CNL vs APRN?

[Farawyn]

I am reading up on this and I really don't see the difference. I am not being facetious. This is not for school, but for my own knowledge. Is anyone a CNL or an APRN that can help clarify? Link below:

Thank you!

American Association of Colleges of Nursing | Frequently Asked Questions

[elkpark]

What, specifically, are you having trouble seeing? There is a huge difference. The CNL is not an advanced practice nurse. The four advanced practice roles are the nurse practitioner, nurse midwife, nurse anesthetist, and clinical nurse specialist.

Did you read the following on the page you linked?

"Q: How is a Clinical Nurse Leader different from a Clinical Nurse Specialist or other advanced practice nurse?

The CNL is not prepared as an advanced practice registered nurse (APRN) as the APRN is currently defined. Advanced practice nurses, including clinical nurse specialists (CNSs) and nurse practitioners (NPs), are prepared with specialist education in a defined area of practice. The CNL and APRN roles complement one another and bring unique expertise to the healthcare team. For example, the CNL may call on the CNS to provide consultation when a specialist area of concern arises (i.e. when a patient does not respond to nursing care or therapeutics as expected). AACN, in consultation with a leading group of CNSs, has developed a document, The CNL-CNS Roles: Similarities, Differences and Complementarities that can be downloaded at American Association of Colleges of Nursing | CNL Programs."

Advanced practice nurses are prepared to provide advanced clinical nursing services in a specific area of expertise. CNLs are generalists with some extra education in leadership, statistics, systems, etc, but are not prepared with a specific clinical expertise and do not practice at an advanced level clinically. I believe that part of the confusion is because the CNL role was invented by the AACN rather than developing "naturally" out of a demand from the bedside (I have my own rather cynical theory about how/why the CNL role was developed). Although the AACN and some of its constituent schools are pushin this idea hard, it remains to be seen how widely the CNL is going to be embraced in the real world. There doesn't seem to be a lot of demand so far. Maybe that will change as time goes on.

[Farawyn]

Yes, thanks, I did read that, and while I have no problem understanding what an APRN does I really don't get the role of a CNL. I was a bit skeptical reading as well.

Is anyone here a CNL?

[elkpark]

Yes, thanks, I did read that, and while I have no problem understanding what an APRN does I really don't get the role of a CNL. I was a but skeptical reading as well.

Is anyone here a CNL?

There are a bunch of older threads here about the CNL role -- have you looked for them? Also, there are a few CNLs (CNL students, at least) who post here sometimes. Maybe one of them will come along.

[Farawyn]

There are a bunch of older threads here about the CNL role -- have you looked for them? Also, there are a few CNLs (CNL students, at least) who post here sometimes. Maybe one of them will come along.

Thanks I will follow up.

[MidwifeAPRN219, MSN, RN, APRN, CNM]

Have you read the CNL White Paper? It explains the role of the CNL a lot more. I am a CNL student. The CNL does not prescribe medication and cannot provide medical diagnoses like APRNs can. The role of the CNL is more to help make Evidence Based Practice changes on the microsystem level. For example, if your unit has a higher incidence of infection than another unit in the hospital, it is the role of the CNL to find out why and help implement Evidence Based Practices that will improve patient outcomes and help reduce costs. I really do find that the CNL role can COMPLEMENT the APRN role, especially if you are going into the APRN role with the frame of mind of trying to change the system. For example, I am going back to school once I am done to become a Nurse-Midwife. This has always been a plan of mine, and was using the CNL program as a stepping stone to get there. However, I really do find that the CNL role can really complement my future practice as a midwife. I know for a fact that L&D floors really lack EBP all over the country and they really do need a CNL helping make the EBP changes at the microsystem level. The United States for example, has a really high rate of C-sections (nearly 33%), some hospitals are at 50%+. The CNL role could look at WHY the L&D floor at a particular hospital has such a high c-section rate, how they could help change those rates through EBP, and evaluate those changes to see if they help and then re-evaluate if they need to implement a different change.

