Clinical Nurse Leader, what is it exactly?

elkpark · Mar 16, 2011

There are a bunch of existing threads here about CNLs. Have you looked at them?

HouTx, BSN, MSN, EdD · Mar 17, 2011

I was at a conference earlier this week - and had an opportunity to hear Polly Bednash (CEO of AACN) address this exact issue. According to her, CNLs work within "microsystems" - one department/unit rather CNS's, who are responsible for working with a designated service line (cardiac, pulmonary, pedi, etc) across an entire organization. For instance, a pulmonary CNS might lead a project to examine evidence-based practices and determine the best way to educate all COPD patients, and then a med-surg unit CNL would work with staff on her dept to incorporate those changes into their patient care routines. CNLs would also be accountable for verification of clinical competency, department-based QI, etc.

CNLs are characterized by very high levels of clinical competency and knowledge. They are the primary clinical resource for the nurses with which they work and serve as a liaison/spokesperson to represent the interests of their department to physicians and other clinical providers. I don't understand how one could possibly jump into this role as a first step into nursing. Even if it were possible, from an educational standpoint - I doubt whether anyone would hire a new grad CNL.

BTW, according to Ms. Bednash, initial research has shown that CNLs are highly effective and associated with many positive patient care and staff-related (job satisfaction, decreased turnover, etc) outcomes.

soxy · May 18, 2011

Thank you! Very informative :)

newmusic · May 18, 2011

]Hi everyone,
Can anyone tell me what exactly a Clinical Nurse Leader does?
I am working on getting into nursing but am completely stumped on what to do as I get closer to finishing prereqs. I hold a non-nursing B.S. and know I want to eventually complete an MSN program. Problem is I don't know too much about what Masters-level types of nursing there is out there. I'm familiar with NP and CRNAs but not sure what a Clinical Nurse Leader does on a daily basis.
Basically, should I go ABSN-->MSN?
or
Direct-entry MSN (clinical nurse leader)-->Potentially other MSN (if Clinical nurse Leader is not for me?)
Advice? Experience? Insight? ANYTHING??
Thanks for any and all comments!

Hey I feel you - I had an alumni connection that could make me a CNL in just under two years - and declined.

I am chomping at the bit for my NP really, but I believe in taking the time to do it the right way.

True that that's not the case with other majors and masters like social work or psychology where you can have a change of heart after undergrad and do something a little different.

I think the proliferation of so0o0o0o many accelerated nursing programs for non-experiences nurses is outrageous and insulting and demeaning - and that's coming from someone who isn't even a nurse yet! But I am an artist and a teacher who loves science and takes my education seriously. Seriously, why rush through this kind of education? Traditional nursing programs dont take that long compared to med school! It's really important to be thorough in this work. I don't want to forget everything right after finals because 6 courses are crammed into one summer term. No, I don't want to rush through my medical education just to get some quickie fast food degree. I don't think you will get hired without a summer student nurse job in between the traditional years anyway, and definitely not at the master's level.

Totally don't mean to come across as so bossy or opinionated :) I am just passionate about this because I have been researching my new career choice like crazy and I also really love learning new things :) and I am not romanced when (always the overpriced private) universities try to swindle young people which is what I believe they are doing with this direct-entry jam.

soxy · May 19, 2011

Hi nursemusic and thank you for your input. Since I originally posted, I am preparing to apply to a direct entry masters program (which has the option of CNL which I will likely do) and I am very excited about it. I am also looking into how I can gain more patient care experience in the meantime (I have several years of clinical experience at my current job but not specifically patient care). So, if anyone has any ideas!!

To address a couple of things in your post--it's not so much that I am in a rush to get through schooling because I dislike it or something. In fact, I thoroughly enjoy school and taking classes and excel in them. However, staying in school not only does not produce a paycheck, but it also costs as you probably know! So, getting through schooling faster, especially when I already hold a degree, is only practical. If I had an infinite amount of money, I would probably also get a PhD, MD, learn to fly a plane, become a chef, etcetc. If you mean I will not be prepared, I would like to know who ever is when fresh out of school (nursing or not). I think how well one does is also greatly influenced by the individual. Additionally, I trust that the 'faster' programs that are approved/accredited/etc.. are approved/accredited/etc.. for a reason.

Also, you bring up a couple of interesting things. I was under the assumption that if you already have a BS then you cannot apply to traditional nursing programs and that they encourage you to apply to a-BSN programs. This is what SDSU told me anyway and besides, why would I want to be in the same applicant pool as those who don't have a degree yet? It doesn't make sense on multiple levels now that I really think of it.

You also bring up accelerated programs as somewhat insulting and I've picked up on this same attitude throughout the allnurses site. I just don't understand why. If anyone could explain why direct-entry and/or accelerated programs are insulting I'd love to understand!

