Registered nurses (RNs) who want to go beyond the basics will find over 100 specialties to consider. In fact, with so many specialties, it may be challenging to choose.
For RNs who want to advance their careers at the front lines of care, the Clinical Nurse Leader (CNL) role may be an ideal option. Like many advanced practice nurses, such as Nurse Practitioner (NP) and Clinical Nurse Specialist (CNS), CNLs need at least a Master of Science in Nursing (MSN).
Because the CNL concentration is relatively new, not as many universities offer this program. The MSN CNL at the University of Louisiana Monroe (ULM), for example, was the first of its kind in the state. This program prepares graduates to practice across the patient lifespan, with attention to rapidly growing needs in gerontology.
Why Are CNLs Important?
According to the American Association of Colleges of Nursing (AACN), CNL is the first new nursing role in more than three decades. It was developed in 2003-2004 by the Institute of Healthcare Improvement (IHI) and the AACN. National CNL certification followed in 2007.
The CNL came about in response to concerns about quality of care. An Institute of Medicine (IOM) — now the National Academy of Medicine — report on patient safety called attention to medical errors as a leading cause of death and injury.
With more people dying from medical errors than from motor vehicle accidents, breast cancer or AIDS, the IOM set forth a “prescription” for safer health systems. Reducing fragmentation of care was a key recommendation, and the CNL role is built for this.
What Do CNLs Do?
An article in the Online Journal of Issues in Nursing (OJIN) describes the CNL as the “stop-gap professional.” CNLs are trained to reduce fragmented care that can result in preventable medical errors such as medication mistakes, hospital-acquired infections and misdiagnosis. Achieving this goal requires skillful communication and coordination of care.
CNLs provide leadership for all members of a clinical team or microsystem. They prioritize safety and quality of care. Operating rooms and neonatal intensive care units are examples of microsystems where CNLs lead teams of nurses, physicians and other clinical staff.
CNL activities may differ from one setting to another, but day-to-day responsibilities typically focus on:
- Providing leadership for a healthcare team.
- Overseeing coordination of care for a group of patients.
- Tracking and evaluating patient outcomes.
- Assessing risk and changing care plans if necessary to improve patient outcomes.
- Facilitating transition of care.
- Fostering inter-professional communication and collaboration.
- Engaging healthcare teams in integrating evidence-based practice as the norm.
CNLs are known as advanced generalists. As the Clinical Nurse Leader Association (CNLA) explains, CNLs can work with all patient populations in all patient settings. Here are a few of the benefits of having CNLs on board:
- Reduced hospital-acquired conditions.
- Improved pain management.
- Improved care handoffs.
- Reduced length of stay and readmission rates.
- Higher patient and nurse satisfaction scores.
- Better collaboration and communication within healthcare teams.
- Increased nurse retention.
What Does It Take to Become a CNL?
Like advanced practice registered nurses (APRNs), CNLs are prepared at the master’s level or higher. The path to becoming a CNL is similar to the pursuit of advanced practice nursing. Candidates must:
- Meet the educational requirements for RN licensure.
- Pass the NCLEX-RN (National Council Licensure Examination — Registered Nurse).
- Maintain RN licensure in good standing.
- Earn at least an MSN with a CNL concentration from an eligible program.
- Pass the CNL Certification Exam.
ULM’s MSN CNL program prepares RNs for CNL certification with a curriculum that reflects the competencies set forth by the AACN. This includes graduate-level courses that prepare CNLs with higher-level physical assessment skills and advanced knowledge of pharmacology and pathophysiology. CNL students also complete the clinical/practice hours required for certification.
In addition, ULM’s CNL coursework builds core competencies in the following essential areas:
- Evidence-based practice
- Global healthcare
- Vulnerable populations
- Organizational management and clinical leadership
- Quality improvement
- Risk management and ethical decision-making
- Strategic planning and economic management
According to the CNLA, students are eligible to sit for the CNL examination in the last semester of their program.
The CNLA describes CNLs as the “air traffic controllers” of patient care. As leaders in optimizing care in complex environments, CNLs are also seen as “systems engineers.” And as advocates for members of the clinical team providing care, they are known as the “safety nurse” and the “nurse’s nurse.”
RNs traditionally choose a career in nursing out of a desire to help others. And the compassionate care they are known for surely contributes to their top ranking year after year in a Gallup poll on honesty and ethical standards across 22 occupations. For RNs who want to further their careers as trusted leaders in clinical care, a CNL degree can lead to powerful opportunities.