Date of Graduation

Winter 12-13-2013

Document Type


Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Dr. KT Waxman

Second Advisor

Dr. Marjorie Barter


The healthcare industry is focused on the implementation of the Affordable Care Act, the payment reform package from Centers for Medicare and Medicaid Services and the development of Accountable Care Organizations. The decisions, behaviors, and practices of medical and clinical staff directly impact patient care, quality, and subsequently cost and reimbursement. The imperative to balance quality and patient safety with cost effectiveness requires a complex orchestration of all the elements of care within the clinical microsystem. A priority is to support and enable bedside nurses’ daily practice, priorities, and decision-making. This can be accomplished through the implementation of the Clinical Nurse Leader. This Master’s prepared advanced generalist has been educated in healthcare reform and its impact on patient safety, quality, and the organization’s financial condition. An evidence-based business case will demonstrate the outcomes and a return on investment for the Clinical Nurse Leader role. The Chief Nursing Officer can employ transformational leadership skills to articulate the need and benefit of such a role, and influence an organization to invest in this valuable intervention.

Keywords: Chief Nursing Officer, CNO, Clinical Nurse Leader, CNL, Value Based Purchasing, VBP, education, quality, pay for performance, evidenced-based practice.