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Department: Leadership Q&A

Preparing for the future

Murray, Kathleen MSN, RN, CNA

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Nursing Management (Springhouse): May 2013 - Volume 44 - Issue 5 - p 56
doi: 10.1097/01.NUMA.0000429013.15882.90
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Q I received a master's degree as a clinical nurse leader (CNL), but I feel like it isn't valued in the work setting. Was I misguided in attaining this degree?

Many hospitals across the country are beginning to realize the value of the CNL role. Your facility may not have a specific CNL job description, but it may have a position that requires a master's degree in nursing with skills that match your education, such as expert clinician, educator, systems analyst, and outcomes manager.

The Veterans Health Administration has been one of the forerunners in strategic planning for implementing CNLs at all points of care by 2016. The core functions of the CNL at VA hospitals include responsibility and accountability for the coordination of care focused on patient transition through the continuum of care, patient and family education, patient self-management after discharge, and supporting factors that impact customer satisfaction.

To respond to your question, I contacted a CNL within a healthcare system, who provided the following insight into her pursuit of the CNL master's degree: “By choosing a role that is new to healthcare, I had to take a leap of faith. Faith aside, I also critically evaluated the possibilities before I decided to invest my time and money in a new degree program. I asked myself the following questions: If I couldn't find a role that was created for a CNL, would my degree be of any value? How would I market myself as a viable candidate for other positions within my organization? When I evaluated the program, I found hugely marketable skills that would be an asset in a variety of leadership roles in healthcare because the CNL track offers the same foundational graduate education as many other master's degree tracks. The CNL specific courses taught me how to manage outcomes, analyze systems, anticipate risks, lead and manage change, budget for a unit, and understand the complexities of the healthcare system. In our very complex and outcome driven system, this knowledge is required for a variety of leadership roles.”


As you move forward on your career path, don't focus on the title CNL; concentrate on the education you received and how it benefits you in an advanced nursing role. You need to believe that your education has provided you with a skill set that you can apply to other master's-prepared opportunities in your hospital. I don't believe that you were misguided or have a useless degree because nurse leaders and mentors frequently advise nurses who desire a master's degree (and don't want to be an NP) to pursue the CNL track. Your academic education has provided you with an excellent advanced practice preparation and the potential to become a future nurse leader.

Q What are the components of the Value-Based Purchasing (VBP) program?

The components of the VBP program really consist of a program description, the VBP measures, quality data collection time frames, and the financial implications for healthcare facilities.

The VBP program is a Centers for Medicare and Medicaid Services' (CMS) initiative that rewards acute care hospitals with incentive payments for the quality of care they provide to Medicare patients based on identified processes of care (core measures) and the patients' perceptions of the care they received (patient satisfaction).1

For the fiscal year (FY) 2013 clinical process of care measures and patient experience survey domains, as well as data collection time frames, see “Value-Based Purchasing: What's The Score?” on page 28.

Participating hospitals will have their base operating diagnosis-related group payments for each patient discharge reduced by 1% for FY 2013, a reduction that will increase by 0.25 percentage points per year through 2017 to reach 2%. The formula for a hospital to earn back the reduction depends on how well it performs in the clinical process of care measures and the patient experience survey domains.

The VBP program clearly marks an unparalleled transformation in the way Medicare reimburses hospitals for services. It's important for hospital leaders, physicians, and nurses to understand the quality and patient satisfaction measures defined by the CMS—along with the VBP measures on the horizon—and to be prepared for the potential impending impact on hospital payment.


1. Centers for Medicare and Medicaid Services. Frequently asked questions: hospital value-based purchasing program.
© 2013 by Lippincott Williams & Wilkins, Inc.