CNL

Nurses General Nursing

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I'm doing some research on the Clinical Nurse Leader (CNL) role. I've read the White paper on the difference between the CNL and the CNS (although the difference still is very clear to me). I understand that CNL is NOT an APRN role and that CNS is.

However CNS, at this time, do not have diagnostic prescriptive authority in my state (NC). Therefore the line between CNS and CNL is further blurred. I understand (in theory) the microsytem and macrosystem levels that each type of nurse works at.

My searches for answers on here haven't yielded much in the way of clear answers. I understand this certification is still new.

I was all for being a FNP up until about about 4 months ago. I'm not sure if I want the responsibility of being a provider yet.

I'm 23 and have been a nurse for just over 3 years and I've learned so much and still have so much to learn. Also, I'm not sure if being an NP, at least at this point in my life, fits the goals I have for myself. I like working less than 5 days a week. Having a job that I can leave work at work. Etc...

I enjoy working the floor (although I Have my days) and I'm interested in the CNL role as an intermediary role that could both allow me to teach in the future or pursue advanced practice. Are any of you certified as Clinical Nurse Leaders (CNLs)? Or do you know of anyone going through a CNL program?

What are your opinions on this new certification. I have wonder what place, if any, will the role fill. In theory, In theory, I can understand the potential benefits of such a role, but is it truly applicable to most health systems? In some ways it seems like a graduate prepared floor nurse or charge nurse.

Specializes in Critical Care, Education.

(full disclosure - CNS, Critical Care & MSN-Education here) I think CNL is bunkum. It was created to justify entry-level MSNs because they had to come up with some sort of "generalized specialization" because it's required for a graduate degree. I do know half a dozen staff nurses who earned their CNLs via online degree completion programs for licensed nurses. But - just like you suspect - they are all working as staff nurses.

If you want to be an educator, get an MSN in education. CNS roles are focused on nursing practice & are associated with very high levels of responsibility. Nurse administrators have grueling jobs with endless responsibilities. If you want an (non-academic) advanced job, an MSN is necessary, but not sufficient. You will also have to have progressive levels of career advancement, beginning at the entry-level.

Nurses with those advanced jobs generally put in long hours. The jobs are all exempt (non-hourly), and productivity is measured in output rather than in hours worked. The expectation is to just work as many hours as it takes to get the job done. Honestly, if working a couple days a week is your goal you'd be better off remaining in a staff position.

PatMac10,RN, RN

1 Article; 1,164 Posts

Specializes in Nursing Education, CVICU, Float Pool.
(full disclosure - CNS, Critical Care & MSN-Education here) I think CNL is bunkum. It was created to justify entry-level MSNs because they had to come up with some sort of "generalized specialization" because it's required for a graduate degree. I do know half a dozen staff nurses who earned their CNLs via online degree completion programs for licensed nurses. But - just like you suspect - they are all working as staff nurses.

If you want to be an educator, get an MSN in education. CNS roles are focused on nursing practice & are associated with very high levels of responsibility. Nurse administrators have grueling jobs with endless responsibilities. If you want an (non-academic) advanced job, an MSN is necessary, but not sufficient. You will also have to have progressive levels of career advancement, beginning at the entry-level.

Nurses with those advanced jobs generally put in long hours. The jobs are all exempt (non-hourly), and productivity is measured in output rather than in hours worked. The expectation is to just work as many hours as it takes to get the job done. Honestly, if working a couple days a week is your goal you'd be better off remaining in a staff position.

You're right.

I actually just completed the first semester of my MSN in education l, as I think I would like to teach in the future. Not sure if I'm ready to teach anyone yet, outside being a preceptor.

I really like my staff nursing schedule, which is part of why I've remained as such. In panning for the future, though, I because interested in my options, outside of management or administration. I wouldn't have the job of administrator or manager for the world. Although I applaud those who handle the difficulties of such a position.

