Implementing the Clinical Nurse Leader Role to Improve RN Satisfaction in an Emergency Department Microsystem

This quality improvement project aimed to enhance registered nurse (RN) satisfaction in the ED microsystem through implementation of the Clinical Nurse Leader (CNL) role. The target population consisted of RN staff in the Emergency Department ED microsystem at the acute care hospital. According to the National Database of Nursing Quality Indicators (NDNQI), the hospital’s current data on RN satisfaction and ED performance metrics were below the national benchmark. A fishbone analysis identified causes of RN dissatisfaction, including insufficient staff collaboration and a lack of leadership and support from management on the unit. A SWOT analysis evaluated strengths, weaknesses, opportunities, and threats associated with implementing the CNL role. The intervention of this project was organized into three phases. Phase I involves creating and conducting a needs analysis, involving a questionnaire aligned with the seven CNL core competencies, to assess the current environment establishing satisfaction baselines, gather nurse feedback, and evaluate the feasibility and potential impact of the CNL role. Phase II focuses on preparing for the CNL role by establishing a budget, defining the job description, and creating a job description table along with a Venn diagram to clearly differentiate the CNL’s responsibilities from similar leadership roles, such as the Clinical Nurse Educator (CNE) and Clinical Nurse Specialist (CNS). Approval from Human Resources, the microsystem manager, and nursing director will be sought from the resource committee to integrate the CNL role into the hospital’s ED organizational structure. Lastly, Phase III involves planning to fill the CNL position through advertising, selecting candidates, and training on unit protocols and team dynamics. Cyclical appraisals, incorporating staff feedback and performance auditing, would be implemented to ensure CNLs are meeting the project’s objectives.Due to time constraints and budget denial, the CNL role implementation was not achieved within the project’s time frame, and we remained in the planning stage of the interventions. Nevertheless, the anticipated benefits of implementing the CNL role include increased RN satisfaction and improved patient care outcomes in the ED microsystem.