What do you think are the implications and possibilities for utilizing CNLs in state and psychiatric hospitals? (If you would like some background, see our August newsletter for an article review on CNL in TJC's Patient Safety)
Last Edited on 3-Aug-2009 12:44 PM
Liz
Guest Aug 03, 2009
12:53 PM
My first take is that since the psychiatric hospitals here are all looking at ways to cut costs – including using less RN time, that this would only add to their budgetary problems. I have not seen them in use here at all. On the other hand, given some of the other cost saving indicators that seem to be positively impacted by the CNL, according to the article, the position may in the long run decrease costs. But it would take a bit of convincing and some solid data to get this started on psych units.
I consider the Clinical Nurse Leader to be an excellent idea---and we will need to wait to see how it works over time. This is one of the first real attempts to change the culture of nursing practice within hospital settings, and I do hope that it will work. I view it as having quite a bit in common with the new "Hospitalist" role in medicine. Most schools of nursing, I believe, have begun with students who have undergrad degrees in other fields and trained them to be both a nurse and a CNL in 3 years. (I believe that there has been federal funding for this.) Because the CNL is a generalist, I doubt that universities would be interested in partnering with psychiatric hospitals; however, there may be some interest in using a psych hospital for a rotation site.
There could be a significant impact if the curriculum at the master's or post masters level is flexible enough to allow the psychiatric nurse to pursue clinical leadership practicum's. I looked at an example of the test for the certificate and it was a clinical case with scenario questions about what the nurse clinical leader would do and although it was a med surg patient it could be easily applied in the psychiatric setting. The problem as I see it is what would encourage nurses to choose the clinical leadership pathway in the first place. I looked at Vanderbilt University that allows home computer course work which would allow the nurse to be employed and not leave home and wondered the costs. Also I'm wondering if Master's prepared nurses could sit for the exam with a modified course program. I might write to the Vanderbilt leadership and ask them!!! All in all from what I understand about the course content and intent, a prepared clinical nurse leader would have an impact in psychiatry and general hospitals as well. I'm most disappointed in what I have experienced as a recipient of care /and or family member of the patient with the nursing leadership ( head nurse, manager and/or charge nurse ) and what they don't do. Most would say it is because of time but I believe it's because they don't know what the role is and have limited critical thinking skills. As for the psychiatric scene I'd have to think hard to identify but a few whom I have met that would fit the model of the clinical nurse leader. Having said what I just said, the psychiatric leadership would have to be educated to know that there is a nurse expertise available which would have a positive impact on patient care delivery and safety and establish an incentive for nurses to want to become Clinical Nurse Leaders. Let me know your thoughts.
I did not answer your question re potential for CNLs in psych hospitals ---but I am not certain that I know the question. I do not know how many CNLs have been certified to date, but I believe that the number will be very small for quite a while. Only nurses who graduated from a specialized program to prep CNLs ---"advanced generalists" at the masters level are allowed to take the exam. If the CNL "takes off", I do believe that psych hospitals could benefit from their services. The attraction is that their focus is exactly the focus of Joint Commission "patient tracers"--- providing and managing care at the point of care with an emphasis on EBP, ongoing assessment, management of risks, coordination with the team and various departments to ensure quality and safety, etc.... A concern is that the CNL is intended to be a clinical leader at the unit level and is NOT prepared or intended to be an administrator or hospital level manager. Because these people will expect higher salaries, I believe that state hospitals will have difficulty finding appropriate positions for them. Even though they are not specialists, I could envision CNLs assisting state hospitals to re-structure how they provide nursing care and how nursing staff coordinate efforts with other staff. This is something that is needed in almost every state hospital----but currently they are not willing to invest money for this type of consultation.
I think it would be a good idea but I doubt psych hospitals will use them because they rarely use Clinical Nurse Specialists now. That concept has been around since I finished school ages ago. SMILE. However, many psych hospitals are beginning to use NPs to do H&Ps and admission work-ups.
