Original ArticlesImplementation of the Clinical Nurse Leader Role in the Veterans Health AdministrationMiltner, Rebecca S. PhD, RN, CNL, NEA-BC; Haddock, Kathlyn Sue PhD, RN, FAAN; Patrician, Patricia A. PhD, RN, FAAN; Williams, Marjory PhD, RN, NEA-BCAuthor Information University of Alabama at Birmingham School of Nursing, Birmingham (Drs Miltner and Patrician); WJB Dorn VA Medical Center, Columbia, South Carolina (Dr Haddock); and Central Texas Veterans Health Care System, Temple (Dr Williams). Correspondence: Rebecca S. Miltner, PhD, RN, CNL, NEA-BC, 1449 Haddon Place, Hoover, AL 35226 (email@example.com). The content is the responsibility of the author(s) alone and does not necessarily reflect the views or policies of the Department of Veterans Affairs or the United States Government. This material is the result of work supported with resources and the use of facilities at the Central Texas Veterans Health Care System and the Columbia VA Health Care System. Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.NAQjournal.com). The authors declare no conflict of interest. Nursing Administration Quarterly: July/September 2020 - Volume 44 - Issue 3 - p 257-267 doi: 10.1097/NAQ.0000000000000428 Buy SDC Metrics Abstract The Veterans Health Administration (VHA) led implementation of the Clinical Nurse Leader (CNL) role nationally with the goal to meet system needs for strong clinical leadership across all settings. After a decade of CNL role implementation, the VHA supported this evaluation to determine the current state, the successes, the challenges, and the fidelity to the original intent of the role. The team used mixed methods to evaluate the state of the CNL initiative. Ten evaluation activities were undertaken including a facility survey directed toward chief nurse executives at all VHA facilities, and a second survey directed at registered nurses who completed a CNL graduate program, were certified as a CNL, or were currently enrolled in a CNL graduate program. The evaluation results suggest the CNL initiative had not yet accomplished the stated goals to improve cost and financial outcomes, increase patient satisfaction, increase staff satisfaction and retention, improve quality and internal processes, and facilitate practice model transformation including evidence-based practice and collaborative, interdisciplinary practice across the system. Observed CNL practices within the VHA could serve as exemplars for developing a care delivery model that could achieve these goals and offer potential paths to move this role forward. © 2020 Wolters Kluwer Health, Inc. All rights reserved.