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Nurses for the 21st Century

Patients today face a fractured healthcare system and the threat of deadly medical errors. Clinical nurse leaders are being trained to combat these thorny problems.

A bit of bone marrow was a small thing for Rebecca Stanley to give up, if it meant saving a life. Not only did it help zap her sister’s cancer, it also changed the course of Stanley’s career. “The whole experience was pretty intense,” she says. “The nurses were amazing; they had such an impact on me and my whole family.” The encounter was so special, she decided to become a nurse herself.

“I wanted something more fulfilling,” says the former art student who once worked for a paper broker. Then Stanley looked into Seton Hall’s clinical nurse leader (CNL) program. “I saw how much it was devoted to making positive changes in health care, helping with costs and patient care,” she says. “I started taking classes and loved it.”

Clinical nurse leaders coordinate the care patients get from physicians and other healthcare providers as they move throughout the medical system, be it in a hospital’s intensive care unit or maternity ward, an assisted living facility or rehabilitation center. CNLs, who earn master’s degrees in the science of nursing, focus on quality improvement and safety.

These nurses solve problems and monitor patients’ care, as all nurses do. But they also analyze how to improve processes. They identify risks in care, such as patient falls or ineffective emergency-room policies, and research peer-reviewed journals to learn how others have resolved similar issues. CNLs then put this “evidence-based practice” into action by leading fellow nurses, physicians, pharmacists, healthcare specialists, social workers and others toward better patient care and policies.

“CNLs are raising the profile of Seton Hall’s College of Nursing,” says Dean Phyllis Hansell, Ed.D. “This is a new, innovative model of nursing education that’s taking hold nationally. … We’re looking forward to seeing a lot of changes for the better.”

The nation’s disjointed healthcare system needs it. There is often iscommunication between different specialists. “You have several doctors, different nurses, pharmacists — all these people — and they don’t always coordinate care,” says Phyllis Russo, Ed.D., director of Seton Hall’s CNL program. Medication mishaps, hospital-induced infections and misread patient charts may result.

According to a 1999 report issued by The Institute of Medicine, as many as 98,000 people die in hospitals each year from preventable medical errors. That’s more deaths than from motor-vehicle accidents, breast cancer or AIDS.

The situation prompted the American Association of Colleges of Nursing to create the clinical nurse leader position as a new model for patient care, focusing on organizational skills in addition to clinical expertise. Today, 88 U.S. universities have a CNL program and, as of April, there were 1,000 certified CNLs, says Mary Stachowiak, president of the Clinical Nurse Leader Association.

Seton Hall’s program, introduced in 2008, is the only one in the New York metro area that enables people without undergraduate nursing degrees to enter nursing at the master’s level. Artists and attorneys, teachers and psychologists enter the full-time, 22-month program and, in their final semester, immerse themselves four days a week, eight hours a day doing hands-on work at New Jersey hospitals and other healthcare agencies.
Even as the students learn, they bring new perspectives to hospital CNLs, says Patrick Troy, associate director for patient care services for the Veterans Affairs New Jersey Health Care System. “Their enthusiasm creates even more interest and refreshes the practice.”

Bob LaPointe, M.S.N. ’10, a former mental health administrator, is charged up. “Being a CNL will allow me to build on what I was doing before, helping people on a day-to-day basis, while addressing system and policy issues. I’m really excited about bridging the gaps between science and practice, and research and implementation.”

CNLs also face challenges. Many people don’t yet fully understand their role, and healthcare cuts hinder the profession’s growth. The expectation is that as CNL educational programs develop and these nurses demonstrate what they’re capable of, they will continue to prove their value.

Seton Hall’s students are already doing just that. At the VA Medical Center, students each picked a project that relates to an aspect of healthcare reform. One helped alter emergency-room policy to allow admitting nurses to order X-rays, which cut patient wait times and department costs. “Our CNLs are implementing changes in the positive direction that health care is going in,” says Linda D’Antonio, a faculty associate in the College of Nursing. “And that’s a real shining star for Seton Hall.”

Claire Sykes is a freelance writer in Portland, Oregon. She can be reached at

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