Tennessee Valley Healthcare System initially piloted the Unit-Based Care Manager staffed by a Clinical Nurse LeaderSM on five acute care units.  An initial analysis of data from the pilot units revealed improvements in quality indicators and financial performance.

TVHS began a broadscale implementation of the Care Manager role in January 2006. They initially hired 9 CNLsSM, some of whom were masters-prepared case managers. TVHS layered the career ladder requirements for staff with CNLSM descriptions and developed the new role.

From the Unit Based Care Manager’s inception, TVHS actively involved union partners in planning for the role and communication to staff about the role.  TVHS provided information on this new role verbally in meetings with union partners and in writing with hard coy materials.  The unions provided a helpful second vehicle for communicating to staff RNs that the Unit-Based Care Manager was not another managerial role, but as an additional clinical role for the unit.

TVHS marketed the new role as a career mobility option for staff RNs who desired to remain at the bedside while progressing through the career ladder system.

Initially, TVHS hired internal case managers to serve as Unit-Based Care Managers, but now they hire exclusively Clinical Nurse LeadersSM, primarily graduates from Vanderbilt University.  (The initial group of internal case managers did not transition well to the new role.)

As of August 2007, TVHS staffed five CNLsSM and they are aggressively recruiting for the remaining 12 positions.  TVHS expects the recruitment to become easier as more CNLSM graduates enter the job market.

Tennessee Valley Healthcare System partnered with Vanderbilt University in developing the educational program for the CNLsSM (that would fill the role of Unit-Based Care Manager).  Staff in the units served as the preceptors for the clinical immersion portion of the education, and all classroom learning occurred at Vanderbilt.

For all new staff members, the role of the Unit-Based Care Manager is reviewed.

The VA Healthcare System is committed to implementing the CNLSM role in all VA systems by 2012.  Currently, 80 of the 150+ VA’s are in different phases of planning, implementation, and role evolution.

Initially, VA TVHS hosted site visits for other VA systems to learn about the CNLSM role and how TVHS deployed the role.  Then, in order to facilitate faster implementation, leaders from VA TVHS made visits across the country to gatherings of other VA clinical leaders to present information on the CNLSM role.

While VA TVHS has presented how they have used CNLsSM in the role of Unit-Based Care Managers, they have not been prescriptive about the role.  Each VA system is able to evaluate the CNLSM role and determine how best to deploy the new role to serve their patient and care needs.

Many hospitals throughout the country are beginning to hire and deploy CNLs in a variety of roles and positions.  While the Unit-Based Care Manager has been a successful use of the CNL for VA TVHS, other hospitals considering the use of CNLs may want to consider how best to deploy the role in their own facilities and how to adapt their care models to incorporate the skills and expertise of CNLs.