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.”
One of Rankin’s most memorable stories involves her efforts to improve care for older adult patients. After completing an assessment of her unit, she realized that more than one-third of the unit’s population consisted of patients aged 65 or older. 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 access to best-practice resources.
She recalls one case in particular:
“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,” Rankin said.
Upon further questioning, the patient admitted that he and his elderly wife could not afford their medications and food daily. At times, they had to decide between eating or purchasing their medicines. He also admitted he was in a hurry to return home because his wife was alone without a caregiver.
Rankin shared this update with the team and consulted the medical social worker to help. Within hours, the patient was discharged home with a month’s supply of medications, prescriptions switched to lower-cost generics, Meals-on-Wheels arranged, and free transportation services provided. “I was able to use my 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,” she said.
Now a Clinical Nurse Leader since 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 of becoming certified, Rankin shared that she feared not knowing what she would be asked on the exam. With such a broad range of possible material, she was concerned about missing something.
Her best study tactic was writing out flashcards. She also relied heavily on notes from her two-year CNL master’s program, consulted other CNLs® for advice, and studied the 40-page white paper on the CNL® role from the American Association of Colleges of Nursing. When she encountered unfamiliar practice questions, she researched the concepts thoroughly until she fully understood them. If she had to do it over, she would stress less about clinical assessment techniques, since they were not emphasized on the exam.
Rankin recertified in 2016 and will need to do so again in 2021. “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,” she said.
A typical day for Rankin includes rounding with her fellow CNLs® to assess patient needs, attending quality meetings at the hospital, and serving as the CNL® Coordinator for the entire program at her hospital. She tracks outcome trends across 12 CNL® units and helps 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 in the healthcare system. Rankin feels she helps patients the most by growing clinically competent nurses who are empowered to make autonomous care decisions.
Rankin is also certified as a medical-surgical nurse and completed her Doctor of Nursing degree in 2018.
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