Thanks for your Point of View! It seems to be a very..... For lack of a better word..... Awkward position to have been created.

elkpark

14,633 Posts

Thanks for your Point of View! It seems to be a very..... For lack of a better word..... Awkward position to have been created.

Here is my own little personal conspiracy theory about the creation of the CNL; universities found themselves with significant numbers of people who wanted to enter nursing but who already had BA/BS degrees. A lot of these people aren't looking to become advanced practice RNs, they just want to get into nursing (at least for the time being). There is limited financial aid (subsidized Federal financial aid, anyway) for baccalaureate level study for people who already have a baccalaureate degree, and these people want to get financial aid to go to school (and the schools certainly want to make it as painless as possible for them to do so). These individuals can get Federal student aid to study at the graduate level. However, there is no earthly reason to prepare generalist RNs at the graduate level. Hmmmm, what to do, what to do????? And, hey presto, the AACN comes up with this "CNL" idea -- a generalist RN who is prepared at the Master's level, with some extra courses added on (and a fancy "white paper" explaining how they're not just regular RNs) to justify it being a graduate program.

This is a role that was invented by academia. It's not like there was any great cry from healthcare organizations and facilities for Master's-prepared generalist RNs. And much of the clinical world has not rushed to embrace the idea (the only entities I'm aware of that have really bought into the CNL role are the VA system and hospitals that are attached to universities that have CNL programs). But maybe it will catch on over time.

Boomer MS, RN

511 Posts

Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.

A realistic and accurate assessment. Amen.

PatMac10,RN, RN

1 Article; 1,164 Posts

Specializes in Nursing Education, CVICU, Float Pool.

Elkpark, that is very interesting assessment you have. It actually makes a lot of sense. Guess time will tell huh? Thanks for your insight!

Boomer MS, RN

511 Posts

Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.

And my disclosure: CNS graduate here.

However CNS, at this time, do not have diagnostic prescriptive authority in my state (NC). Therefore the line between CNS and CNL is further blurred. I understand (in theory) the microsytem and macrosystem levels that each type of nurse works at.

There has never been prescriptive authority for the CNS role in any state, to my knowledge. The NP role does include prescriptive authority, depending on the state. The four Advanced Practice roles are NP, CRNA, CNM and CNS, each with its own specifics . The direct entry CNL is not an Advanced Practice role. I had an interesting discussion with the Dean of my undergraduate program a couple of years ago, and she was, understandably, defensive of their CNL program, which is at major academic institution. I have faith that their CNL graduates are well prepared as new entry grads, and, according to the Dean, have numerous job opportunities at their university hospital as new grads. HouTx's above comment got it right in a nutshell, IMHO.

PatMac10,RN, RN

1 Article; 1,164 Posts

Specializes in Nursing Education, CVICU, Float Pool.
And my disclosure: CNS graduate here.

However CNS, at this time, do not have diagnostic prescriptive authority in my state (NC). Therefore the line between CNS and CNL is further blurred. I understand (in theory) the microsytem and macrosystem levels that each type of nurse works at.

There has never been prescriptive authority for the CNS role in any state, to my knowledge. The NP role does include prescriptive authority, depending on the state. The four Advanced Practice roles are NP, CRNA, CNM and CNS, each with its own specifics . The direct entry CNL is not an Advanced Practice role. I had an interesting discussion with the Dean of my undergraduate program a couple of years ago, and she was, understandably, defensive of their CNL program, which is at major academic institution. I have faith that their CNL graduates are well prepared as new entry grads, and, according to the Dean, have numerous job opportunities at their university hospital as new grads. HouTx's above comment got it right in a nutshell, IMHO.

Actually, I found Out some states do offer prescriptive authority to CNS, one of the administrators here is a Peds and Adult CNS who works in Nephrology as a CNS. Username escapes me at this time. She always has sub informative posts. And I'm not sure, but I think there may be annex period to the diagnosis part in NC when it comes to the Psych CNS, as I know they can conduct Psychotherapy In NC.

