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The role of Clinical Nurse Leader (CNL) was first introduced in 2003 as the first new nursing role to be defined in more than 35 years. It was created out of necessity, born from an evolving healthcare system that required a well-defined nurse leadership role within the clinical environment. Clinical nurse leaders are master’s-educated RNs capable of providing patient care while also serving in a leadership capacity in virtually any healthcare setting.
The Role of the Clinical Nurse Leader: Job Duties and Responsibilities
Clinical nurse leaders, as their title implies, provide clinical leadership, implementing and evaluating patient care processes and models of care delivery.
The American Association of Colleges of Nursing (AACN), in collaboration with a number of other healthcare organizations, developed the CNL role in such a way that it contributes and fits seamlessly in any setting where healthcare is delivered. Clinical nurse leaders are providers and managers at the point of care who are accountable for the outcome of patient care. The major job duties and responsibilities of CNLs include:
- Designing, coordinating and evaluating the delivery of care for individuals, families, groups, and populations
- Using available data and a series of evaluations to achieve the best patient outcomes
- Designing and implementing evidence-based practices
- Collaborating with other health professional team members and providing team leadership
- Using information systems and technology to improve healthcare outcomes
- Leveraging resources
- Advocating for patients, communities, and the healthcare team
Hallmarks of the CNL role include:
- Risk Anticipation: CNLs are able to critically evaluate and anticipate risks to ensure client safety. Their work includes anticipating risks for patients, particularly when introducing technology, equipment, treatment regimens, or medicinal therapies.
- Mass Customization: CNLs are able to profile patterns of needs and tailor interventions to accommodate these needs. CNLs use an evidence-based approach by identifying patterns and modifying interventions to meet the specific needs of individuals, clinical populations, or communities within a microsystem.
- Client and Community Advocacy: CNLs assume responsibility for the delivery of high-quality care.
Earning a Master of Science in Nursing (MSN) in Clinical Nurse Leadership
Online and part-time MSN-Clinical Nurse Leadership programs have become common, providing candidates with more options and more flexibility than ever.
Online programs—offered in partially (hybrid) or fully online formats—allow students to satisfy most or all of their didactic requirements through web-based study and then satisfy the clinical requirements of the program at partner sites close to home. In many cases, RNs can complete clinical sequences at their current place of employment.
Registered nurses who want to become a clinical nurse leader must complete, at a minimum, a Master of Science in Nursing (MSN) in Clinical Nurse Leadership. Admission into an MSN degree program with a focus on clinical nurse leadership requires the following:
- Current and unencumbered RN license
- A Bachelor of Science in Nursing (BSN)
Depending on the institution, candidates for these programs may also need to possess:
- Clinical RN experience
- Minimum undergraduate GPA
- Minimum GRE scores
- Resume or CV
- Letters of recommendation
In addition to traditional MSN programs that require candidates to possess a BSN and RN license, many institutions now offer RN-to-MSN degree programs that enable RNs with associate’s degrees in nursing to enter an MSN-Clinical Nurse Leader program without first completing their BSN. These programs combine the components of both the BSN and MSN in an accelerated format that ends up granting both degrees.
Core Coursework and Curriculum Framework
The clinical nurse leader is a graduate-level nursing role. Therefore, these professionals must possess, at a minimum, a Master of Science in Nursing (MSN) in Clinical Nurse Leadership.
The graduate-level coursework of an MSN Clinical Nurse Leader degree must include a direct care core in the following areas:
- Physiology/pathophysiology
- Health assessment
- Pharmacology
It must also include a graduate nursing core that addresses the following, essential core areas:
- Quality and safety
- Program evaluation for improving patient and population outcomes
- Policy and advocacy
- Organizational and systems leadership
- Interprofessional collaboration
- Informatics
- Evidence-based practice
- Clinical prevention/population health
In addition to a graduate nursing and direct care core, the MSN Clinical Nurse Leader includes functional area content, which consists of clinical and didactic learning experiences that meet CNL competencies and clinical expectations.
The AACN’s CNL Curriculum Framework for Client-Centered Healthcare includes the following recommended areas of study in an MSN Clinical Nurse Leadership program:
- Nursing Leadership
- Horizontal leadership
- Effective use of self
- Advocacy
- Conceptual analysis of the CNL role
- Lateral integration of care
- Clinical Outcomes Management
- Illness/disease management (care management, client outcomes)
- Knowledge management (epidemiology, biostatistics)
- Health promotion and disease reduction/prevention management (risk assessment, health literacy and education)
- Evidence-based practice (clinical decision making, critical thinking, problem identification)
- Care Environment Management
- Team coordination (delegation, supervision, conflict resolution)
- Health finance/economics
- Healthcare systems and organizations
- Healthcare policy
- Qualify management/risk reduction/patient safety
- Informatics
The AACN reports that the major threads throughout a CNL graduate program should include:
- Critical thinking/decision making
- Communication
- Ethics
- Human diversity/cultural competence
- Global healthcare
- Accountability
- Assessment
- Nursing technology/resource management
- Professional values
- Professional development in the CNL role
A capstone/clinical immersion experience is an important component of an MSN in Clinical Nurse Leadership. Usually consisting of about 500 hours of clinical rotations, the clinical experience allows students to gain practical experience in the role of the clinical nurse leader in a variety of settings.
Professional Certification for Clinical Nurse Leaders
The Clinical Nurse Leader (CNL) certification program, managed by the Commission on Nurse Certification (an arm of the AACN), validates a high level of professional achievement.
To earn the CNL designation, candidates must take and pass the CNL exam. To qualify to take the exam, candidates must:
- Possess a current and unencumbered RN license
- Have graduated from a CNL master’s or post-master’s program (or be in the last term of their CNL program)
The CNL exam consists of 140 multiple-choice questions, some of which are presented in a case study format. Candidates have three hours to complete the examination.
CNLs must renew their certification every 5 years. To qualify for renewal, CNLs must:
- Possess a current and unencumbered RN license
- Have completed at least 2,000 hours of experience in the last five years (does not need to be in a CNL position)
- Complete at least 50 contact hours that support the CNL Exam Content Outline or Competencies and Curricular Expectations for Clinical Nurse Leader Education and Practice
What a Clinical Nurse Leader Is (And Isn’t): CNL Vs CNS
Confusion about the professional role of a clinical nurse leader is nothing new, likely because of its seemingly close resemblance to a number of other nursing roles—namely, the clinical nurse specialist. However, these two nursing roles play distinctly different roles in the delivery of healthcare.
The clinical nurse leader, unlike the clinical nurse specialist, is not an advanced practice registered nurse (APRN) role. Clinical nurse specialists, as APRNs, are prepared with a specialized education in a defined area of practice. In other words, they provide care to specific patient populations and must hold national certification that reflects their chosen patient population.
Clinical nurse leaders, on the other hand, are not specialized providers but generalists, as their credentials allow them to practice across the continuum and in any healthcare setting. While clinical nurse specialists focus their profession on a specialized area of practice (usually with complex or critically ill patients), clinical nurse leaders implement principles that ensure the consistency of clinical care across the board. Both roles require education at the master’s level.
It is not unusual, however, for clinical nurse leaders to work alongside clinical nurse specialists, particularly when a specialist area of concern occurs.