Integration Into Care Delivery Miriam Bender, PhD Marjory Williams, PhD Wei Su, PhD BACKGROUND: The Clinical Nurse Leaderi (CNL) initiative is in its 2nd decade. Despite a growing theoretical and empirical body of CNL knowledge, little is known about CNLs themselves or where and how their competencies are being integrated into care delivery across the country. OBJECTIVE: The aim of this study was to describe certified CNL characteristics and roles as part of a larger study validating a model for CNL practice. METHODS: This study used a descriptive analysis of survey data from a national sample of certified CNLs. RESULTS: Survey response rate was 19%. Sixty per- cent have greater than 10 years of RN experience, and 75% have additional specialty certifications. Fifty-eight percent are practicing in a formal CNL role and report a high degree of accountability for all 9 CNL essential competencies. Author Affiliations: University of California, Irvine (Dr Bender); Central Texas Veterans Health Care System, Temple (Dr Williams); and School of Public Health, University of Alabama at Birmingham (Dr Su). This study was funded by the Commission on Nurse Certifica- tion, Washington, DC, and the University of California, Irvine_s Center for Organizational Research. This work was completed with support from the Central Texas Veterans Health Care System. The views are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. The authors have no other disclosures. The authors declare no conflicts of interest. Correspondence: Dr Bender, Program in Nursing Science, University of California, Irvine, 252C Berk Hall, Irvine, CA 92697- 3959 (miriamb@uci.edu). Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal_s Web site (www.jonajournal.com). DOI: 10.1097/NNA.0000000000000365 CONCLUSIONS: Findings help understand the ex- tent of CNL adoption and spread across the country and the level to which the initial vision of CNL prac- tice is being achieved. Healthcare delivery is a complex process tasked with reducing the burden of illness and increasing overall health of the population. The system currently in place is unable to provide consistent high-quality care. 1,2 Medical care and healthcare services have become more complex and increasingly specialized. Speciali- zation of care settings and practitioners has resulted in a narrowed focus for care in each setting and spe- cialty. Despite unprecedented advances, a consequence of specialization is fragmented care. 3 Barriers to pro- viding adequate, real-time coordination among spe- cialties and practitioners in the current fragmented system contribute to patterns of care delivery that fall short of achieving desired overall patient care quality. The Clinical Nurse Leader Initiative The nursing profession is playing a key role in re- designing care delivery to bridge the gap between fragmented care and integrated multidisciplinary care processes. 4 One example is the Clinical Nurse Leader (CNL) initiative. The American Association of Colleges of Nursing (AACN) launched the CNL initiative more than a decade ago as a key nursing strategy for re- designing care delivery to address quality and safety gaps. The CNL is an RN with a Master_s level educa- tion and advanced competencies in clinical leadership, care environment management, and clinical outcomes JONA Vol. 46, No. 7/8 July/August 2016 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.