Thanks and I'd love to hear any responses :)

newmusic · May 19, 2011

Hi nursemusic and thank you for your input. Since I originally posted, I am preparing to apply to a direct entry masters program (which has the option of CNL which I will likely do) and I am very excited about it. I am also looking into how I can gain more patient care experience in the meantime (I have several years of clinical experience at my current job but not specifically patient care). So, if anyone has any ideas!!
To address a couple of things in your post--it's not so much that I am in a rush to get through schooling because I dislike it or something. In fact, I thoroughly enjoy school and taking classes and excel in them. However, staying in school not only does not produce a paycheck, but it also costs as you probably know! So, getting through schooling faster, especially when I already hold a degree, is only practical. If I had an infinite amount of money, I would probably also get a PhD, MD, learn to fly a plane, become a chef, etcetc. If you mean I will not be prepared, I would like to know who ever is when fresh out of school (nursing or not). I think how well one does is also greatly influenced by the individual. Additionally, I trust that the 'faster' programs that are approved/accredited/etc.. are approved/accredited/etc.. for a reason.
Also, you bring up a couple of interesting things. I was under the assumption that if you already have a BS then you cannot apply to traditional nursing programs and that they encourage you to apply to a-BSN programs. This is what SDSU told me anyway and besides, why would I want to be in the same applicant pool as those who don't have a degree yet? It doesn't make sense on multiple levels now that I really think of it.
You also bring up accelerated programs as somewhat insulting and I've picked up on this same attitude throughout the allnurses site. I just don't understand why. If anyone could explain why direct-entry and/or accelerated programs are insulting I'd love to understand!
Thanks and I'd love to hear any responses :)

Hey thanks for your perspective, definitely different from mine and you bring up some interesting points. The nursing schools I have been dealing with are upper division two year programs that don't offer an accelerated nor a 4 year option - in other words it's all nursing courses with a summer in between. Many schools have different requirements and some will stick second degreers in the accelerated pool automatically, as you say, while others leave you the choice. Well, good luck with everything! Do you work in a hospital now? (I had to change my username from nursemusic)

38866 · Jun 10, 2011

I am a CNL. I graduated 2 years ago and have been functioning in the role for nearly 5 years. I love my role. I function close to the white paper ideals.

http://www.aacn.nche.edu/CNL/index.htm

is a great site to get you started. I've been to/presented at two different national conferences and the CNL varies a lot, depending on the institutions expectations of you. A lot of CNLs I meet are not as fortunate as I am.

A lot of your education is similar to APRN. If I ever wanted to be an APRN it would be another year of education. I've never wanted to be an APRN, the CNL role is a great fit for me.

http://www.amazon.com/Initiating-Sustaining-Clinical-Nurse-Leader/dp/0763776319 This is the first text on the CNL. James Harris is part of the VA system, who has been a big supporter of the CNL. Linda is also fabulous and has been a great advocate. There is a chapter in there that features different CNLs across the country. I haven't read the whole book, just that section. Otherwise, I skimmed the content and it all looked really great. This book came out about a year ago or so.

soxy · Jun 16, 2011

Thanks 38866. Both of those links were very helpful and it's nice to hear you are truly enjoying your role as a CNL. But I gotta ask about something you mentioned-- " A lot of CNLs I meet are not as fortunate as I am."I would be interested to know what you mean by that.

Thanks again!

EricJRN, MSN, RN · Jun 16, 2011

Although the CNL role isn't something I run into in the area where I work, I can speak to a financial reason that a direct-entry MSN might not necessarily make the most sense for everyone.

Think of your initial licensure program as the one that you get to pay for. It's pretty standard, at least in my area, for hospitals to offer tuition reimbursement to their nurses. Even with hospital belt-tightening in poor economic conditions, many nurses are able to have their graduate educations entirely paid for by their employers.

For some, it makes sense to become a nurse in the most economic and efficient manner possible, to begin working and then to allow the hospital to pay for any further academic pursuits. This might also allow you to determine whether any additional educational investment would be worth it. (Not uncommonly, nurses decide to defer admission to grad programs to avoid a five-figure cut in pay when transitioning from experienced nurse to new APN.)

I think the situation really depends on the cost and accessibility of each initial licensure program in your area. You might even decide that an ADN is the way to go. I'm an experienced ADN with a psych BA. I'm in the process of applying to an MSN program that will admit me without requiring any BSN coursework. Several of these programs exist.

Just as you notice the common opinion here that nurses should have experience prior to leadership or advanced roles, there is sometimes a noticeable belief (on AN and beyond) among pre-nursing students with a previous BA/BS that the MSN is logically the only answer. It's easy to fall into that line of thinking without thoroughly checking out each option, but it sounds like you are doing a good job of looking at multiple routes of entry.

Good luck to you!

38866 · Jun 16, 2011

I stated earlier that some CNLs aren't as fortunate as I am in their place of work. A lot of CNLs I have met at conferences have enormous pateint loads (around 60) and aren't really allowed to get to know their patients. They end up doing a lot of auditing and trying to fix issues, like Falls. They dont' get to actual direct patient care and be the horizontal leader that the role was designed for. My job description/role is very close to the white paper ideal. Many are not.

PMFB-RN, RN · Jun 16, 2011

A title looking for a job. Every clinical nurse leader I know of is working as a staff RN equal in responsibility and pay to the ADN and BSN co-workers.