As stated above, I'm well aware of the CNL not being an Advanced Practice Role. I think it is a new concept, like Elk said, and we'll have to see if it will catch on.

Boomer MS, RN

511 Posts

Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.
Actually, I found Out some states do offer prescriptive authority to CNS, one of the administrators here is a Peds and Adult CNS who works in Nephrology as a CNS. Username escapes me at this time. She always has sub informative posts. And I'm not sure, but I think there may be annex period to the diagnosis part in NC when it comes to the Psych CNS, as I know they can conduct Psychotherapy In NC.

As stated above, I'm well aware of the CNL not being an Advanced Practice Role. I think it is a new concept, like Elk said, and we'll have to see if it will catch on.

I stand corrected, as you have found some information that I am unaware of. Some of my colleagues in my CNS program (Critical Care /Trauma) later then went back for an additional year of education to become an Acute Care Nurse Practitioner as well and thus, with passing the NP certification exam, could prescribe. In this instance these colleagues are both a CNS and an NP. I don't doubt that you're saying at all. But this is how it works in CA. I am surprised if a CNS has prescriptive privileges, but we all know things do change! The CNL programs and role are not new, at least not in CA.

PatMac10,RN, RN

1 Article; 1,164 Posts

Specializes in Nursing Education, CVICU, Float Pool.
I stand corrected, as you have found some information that I am unaware of. Some of my colleagues in my CNS program (Critical Care /Trauma) later then went back for an additional year of education to become an Acute Care Nurse Practitioner as well and thus, with passing the NP certification exam, could prescribe. In this instance these colleagues are both a CNS and an NP. I don't doubt that you're saying at all. But this is how it works in CA. I am surprised if a CNS has prescriptive privileges, but we all know things do change! The CNL programs and role are not new, at least not in CA.

Yep. The National Association of Clinical Nurse Specialists maintains a list of states that allow for CNS to practice independently and/ or prescribe.

See the following:

http://www.nacns.org/docs/toolkit/5-AuthorityTable.pdf

I never knew CNS prescribed until reading posted from TrAumaRUS, who is the forum Admin on here who is a practicing CNS who prescribes. She is going back to school (may be finished now?) to be a FNP for multiple reasons.

Also, I think the title or designation of CNL has existed for a while, but the new graduate level ANCC certification is more new. Though I could be mistaken.

Boomer MS, RN

511 Posts

Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.
Yep. The National Association of Clinical Nurse Specialists maintains a list of states that allow for CNS to practice independently and/ or prescribe.

See the following:

http://www.nacns.org/docs/toolkit/5-AuthorityTable.pdf

I never knew CNS prescribed until reading posted from TrAumaRUS, who is the forum Admin on here who is a practicing CNS who prescribes. She is going back to school (may be finished now?) to be a FNP for multiple reasons.

Also, I think the title or designation of CNL has existed for a while, but the new graduate level ANCC certification is more new. Though I could be mistaken.

Good to know! Thank you. I've read posts from TrAumaRUS but never picked up that she prescribed.

cjcsoon2bnp, MSN, RN, NP

7 Articles; 1,156 Posts

Specializes in Emergency Nursing.

To the OP, I think that HouTx made some very good points about the CNL role.

I am currently in an MSN in Nursing Education program that also offers a CNL track and although the Nursing Education and CNL students share quite a few classes there are some significant differences between the two roles. When reviewing my graduate program I knew from the beginning that the limited job prospects and confusion about the CNL role within the nursing community would make it a bad choice for me personally. With that being said, I know a few CNLs who work for the VA and seem to be very happy in their new positions.

I made a post discussing the differences between the clinical nurse leader (CNL) versus the clinical nurse specialist (CNS) in another thread, you might want to take a look. Here is the LINK

!Chris :specs:

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