What is a Clinical Nurse Leader?
Clinical nurse leader is a relatively new designation for nurses, but one that’s already become vital in many healthcare settings.
A clinical nurse leader (CNL) is a nurse who takes on high-level leadership responsibilities and works to improve patient outcomes in their healthcare facilities. The designation is relatively new in the world of nursing.
The American Association of Colleges of Nursing (AACN) created the CNL role in 2004. Since then, it’s grown exponentially. In 2006 there were 84 certified CNLs practicing in the United States, according to the AACN. By 2020, there were 8,175. That’s an increase of nearly 10,000%.
The role of CNL was created to address quality of care issues. CNLs use their nursing experience and advanced education to oversee patient care, look at potential problems, identify solutions, and implement new policies. CNLs bring a nursing perspective to healthcare leadership, often acting as a bridge between nursing departments and hospital administration.
“Unlike the familiar nurse-patient relationship in which one nurse is overseeing several patients, the CNL looks at the whole unit as a population,” explains Stephen Ferrara, DNP, FNP-BC, FAANP, associate dean of clinical affairs and associate professor at Columbia University’s School of Nursing.
What Do CNLs Do?
CNLs are leaders who use their nursing skills to improve patient outcomes on a large scale. They’re often part of multidisciplinary teams, working with physicians, therapists, social workers, and other professionals to oversee patient care. CNLs take on tasks such as:
The role of CNL is unique among other nurses in a department or care unit. First of all, CNLs don’t normally care for patients. They’re focused on a nursing unit, not on a specific patient.
“Traditional bedside nurses are providing care for their patients. They are focused on caring for that number of patients for that day, and they are rarely able to look outside of those six or seven patients that they’re caring for,” says Ferrara. “What the clinical notice leader is doing is really looking at the unit as a whole.”
You might think that sounds a lot like a charge nurse or a nurse manager, but there’s a big difference. CNLs don’t lead by supervising other nurses, they lead by directing care. CNLs often interact with other nurses to ensure quality care, but they don’t manage them.
Unlike a nurse manager or charge nurse, CNLs don’t manage other nurses.
“It really is a clinical leadership role,” says Ferrara. “I know this is a nuance, but it’s important to differentiate how the clinical nurse leader fits into the healthcare landscape.”
CNLs are also distinct from nurse case managers. While nurse case managers also oversee patient care and work as a part of interdisciplinary teams, they have a set number of patients at any time assigned to them. CNLs always oversee patient care for an entire unit.
These differences are why the CNL was created. CNLs fill a unique need in healthcare. They’re able to bridge a gap that can exist between nursing and other departments to improve patient outcomes.
CNLs bridge the gap that can exist between nursing and other departments to improve patient outcomes.
“(CNLs) are working with the whole unit and leading that team,” explains Ferrara. “They’re the point person to help coordinate and communicate the care that’s happening to the patient.”
The enhanced communication that CNLs can facilitate really makes a difference in patient care, he says.
“One of the great potentials of this role is really the way that they are able to open those lines of communication and ensure that truly everyone is on the same page when it comes to the care of any individual.”
Is a CNL Part of the APRN Family?
A CNL is an advanced nursing role that requires at least a Master of Science in Nursing (MSN) degree, but it’s not an advanced practice registered nurse (APRN) role.
Only four nursing roles fall under the APRN umbrella:
Clinical nurse specialists (CNSs)
Nurse anesthetists (CRNAs)
Certified nurse midwives (CNMs)
Nurse practitioners (NPs)
CNLs share similarities with some of these roles, especially CNSs, who also take on a leadership role. It’s easy to confuse the roles of CNSs and CNLs, but there are key differences. CNSs always specialize in a certain patient population; for example, pediatrics. A CNL, by contrast, is always a generalist. They don’t specialize and are able to bring their skills to any unit.
CNLs are focused on care coordination, while APRNs are focused on providing direct patient care.
Another big difference? Unlike APRNs, CNLs aren’t able to prescribe medication. The ability to prescribe medication, known as prescriptive authority, allows APRNS to operate as primary care providers.
CNLs are never primary care providers. A good way to think of it is that CNLs are focused on care coordination, while APRNs are focused on providing direct patient care.
What Degree Do I Need?
