Clinical Nurse Leaders Making a Difference at VA

A man and woman nurse look at a computer and smile in a hospital corridor

Kimberly Kirkpatrick, a CNL at the Portland VA, discusses a patient’s diabetes flow sheet with LPN Paul Ahola.

Slowly but surely, VA is introducing a whole new kind of nurse at its medical centers across the country, and it’s making a noticeable difference in the level of care patients are receiving.

They’re called Clinical Nurse Leaders (CNLs).

“These health care professionals absorb vast amounts of information every day and get that information to those who need it, when they need it,” explained Cathy Rick, chief nursing officer for VA. “They help to ensure that the unit is performing at peak efficiency and that every patient’s needs are being addressed.”

Clearing Roadblocks

Rick said the CNL is not a Nurse Manager, the traditional ‘boss’ of any nursing unit, but something very different.

“Unlike the Nurse Manager, who must often spend a considerable amount of time and energy dealing with administrative issues, the CNL remains on the nursing unit, in the thick of things, serving as a resource for nurses and an advocate for each patient,” Rick said. “The CNL is an expert at clearing away care roadblocks and keeps a close watch on the status and progress of each patient, as well as their safety.”

Marjory Williams, program director for the VA Office of Nursing Services CNL Implementation & Evaluation Service in Temple, Texas, said VA’s goal is to have CNLs at all points of care across the VA system within the next three years.

“We had 188 CNLs last year,” she reported. “This year we have around 300. And we have an additional 75 nurses enrolled in CNL academic programs, reflecting an ongoing pipeline of emerging CNL talent.”

 Every nurse wants to provide the best possible care to their patients. I help them do that. 
— Kimberly Kirkpatrick, Portland VA Medical Center

The Name of the Game: Communication

Shawna Clausen is one of VA’s original CNLs, having helped implement the CNL role at the Minneapolis VA back in 2005. Currently the Home and Community Care Director at Minneapolis, Clausen said her most important job as a CNL was, without a doubt, communication.

“For example,” Clausen said, “it’s important for the next shift to know everything about a given patient; whether it’s their diagnosis, any safety precautions that are needed, any medication changes. My job was to carry over important information from earlier in the week, from interdisciplinary team rounds, from the physicians, and disseminate it to the front line staff that needed it.

“My role was also to provide education, as needed, so if something new came up that the nurses weren’t familiar with, I could provide them with some detail,” Clausen explained.

two female nurses viewing a computer screen

Kimberly Kirkpatrick (left), a CNL at the Portland VA, discusses a patient’s diabetes flow sheet with staff nurse Andrea Elia Gill, a Marine Corps Veteran.

Seeing the Forest, Not the Trees

Claire Gangware, a CNL at the Jesse Brown VA Medical Center, Chicago, Ill., since 2009, said CNLs often encounters situations that not only require in-depth technical skills, but an emotional intelligence that enables them to quickly grasp what’s actually happening with a particular patient.

“A patient recently transferred to our unit with lung cancer,” Gangware said. “He hadn’t been with us long; our primary goal was to stabilize him so he could be transferred to a nursing home closer to where he lived.”

Gangware said she was visiting the patient one day when she suddenly sensed that something was different.

“I got a feeling that he seemed to be declining,” she said. “I was worried that he wouldn’t make it to the nursing home where his family was planning to visit him.

“His son happened to call while I was there; the two talked for a bit, but not too long. When their conversation ended, I decided to go out on a limb: I asked him if he had said everything to his son that he would want to say if they didn’t get a chance to talk again. He got quiet for a minute, then looked at me and said, ‘You don’t think I have long to live, do you?’

“He asked me to call his son and ask him to come visit that evening,” Gangware said. “The son came to see his father, which was good, because the next morning his father died, with the son at his bedside.

“A significant part of my job,” she added, “is to see the broader picture, to see the whole patient — not just what antibiotics he needs that day, or what lab work needs to be done. That information is then communicated to the whole team, which helps us interact with the patient on a more personal, thorough level and improves the quality of care.”

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