The AACN developed this role as a clinical nurse leader to really provide more highly skilled clinicians that remain in the direct care setting. They provide support to the nursing staff and all members of the team, and they serve as an expert resource. So, for example, if someone has a clinical question about a specific disease, the clinical nurse leader can serve as a resource for that nurse. In addition, they provide really valuable leadership in bringing staff together to focus on patient safety issues, quality outcomes, and effective coordination and continuity of care for veterans. They are there to help the staff and interact with the families and then, last but certainly not least, they are also helping to increase efficiency and sustainability of improvements and looking at areas in which we can make some process improvements, or redesign systems and integrate them into the way that we practice and the care that we provide to our veterans. So it’s really that one individual that helps bring together and integrate all of the change and improvements to the delivery of care.

The nurse practitioners really are part of the solution to assisting with our shortage of clinicians in providing primary and specialty care services and meeting the rising demand of our health care needs for us in the VA and as a nation.

In 2011, the Office of Nursing Services launched the CNL Implementation and Evaluation Service to provide assistance, guidance, and onsite consultation to VA medical facilities. Today, there are over 400 CNLs in the VA nursing workforce, and the integration of CNL practice continues to expand throughout our inpatient, outpatient, long-term care, and specialty care areas across the entire VHA health care system.

 

Are clinical nurse leaders also becoming more common outside the Veterans Health Administration?

Yes, I believe they are. In fact, I’m aware of a number of academic institutions that have just started new programs or are getting ready to start their new program this fall. But over the last decade, 10 years, since its inception, there are now several thousand CNLs across the nation, and they’ve developed a certification to test the knowledge and expertise for this group. I think that as people see the demonstrated value in the workforce that more and more institutions are employing them and encouraging their staff to go back to school to become a clinical nurse leader.

 

Could you describe the role nurse practitioners play today in the Veterans Health Administration?

They play a very critical role for us here in the VA. I can tell you that we have over 6,000 nurse practitioners practicing and working here in the VA currently. What’s important about them and their role is that they really help provide care to our veterans. The majority work in primary care, but also specialty care. Many nurse practitioners have specialized in different areas of care, and so they have been providing those specialized services to our veterans both in the medical centers and in our clinics as well.

 

Do you see that demand for nurse practitioners increasing because of the demographics that are at work today?

Yes. I actually see the nurse practitioner role helping with our access issues and the demand with our veteran population and, also in the private sector, the demand and the need for health care as our population continues to age. There is increasing demand due to, as we know, the graying of America, with the baby boomers retiring, and with the implementation of the Affordable Care Act. There is, as well, the projected shortage of primary care physicians. All of these factors will overburden our nation’s health care system and the VA will experience many of the same issues. So, the nurse practitioners really are part of the solution to assisting with our shortage of clinicians in providing primary and specialty care services and meeting the rising demand of our health care needs for us in the VA and as a nation.

Often, nurse practitioners very much want to and enjoy practicing in rural health care settings, and in particular if they come from a rural setting, they really want to stay or go back home to their hometowns and enjoy providing care to their neighbors, back in the rural setting, so I really do see nurse practitioners as part of the solution.

 

I know that’s definitely a need, to try to expand access to care, so that seems like a good thing.

Yes, yes, most definitely.

 

When did nurse practitioners first begin practicing within the VA?

It’s interesting – because it was hard to believe myself, looking at that – but we actually had nurse practitioners that were added to the VA model of care back in 1973. So we have gone from having 43 nurse practitioner positions beginning in 1973 to having, now, over 6,000 nurse practitioners working in the VA. They certainly have assisted us in providing care and meeting that demand for care.

 

What recent technological or medical advances do you think have had a large impact on nursing in the VA system?

I think what’s exciting about that is we’ve been able to use technology to really help support and enhance the delivery of care. Not replace it, but enhance it.