2006 Resolution - 003

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SUBJECT: The United American Nurses’ Position on Clinical Nurse Leader

Introduced by: The E&GW Commission of the Minnesota Nurses Association

Action: Passed Unanimously 3/16/06

WHEREAS, the Clinical Nurse Leader (CNL) is an RN with a master’s degree preparing the nurse to oversee care coordination and evaluate care for a distinct group of patients and actively direct patient care in complex situations (UAN Report for National Labor Cabinet, 2005); and

WHEREAS, the CNL role purports to address the nursing shortage by filling a gap in the current health care arena by preparing another educationally different path of master’s prepared nursing leaders who can focus on the structure, processes, and procedures of both the formal and informal systems of care as well as policy-level decision making in the organizational and national health policy arenas (Journal of Professional Nursing, March-April, 2005); and

WHEREAS, recent data (Aiken, 2002, Needleman, 2002, IOM Report: Keeping Patients Safe, 2004) have exhibited a correlation between the amount, type, and skill mix of nursing staff at the bedside with patient morbidity and mortality statistics; and

WHEREAS, currently the RN at the point of care assumes the responsibility and plan development, implementation, and evaluation of the client/patient plan of care; and

WHEREAS, not only are nurses at the bedside expected to delegate and deliver highly complicated, individualized care to patients who are sicker, increasingly diverse, more informed, they are also responsible for unplanned system and environmental factors in a condensed time frame (“Complexity Compression,” Minnesota Nursing Accent, 2005); and

WHEREAS, implementation of the CNL role moves responsibility and accountability for patient care away from the RN and the point of care; and

WHEREAS, implementation of the CNL role directly conflicts with UAN collective bargaining work thereby eliminating collective bargaining positions; and

WHEREAS, implementation of the CNL role places a novice RN in a position of leadership over the expert nurse, thereby interfering with the novice to expert model of nursing care; and

WHEREAS, implementation of the CNL role adds to the burden of the current critical shortage of nurse educators; and

WHEREAS, implementation of the CNL role creates confusion for the patient population, adding yet another level of care providers; and

WHEREAS, the CNL role creates an additional layer of nursing personnel that could complicate and confuse the authority for clinical decision making and communication within the health care team; and

WHEREAS, lack of communication among the health care team is the number one cause of sentinel events (JCAHO Resource Report, 2005); and

WHEREAS, patient safety data supports authority for clinical decision making to be at the bedside where specific expertise about the decision exists (IOM Report: Keeping Patients Safe, 2004); and

WHEREAS, the CNL role is duplicative of current nursing positions, e.g. assistant nurse managers and clinical nurse specialists, further dividing, rather than uniting, practice and education; and

WHEREAS, the role description of the CNL compares to the highest level of expert practice as described by Benner (Expertise in Nursing Practice, 1996) when, in reality, the curriculum does not require expertise gained with experience at the bedside; and

WHEREAS, we currently have programs that serve post-baccalaureate students on a fast track to a certificate in nursing as well as BSN programs designed to meet the needs of these students; and

WHEREAS, we recognize new curricula and changes in nursing are inevitable and certain; we believe elected nursing leaders in practice as well as academia should be shaping the future of nursing education; and

WHEREAS, research-based evidence that the role of the CNL improves care for patients or enhances nursing practice is absent in the literature;

NOW THEREFORE BE IT RESOLVED, that UAN continue to support a nursing care model that encourages professional growth of the RN at the bedside and in the workplace while maintaining decision-making at the point of care; and

BE IT FURTHER RESOLVED, that UAN supports its members’ right to collective bargaining and will protect all bargaining unit work; and

BE IT FURTHER RESOLVED, that UAN supports registered nurse leadership roles in its collective bargaining units for experienced, expert nurses who are uniquely qualified to work with patient populations and direct care at a systems level while keeping their expertise at the bedside. UAN does not support entry level nurses starting their career in management roles; and

BE IT FURTHER RESOLVED, that UAN provide education to bargaining unit leaders by preparing and distributing information, including speaking points in the Activist and on its web site to enable our members to speak with managers and administration about this role; and

BE IT FURTHER RESOLVED, that UAN support efforts of its members to enhance the expertise and leadership abilities of experienced clinical registered nurses; and

BE IT FURTHER RESOLVED, that UAN support and create partnerships where Registered Nurses from education programs and practice settings engage in a collaborative effort in the curriculum development stage of any proposed new roles for nursing practice settings; and

BE IT FURTHER RESOLVED, that UAN will demand to have a voice whenever changes in the nursing care delivery system and the role of the bedside nurse in providing quality care and maintaining safety of the patient is being discussed; and

BE IT FURTHER RESOLVED, that UAN will use collective bargaining and political action to achieve these demands; and

BE IT FINALLY RESOLVED, that the UAN opposes the Clinical Nurse Leader role, will convey this resolution to the AACN (developers of this role), and will forward this to ANA as a resolution for the June 2006 HOD.