I copied this from the CNL white paper...maybe it will help some:

Fundamental aspects of the CNL role include:

• Leadership in the care of the sick in and across all environments;

• Design and provision of health promotion and risk reduction services for diversepopulations;

• Provision of evidence-based practice;

• Population-appropriate health care to individuals, clinical groups/units, andcommunities;

• Clinical decision-making;

• Design and implementation of plans of care;

• Risk anticipation;

• Participation in identification and collection of care outcomes;

• Accountability for evaluation and improvement of point-of-care outcomes;

• Mass customization of care;

• Client and community advocacy;

• Education and information management;

• Delegation and oversight of care delivery and outcomes;

• Team management and collaboration with other health professional teammembers;

• Development and leveraging of human, environmental and material resources;

• Management and use of client-care and information technology; and

• Lateral integration of care for a specified group of patients.

In summary, the role of the beginning CNL encompasses the following broad areas:

• Clinician: designer/coordinator/integrator/evaluator of care to individuals, families,groups, communities, and populations; able to understand the rationale for care andcompetently deliver this care to an increasingly complex and diverse population inmultiple environments. The CNL provides care at the point of care to individuals acrossthe lifespan with particular emphasis on health promotion and risk reduction services.

• Outcomes manager: synthesizes data, information and knowledge to evaluate andachieve optimal client outcomes.

• Client advocate: adept at ensuring that clients, families and communities are wellinformedand included in care planning and is an informed leader for improving care.The CNL also serves as an advocate for the profession and the interdisciplinary healthcare team.

• Educator: uses appropriate teaching principles and strategies as well as currentinformation, materials and technologies to teach clients, groups and other health careprofessionals under their supervision;

• Information manager: able to use information systems and technology that putknowledge at the point of care to improve health care outcomes;

• Systems analyst/Risk anticipator: able to participate in systems review to improvequality of client care delivery and at the individual level to critically evaluate andanticipate risks to client safety with the aim of preventing medical error.

• Team Manager: able to properly delegate and manage the nursing team resources(human and fiscal) and serve as a leader and partner in the interdisciplinary health careteam; and

• Member of a profession: accountable for the ongoing acquisition of knowledge andskills to effect change in health care practice and outcomes and in the profession.

• Lifelong Learner: recognizes the need for and actively pursues new knowledge andskills as one's role and needs of the health care system evolves.

If you read the rest of the white paper, it gives you more information about the specific role.

http://www.aacn.nche.edu/publications/white-papers/ClinicalNurseLeader.pdf

[Farawyn]

Thank you for the clarification.

I stumbled across it by accident and have never worked with a CNL.

[elkpark]

Have you read the CNL White Paper? It explains the role of the CNL a lot more. I am a CNL student. The CNL does not prescribe medication and cannot provide medical diagnoses like APRNs can. The role of the CNL is more to help make Evidence Based Practice changes on the microsystem level. For example, if your unit has a higher incidence of infection than another unit in the hospital, it is the role of the CNL to find out why and help implement Evidence Based Practices that will improve patient outcomes and help reduce costs. I really do find that the CNL role can COMPLEMENT the APRN role, especially if you are going into the APRN role with the frame of mind of trying to change the system. For example, I am going back to school once I am done to become a Nurse-Midwife. This has always been a plan of mine, and was using the CNL program as a stepping stone to get there. However, I really do find that the CNL role can really complement my future practice as a midwife. I know for a fact that L&D floors really lack EBP all over the country and they really do need a CNL helping make the EBP changes at the microsystem level. The United States for example, has a really high rate of C-sections (nearly 33%), some hospitals are at 50%+. The CNL role could look at WHY the L&D floor at a particular hospital has such a high c-section rate, how they could help change those rates through EBP, and evaluate those changes to see if they help and then re-evaluate if they need to implement a different change.

I copied this from the CNL white paper...maybe it will help some:

Fundamental aspects of the CNL role include:

• Leadership in the care of the sick in and across all environments;

• Design and provision of health promotion and risk reduction services for diversepopulations;

• Provision of evidence-based practice;

• Population-appropriate health care to individuals, clinical groups/units, andcommunities;

• Clinical decision-making;

• Design and implementation of plans of care;

• Risk anticipation;

• Participation in identification and collection of care outcomes;

• Accountability for evaluation and improvement of point-of-care outcomes;

• Mass customization of care;

• Client and community advocacy;

• Education and information management;

• Delegation and oversight of care delivery and outcomes;

• Team management and collaboration with other health professional teammembers;

• Development and leveraging of human, environmental and material resources;

• Management and use of client-care and information technology; and

• Lateral integration of care for a specified group of patients.

