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The vision for the Clinical Nurse Leader(CNL) role began in response to the quality and safety reports of the Institute of Medicine (IOM). As a nurse with advanced master's level preparation and specialized health system clinical leadership competencies, the CNL is prepared for direct clinical leadership at the point of care to ensure that care delivery is safe, evidence-based, and targeted towards optimal quality outcomes for the cohort of clients served by the CNL.

With specific regard to a culture of safety, a critical component of the CNL role centers on improving effective interdisciplinary communication and coordination at the point of care. One of the biggest challenges in our complex healthcare settings is effective and timely communication among multiple healthcare providers, including physicians, nurses, therapists, and consultants (Reid & Dennison, 2011).

Without this communication, care can become fragmented for the patient and family, increasing their risk of harm. An important part of the CNL role is to fill this gap by insuring that patient and family needs are not only assessed, but also consistently communicated with all members of the healthcare team so that care can be more effectively coordinated. This communication and coordination is also vitally important as patients move from setting to another within the system because gaps in care are prone to occur during these moves.

This coordination of care between settings, often referred to as ‘lateral integration,' enables the CNL to serve not only as the patient advocate/care navigator, but more importantly, as the stop-gap professional to reduce fragmentation in care that may lead to lapses in the safety of the care provided. One of the early examples of the CNLs ability to provide strong evidence supporting point-of-care clinical leadership was the 12-bed hospital project at Baptist Hospital in Miami, Florida.

Implementation of the CNL role, along with a work redesign, showed improved patient throughput, consistent scores in the top ten percent on Centers for Medicare and Medicaid Services (CMS) core measures, and high patient satisfaction. The 12-bed hospital model of care delivery, including the Clinical Nurse Leader, has been recognized by the Robert Wood Johnson Foundation as one of the most innovative and promising new care delivery models (Reid & Dennison, 2011).

Reid,. K., Dennison, P., (September 30, 2011) "The Clinical Nurse Leader (CNL): Point-of-Care Safety Clinician" OJIN: The Online Journal of Issues in Nursing Vol. 16, No. 3, Manuscript 4.