A CNL takes on a high-level role and advanced responsibilities, so it’s not hard to see why you’ll need an advanced degree to obtain a CNL job. You’ll need at least a master’s degree in addition to your RN license. An MSN degree is the most common degree offered for CNLs. However, if you already have a master’s degree in something else, there are schools that offer post-master’s certificates.
No matter what, you’ll need to be an RN in good standing before you apply to any program. Generally, you’ll need to have a BSN before looking at CNL programs, but RN-to-MSN bridge programs for associate degree-educated nurses are offered by some universities.
You’ll need at least a master’s degree in addition to your RN license before you can work as a CNL.
What You’ll Study
Your MSN degree will track to the work you’ll do as a CNL. You’ll focus less on clinical skills and more on care coordination. For example, MSN programs for an aspiring NP or CNS always include pharmacology classes and focus on your specialty. An MSN for a CNL, however, doesn’t need to include those elements, since CNLs don’t specialize or prescribe medicine.
Additionally, your MSN or post-master’s certificate needs to come from a university with a CNL program that has been approved by the AACN. You won’t be able to apply for certification as a CNL if you don’t graduate from an approved program. If you already have an MSN from a school that’s not on the AACN’s approved list, you’ll need to pursue a post-master’s certificate from one that is.
You’ll need to get certified as a CNL after you earn your MSN. Only nurses who are certified are eligible to work as CNLs. Certification is offered through the AACN. To be certified, you’ll need to:
About the Exam
Once you submit all the needed information, the AACN will approve you to take the CNL exam. You’ll need to take and pass the exam before you’ll be awarded certification. You’ll receive an instant pass-or-fail notification when you take your exam. If you pass, you’ll be sent a packet in the mail within 60 days containing your official score and certification.
Your CNL certification will need to be renewed every five years. You’ll need to submit a renewal application along with proof of your current RN license, proof of at least 2,000 hours of professional practice, and proof of at least 50 continuing education hours. Your continuing education hours can be the same as the ones that were used to renew your RN license and do not need to be specific to CNL practice.
How Long Does It Take?
Your first step toward working as a CNL is to earn your RN license. Getting the education you need for your RN license can take between two and four years.
Nurses who chose to go the ADN route for their RN are generally finished in two years, while nurses who pursue a BSN generally spend four years preparing for RN practice. The time it takes from there will depend on your path, but some program lengths to be aware of include:
How Much Does a CNL Make?
At this time, clinical nurse leader is not a profession that’s tracked by the U.S. Bureau of Labor Statistics (BLS). However, data that is available suggests that CNLs make a salary that falls in line with the broad BLS umbrella grouping of “Medical and Health Services Managers.”
Professionals in that category earn an average of $115,160, according to the BLS. That means CNLs well out-earn RNs, who earn an average of $77,460, and are about even with APRNs who, collectively, earn an average of $115,800.
Keep in mind that your salary will depend on factors like your employer, location, and experience.
What’s the Job Outlook?
CNLs fulfill a critical role in the nursing field. As healthcare continues to change, the role of the CNL is likely to become even more important.
“Healthcare is complicated and it truly needs the coordination of someone who can speak the language and really be able to get the patients what they need,” says Ferrara.
As new information and technology become available, healthcare is likely to become even more complicated. Plus, it’s not just treatments that are becoming more complex. The Centers for Disease Control and Prevention reports that 40% of American adults have two or more chronic conditions.
Multiple chronic conditions often mean care from multiple medical professionals. A CNL can coordinate that care to make sure it’s safe and effective for the patient.
Where’s the Need?
The types of facilities and care centers where complex care is delivered are prime locations for CNLs.
“The demand is in the higher-complexity, larger facilities where (CNLs are) just involved with so many more aspects of the delivery of healthcare,” says Ferrara. “(For example,) transplant and cancer centers, and highly complicated academic medical centers, are places where there’s just so much going on. That’s why we talk about care coordination these days, because it is so complicated when you have multiple specialties.”
However, it’s not just large specialty hospitals where CNLs are needed. CNLs can bring their expertise to rural hospitals, medical centers, and more. Ferrara believes we’ll see CNLs branch out to a variety of healthcare facilities in the years to come.
A CNL’s skills are appropriate not only at facilities that deliver complex care, but also acute care and continuing care settings.
“There’s also the potential for these clinical nurse leaders to be in nursing homes and assisted living and other community-based settings because that’s where care is also delivered,” says Ferrara. “It’s really the continuum of care. This is where these clinical nurse leaders could really play a critical role.”