In summary, the role of the beginning CNL encompasses the following broad areas:

• Clinician: designer/coordinator/integrator/evaluator of care to individuals, families,groups, communities, and populations; able to understand the rationale for care andcompetently deliver this care to an increasingly complex and diverse population inmultiple environments. The CNL provides care at the point of care to individuals acrossthe lifespan with particular emphasis on health promotion and risk reduction services.

• Outcomes manager: synthesizes data, information and knowledge to evaluate andachieve optimal client outcomes.

• Client advocate: adept at ensuring that clients, families and communities are wellinformedand included in care planning and is an informed leader for improving care.The CNL also serves as an advocate for the profession and the interdisciplinary healthcare team.

• Educator: uses appropriate teaching principles and strategies as well as currentinformation, materials and technologies to teach clients, groups and other health careprofessionals under their supervision;

• Information manager: able to use information systems and technology that putknowledge at the point of care to improve health care outcomes;

• Systems analyst/Risk anticipator: able to participate in systems review to improvequality of client care delivery and at the individual level to critically evaluate andanticipate risks to client safety with the aim of preventing medical error.

• Team Manager: able to properly delegate and manage the nursing team resources(human and fiscal) and serve as a leader and partner in the interdisciplinary health careteam; and

• Member of a profession: accountable for the ongoing acquisition of knowledge andskills to effect change in health care practice and outcomes and in the profession.

• Lifelong Learner: recognizes the need for and actively pursues new knowledge andskills as one's role and needs of the health care system evolves.

If you read the rest of the white paper, it gives you more information about the specific role.

http://www.aacn.nche.edu/publications/white-papers/ClinicalNurseLeader.pdf

My issue with all of this is that, every time I read any of this stuff about what CNLs can do, it sounds to me like what I would expect any experienced, expert bedside RN to be doing. I don't see why we dreamed up a fancy new degree and title for what nurses have been doing all along (esp. the direct-entry programs that are training non-nurses to be clinical nurse "leaders").

[Farawyn]

My issue with all of this is that, every time I read any of this stuff about what CNLs can do, it sounds to me like what I would expect any experienced, expert bedside RN to be doing. I don't see why we dreamed up a fancy new degree and title for what nurses have been doing all along (esp. the direct-entry programs that are training non-nurses to be clinical nurse "leaders").

Okay, this was kind of what I was getting at but wanted to make sure I wasn't missing anything. It sounds a little shenanigan-ish.

(elk has bigger cajones than me!)

[llg, PhD, RN]

I don't totally agree with everything the AACN says about the CNL role. I wish they would revise their stance to match the real world.

But ... I do think there is a need for a master's degree that prepares staff nurses to be unit-level leaders. We need good Staff Development educators, Managers, etc. leading the staff in evidence-based practice initiatives, quality assurance efforts, program coordinators, etc. There really is a need for people who have more than the entry-level BSN education to be "front line" leaders -- and the APN's with DNP's are not interested in those roles and not always well-prepared for them.

I have worked with a couple of CNL's in a hospital setting and found them to be well-prepared to meet the needs. Those people were not in CNL roles, etc. They had other job titles, but had gotten CNL degrees. I wish the AACN would drop/change their description of the CNL role -- and focus on developing the CNL degree to be the one that prepares nurses for the multiple unit leadership roles that are needed by employers.

Once again, academic leaders are shooting the profession of nursing in the foot by confusing a degree with a job role. They are 2 different things. Let the employers organize the work of their facility and create the specific jobs needed to get the work done. Let the schools develop programs of study that give people the knowledge and skills to fill a variety of roles that may exist in a continuously changing job market. Let the job markets evolve as they must to meet the needs of society. Job markets move quickly. Schools move slowly and can't keep creating new degrees for each new possible job. We need a MSN that matches the reality that people at that level of practice frequently find their roles evolving and combining different functions -- staff educator, manager, coordinator, change-agent, care coordinator, etc. A good generic MSN with the ability to fulfill multiple functions is what we need -- like a good CNL -- not locked into one specific job role, but rather, flexible.

OK ... rant over for now.

[klone, MSN, RN]

But ... I do think there is a need for a master's degree that prepares staff nurses to be unit-level leaders. We need good Staff Development educators, Managers, etc. leading the staff in evidence-based practice initiatives, quality assurance efforts, program coordinators, etc.

That's kind of what the MSN in Leadership is for.

[elkpark]

That's kind of what the MSN in Leadership is for.

And MSN in education, and CNSs ...