Connect

For Emily Brady (MSN ’17), it was desperately trying to find ways to better connect intensive care unit (ICU) patients with palliative care consults.

For Ashley Walters (MSN ’12), it was evaluating evidence-based practices to warm breastmilk prior to feeding the at-risk neonatal population to improve outcomes and prevent harm.

For May Gallanosa (COL ’03, MSN ’17, MSN ’19, DNP ’20), the sole provider at three Richmond bone health clinics who juggled seeing patients, care coordination, and administrative duties without enough support, it was the exasperated question in her head: “Why can’t we do better?”

Brady, Walters, and Gallanosa, all graduates of UVA’s Clinical Nurse Leader master’s program, have finally landed their dream nursing jobs: new CNL-specific positions that enable them to drive process changes and make improvements, roles that, as Gallanosa says, are “a testament to how hospital systems are starting to take seriously the service CNLs provide to the hospital system."

UVA’s now 20-year-old CNL program — ranked No. 1 by U.S. News & World Report — draws individuals with at least a bachelor’s degree in a non-nursing field to become nurses on a fast track, as well as registered nurses interested in a part-time graduate program to augment their evidence-based practice and leadership skills, and their professional trajectory.

Although CNLs who graduate from UVA’s program earn a master’s degree and are ready for entry-level nursing positions after graduating, they tend to rise quickly through the ranks because they’ve not only mastered the mechanics of nursing care but know how to assess care rationale, dive into evidence-based practice, and use research to conceptualize, guide, and evaluate interventions. They also take leadership-intensive courses that strengthen their ability to lead groups through change.

“It’s a beautiful thing,” Gallanosa added. “I love working with patients and providing care, but there has always been a part of me that wants to, needs to, look at the bigger picture.”

Beyond UVA Health, though, nursing positions specifically designed for CNL-educated and certified nurses aren’t common because few healthcare systems understand what benefits these specially trained nurses offer. But after COVID-19 birthed the twin crises of explosive nurse turnover and the crippling financial toll of travel and contract staff to replace them, CNL program director Sharon Bragg said it’s high time that CNL-educated nurses are seen for the value they bring: the ability to force and lead change to improve work environments, stabilize staffing, improve retention, and hospitals’ bottom lines.

In a typical year, more than half of UVA’s CNL graduates accept positions across UVA Health, usually in entry-level nursing positions. In spring 2024, however, thanks to Kathy Baker, UVA Health University Medical Center’s chief nursing officer, Kelly Walsh, director of evidence-based practice and a CNL herself, and Pam DeGuzman (BSN ’96, MSN ’00, PhD ’12), the resident nurse scientist, eight new CNL-specific positions were created. The jobs require completion of an accredited CNL program, passing the CNL certification exam, and at least two years of clinical experience. As of this summer, four more CNL-specific nursing roles have been posted, for a total of 12 across UVA Health.

“CNLs are critical to re-invigoration of evidence-based practice at UVA Health,” DeGuzman said. “In fact, we love when CNLs who were educated at UVA come work with us because we know that they are highly trained in how to read, critique, and synthesize research, and can lead efforts to incorporate high quality research into patient care.”

Gallanosa, an experienced ICU nurse and family nurse practitioner, began new role last May by assessing operations at 12 ambulatory primary care and five behavioral health clinics at UVA Health. With an eye on factors that impact retention, efficiency, and workload, she’s examining clinic workflows, spending time with staff nurses, medical assistants, and LPNs to hear their thoughts, and supporting staff to work at the top of their practice scope.

Like her fellow CNL-hires, she’s digging into data, too — EPIC and patient and staff satisfaction surveys — and chatting with people as she considers what improvements to make, using “CNL scorecards” that monitor patient and staffing metrics over time, so “we know where we started, what the goal is, and how interdisciplinary projects help to move us towards our goals over time." 

Brady — who’s focused on units’ central line maintenance protocols, finding ways to decrease catheter use, given the risk of infection, improving onboarding processes, and process standardization across UVA’s dialysis clinics—leapt to apply for UVA Health’s CNL-specific role because she’d “caught the literature bug during the program.”

“It has not left me still,” Brady said, who called the enthusiastic support she receives from her fellow CNLs “instrumental.”

“It’s been fantastic to know that I have all these people that have the same goals as I do,” Brady said, “and have the same CNL viewpoint that I’ve got.”

For Walters, the chance to employ her “CNL brain” is empowering.

“As a team, we are building the structure and support to consider things systematically," Walters said. "We're passionate about collaborating across teams and sharing the 'why' behind best practices for our patients."

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UVA Health currently seeks CNL-certified nurses for its perioperative services, children’s acute care pediatrics, labor and delivery, and the mother-baby units.