Veronica Rankin DNP, MSN, RN-BC, NP-C, CNL

By Erin Flynn Jay

Veronica Rankin decided to become a Clinical Nurse Leader (CNL®) because while she had a desire to earn her master’s in nursing, she also wanted to remain at the bedside, impacting care with frontline nurses. As a nurse many years ago, she envisioned the need for such a role, so when the opportunity presented itself she knew it was her calling.

Rankin loves the patient interaction at Carolinas Medical Center, Atrium Health, in North Carolina, and building her relationships with patients, their families, and her nursing colleagues. “As a CNL®, I serve as the ‘all-purpose cleaner’ to resolve barriers regarding top-quality care provision of a group of patients I am assigned to. My job is to oversee the clinical outcomes of these patients while they are on my unit for however long they need to be hospitalized,” said Rankin. “Before becoming a CNL®, I identified a need for a back-up clinical expert to catch the flags that busy nurses can sometimes miss at the bedside. I felt we needed someone who could step back, look at the big picture of what is going on with a patient and maintain the continuity of care that is oftentimes weakened in our current practice models. You have one CNL® assigned to several rooms. The CNL® is the constant in that patient’s journey throughout his or her hospitalization.”

Rankin recalls one special story related to her role as a CNL®. After completing an assessment of her unit, she realized that more than one-third of the unit's population consisted of older adult patients aged 65 years old or greater. Consequently, she led an initiative that resulted in a NICHE (Nurse Improving Care for Healthsystem Elders) designation that afforded her and her colleagues geriatric-friendly training, education, and open access to best-practice resources geared toward improving care outcomes for older adult patients.

“One elderly patient was being discharged from my unit back to his home. This patient informed the team that he could afford all of his home medications and would attend his follow-up appointment with his primary doctor. Although the patient seemed particularly in a hurry to be discharged home, it wasn't until further assessment of his chart and past medical history that I sensed inconsistencies with his reports,” she said. “Upon further questioning, the patient admitted that he and his elderly wife could not afford their medications and food daily. He shared that there were times that they had to decide to eat OR purchase their medicines. He shared that he was in a hurry to get home because his wife was home by herself without a caregiver.”

Rankin shared this update with the team and consulted the medical social worker to help this patient. Within a few hours, the patient was discharged home with a month's supply of medications, a change in many of his medications to cheaper generic forms of the medications (making many of them free with their insurance), Meals-on-Wheels, and free transportation arrangements with the Salvation Army. She was able to use her CNL® skills that included advanced assessment, patient advocacy, risk anticipation, and team management to ensure that this patient's needs were met to improve his outcomes even after hospital discharge.

Now a Clinical Nurse Leader since August 2011, Rankin said she believes in the validation of clinical expertise in leadership and practice. “I wanted to have that proof for my partners and anyone else who may be questioning my education and training,” she said. “I have proof of why I am making these decisions in the practice setting.”

When asked about the most difficult part about becoming certified as a CNL, Rankin stated that she mostly feared not knowing what she would be asked on the exam. Rankin said there was so much information it could cover that she was afraid she would miss something and not be prepared.

Rankin said the best study tactic she used to prepare for the exam was writing out flashcards. She went through the notes she took during her two-year CNL master’s program. She got in touch with other CNLs® who had passed the exam to ask them what tools or books they found helpful. Rankin also studied the 40-page white paper that’s offered by the American Association of Colleges of Nursing on the CNL® role.

With any practice questions that Rankin did not know, she would dig into that concept to make sure she had a thorough understanding going into the exam. If she had to do it over, she would stress less about clinical assessment techniques because they were not asked on the exam. “The exam did not go that deeply into the assessment factor,” she said.

Rankin had to recertify in 2016. “I had to prove that I am continuing to pursue education in CNL-related updates with hours of education, where and who offered that CE. I don’t have to do that again until 2021,” she said.

A typical day for Rankin is rounding with her fellow CNLs® to see how things are going. She attends quality meetings at the hospital because they are focused on patient outcomes. Rankin serves as the CNL® Coordinator for the entire CNL program at her hospital. She tracks patient outcome trends on all 12 CNL® units and helps guide their focus to identify and improve areas of opportunity.

Her favorite part of being a Clinical Nurse Leader is empowering nurses to serve as leaders and realize their worth to the business of healthcare. Rankin feels she helps her patients the most by “growing clinically competent nurses who are empowered to make autonomous decisions about the care needs of the patients.”

Rankin is also certified as a medical-surgical nurse and completed her Doctor of Nursing degree in 2018.

 

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