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Clinical Nurse Leaders: Point-of-Care Leadership

Clinical Nurse Leaders are master's educated nurses who take on leadership roles while continuing to be very involved with the care of individual patients. The American Association of Colleges of Nursing (AACN) describes the role as point-of-care leadership and notes that Clinical Nurse Leaders provide direct care in situations of particular complexity.

The AACN developed the Clinical Nurse Leader (CNL) role after multiple stakeholders, including the Robert Wood Johnson Foundation, identified the need. The Robert Wood Johnson Foundation has been instrumental in calling attention to medical errors and also to the potential of highly educated nurses to improve the situation. These master’s educated nurses can do far more than minimize gross errors, though. They can integrate the latest evidence to improve outcomes. They can identify gaps and redundancies in care.

The majority of Clinical Nurse Leaders are employed in inpatient acute care – more or less traditional hospital settings. However, they are everywhere: long-term care, home health, outpatient clinics, community and public health.

Clinical Nurse Leader Roles and Duties

The potential benefits from CNL leadership are many. Modern nursing care has so many pieces – and holds so much promise. The AACN noted in a 2017 white paper that children and adults alike are living with chronic illnesses that would have been death sentences in decades past.

Social justice is among the core values. So is economic responsibility. It’s not just care and innovation that cause healthcare costs to mount. There are many components of the current health system that are not working well together or not working well at all. An example is healthcare associated infections. People enter the hospital for acute care – and to get better – but they are vulnerable to complications and not infrequently contract illnesses that they didn’t have to begin with.

Clinical nurse leaders have the responsibility for quality of care for groups of patients. Duties include providing care coordination for patients with complex needs, implementing evidence-based practice, instituting quality improvement measurements, and coordinating lateral interdisciplinary care that includes disciplines as diverse as occupational and physical therapy. CNLs use appropriate tools to assess risks for adverse outcomes and implement healthcare customization on a widespread level.

Early studies have been promising.

Clinical Nurse Leader Programs

The Clinical Nurse Leader is a popular choice for professionals who enter the nursing field after earning bachelor's degrees in other fields. It is quicker to achieve the CNL credential than it is to achieve a nursing credential that authorizes advanced clinical practice. The single largest group of individuals who have pursued Clinical Nurse Leader nursing education are those who have already earned bachelor’s degree in other fields. Programs designed for this group have graduated slightly more than half the total CNL students since 2010. It’s a group has much to offer. The AACN notes the importance of liberal education in preparing nurses.

The Clinical Nurse Leader role is a newcomer to the nursing scene, but the number of enrollees and graduates has been increasing over the past decade. A substantial subgroup achieve the CNL through Clinical Nurse Leader programs designed for graduates of Bachelor of Science in Nursing (BSN programs). Programs for nurses with Associate Degrees in Nursing (ADNs) or prior graduate education turn out only a small percentage – but they exist as options.

Some schools allow their graduate nursing students to earn Clinical Nurse Leader certification en route to advanced practice credentials. Many advanced practice clinical roles now require education at the doctoral level. While the CNL does not require as high a level of clinical training, it is a distinct discipline with a particular set of competencies that must be mastered; it is not sufficient to have just an RN license and a master's degree.

Students receive education in graduate level core nursing competencies as well as role-specific ones. Clinical Nurse Leader programs, like other programs that prepare master’s level nurses for roles that include direct clinical care, povride advanced coursework in physiology, pharmacology, and health assessment.

Programs include clinical immersion experiences.

Clinical Nurse Leader Certification

In order to actually call oneself a Clinical Nurse Leader, one must pass a third party certification examination.

Education must be qualifying. The AACN has provided a directory of eligible programs (http://www.aacnnursing.org/CNL-Certification/Apply-for-the-Exam/Eligible-CNL-Programs).

Candidates take a computer-based examination. Content falls into three broad categories: clinical outcomes management, care environment management, and leadership. Care environment management is weighted 45%. Team coordination, evidence-based practice, healthcare informatics, and health finance/ economics are among the sub-domains.

Students often take the certification examination before graduation. Second degree students sometimes take it before the NCLEX – but they don’t actually receive their credential until afterward.

While first-time examination pass rate changes from year to year, it hovers at around 70%.

Clinical Nurse Leader Certification must be renewed every five years.

Clinical Nurse Leader Job Positions

While Clinical Nurse Leader education and certification prepare nurses for a particular role, nurses will not necessarily carry out all duties associated with that role. There have been multiple implementation models. The number of possible job titles is many. Clinical Nurse Leaders are registered nurses and as such can function in many positions. An AACN survey found more than half of respondents considered themselves to be working in CNL roles (http://www.aacnnursing.org/CNL). Others reported positions such as staff nurse, manager, clinical educator, or patient navigator/ care coordinator.

Additional Resources

The Clinical Nurse Leader Association (CNLA) is a specialty-specific nursing association. The organization can provide resources for beginning one’s career (https://cnlassociation.org/). CNLA members can request job shadowing or mentoring at the student level.

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