Running head: CNL DEVELOPMENT 1

Serving as Leader and Member of a Multidisciplinary Team:

A Reflection on CNL Development
Amie Roberta Howard
University of San Francisco








CNL DEVELOPMENT 2
The discussion and reflection behind my own development as a clinical nurse leader
invokes just a smidge of anxiety. Much of this program focuses on clinical skill mastery and
critical thinking as a bedside nurse, and often the undertaking of analyzing and nurturing
leadership styles is left last on the endless task list of a nursing student. Sometimes, it can feel as
though I should have it all figured out, when really, I am just grasping my own leadership
abilities and how those will play out in the nursing world. In order to truly understand how I will
lead, it is most important for me to reflect on past experiences in my cohort and envision my
future career environment as a member and leader of a multidisciplinary team. The CNL role is
classically fitted to acute care settings, although my passion lies outside the hospital. I am deeply
inspired by and motivated to work in preventative and outpatient care. Atul Gawande (2011)
describes a model of care aimed at high utilizers of healthcare, providing better care for the
neediest patients, in order to reduce healthcare costs and get to the heart of managing chronic
conditions in the outpatient care setting. This type of care requires a compassionate and
dedicated leader to the team, the patient and themselves. I hope to adapt clinical nurse leader
competencies to the preventative and outpatient care setting by using servant and
transformational leadership styles to be both a leader and member of a multidisciplinary team.
The American Association of Colleges of Nursing (2013) nine essential competencies of
CNL education defines most of my learning both in the classroom and in clinical. I am asked
every semester to reflect on the competencies and the CNL role. I understand what each
competency is asking of me, I just havent quite figured out how I will engage in them. What I
find lacking, until recently, is my self-assessment of those competencies in relation to my ability
to lead. Through self-reflection and analysis, I am building the bridge between understanding the
definition of the competencies and mastery of them. By understanding my own novice
CNL DEVELOPMENT 3
relationship with the practical use of these competencies, I am able to identify where I need to
grow and in what capacity I have achieved enough understanding to be an expert in the nine
essentials of clinical nurse leadership (Brenner, 2001). I think having a real-time knowledge of
my own CNL skill set will help me to grow as a leader and member. Developing specific
leadership styles will strengthen my ability to perform the CNL competencies, especially in an
outpatient care setting. I plan on representing each competency through servant and
transformational leadership.
Servant leadership is a type of leadership I am very comfortable with and enjoy
performing with team members. I find that I rely heavily on empathy, healing, awareness,
commitment and community building to build relationships with team members and the patient
(Harris & Roussel, 2010). In order to bring servant leadership into the outpatient care setting as a
CNL, I will focus on mentoring and coaching team members to take ownership of their patients
holistic progress. I believe in this caring approach to leadership in order to build trust and
meaningful relationships, especially in community health care. This also means building the
same trust, healing and empathy in myself. This semester I have made the conscious effort to
build community and promote healing through discussion with my cohort. This has meant being
honest about my own feelings and how I hope to bring more kindness into my role as a student,
peer, care provider and leader. I hope to encompass the affirmation that compassion for others
begins with kindness to ourselves (Chodron, 2001, p. 6).
Transformational leadership has the potential to combine servant leadership and mastery
of the CNL competencies into a practical application of daily leadership. Similar to servant
leadership in its caring approach and to CNL competencies in that its guidelines to gauge
proficiency, I think transformational leadership in nursing is pivotal to my success as a CNL. As
CNL DEVELOPMENT 4
a CNL in a community care setting, I will combine the four components of transformational
leadership: idealized influence, inspirational motivation, intellectual stimulation and
individualized attention with the five practices of leadership: model the way, inspire a shared
vision, challenge the process, enable others to act and encourage the heart
(Transformational Leadership, 2007; Kouzes & Posner, 2012). Both of these concepts stress the
importance of the leader as a lateral integrator of care. Someone who is able to lead by example,
provide support for her teammates and foster collaboration. This is most beneficial when
working with a multidisciplinary team to come up with a plan of care for a patient. I imagine
small community programs might lack the internal structure of leadership. Gawande (2011)
describes just that, a program built out of need by one doctor. The doctor exemplified
transformational leadership by thinking outside the box, sharing the vision of change and
fostering teamwork to provide case management and care for chronically ill patients. A CNL
(me!) could just as easily take that role of the doctor, managing care from beginning to end with
a diverse team of specialists. Currently, I am working on achieving all four components of
transformational leadership within my cohort. I think my success depends largely in my self-
confidence to be labeled as leader and act as such. Graduating as a CNL will force me into that
identified leader role and I expect to be comfortable with obtaining leadership roles labeled as
such, instead of assuming much of the responsibilities without the title.
The clinical nurse leader is a valuable role in healthcare. We are trained to analyze
system flaws and successes, provide safe and quality patient-care and promote fiscal
responsibility. Identifying my own leadership styles gives me the opportunity to fit all the pieces
together in a way that supports my passion for community and compassionate health care.
Reflecting on leadership allows me to figure out how caring and compassion for myself, my
CNL DEVELOPMENT 5
team and my patient are translated into the CNLs responsibility of ensuring positive outcomes at
the microsystem level.





















CNL DEVELOPMENT 6
References
American Association of Colleges of Nursing. (2013). Competencies and Curriculum
Expectations for Clinical Nurse Leader Education and Practice. Retrieved from
http://www.aacn.nche.edu/publications/white-papers/cnl
Brenner, P. (2001). From novice to expert: Excellence and power in clinical nursing practice.
NewJersey: Prentice Hall Health.
Chodron, P. (1994). Start where you are: A guide to compassionate living. Massachusetts:
Shambhala Publications, Inc.
Gawande, A. (2011, January 24). The hot spotters. The New Yorker, 86(45). Retrieved
from http://www.newyorker.com/reporting/2011/01/24/110124fa_fact_gawande
Harris, J.L. & Roussel, L. (2010). Initiating and sustaining the clinical nurse leader role: A
practical guide. Massachusetts: Jones and Bartlett Publishers.
Kouzes, J.P. (2012). The leadership challenge (5
th
ed.). San Francisco, CA: Jossey-Bass.
Tranformational Leadership. (2007). The transformational leadership report. Retrieved from
http://www.transformationalleadership.net/products/TransformationalLeadershipReport.p
df