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

[traumaRUs, MSN, APRN]

@Elkpark - my thoughts exactly.

One more way to push the CNS degree out the door.

So glad I chose to go back to school.

[Red Kryptonite]

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").

If nurses are doing so well with implementing EBP and don't need any special role for doing so, then why is this still true?

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.

The high cesarean rate and other dysfunctional practices and outcomes in L&D are not totally the fault of nurses, obviously. However I do clearly remember that it was a nurse who instructed me to sit on my tailbone while pushing, making the outlet smaller, and who instructed me told my breath and "purple push" thus deoxygenating my baby. And it was a nurse who tried to tell me I could not stand by the bed with the fetal monitor on until my midwife shut her down. It was a nurse who, in violation of my wishes for a natural birth, came in every 20-30 minutes and asked, "don't you want your epidural YET?!" And it was a nurse who, after everything I wanted my birth to be had been destroyed, and I ended up with a cesarean, and felt utterly defeated and broken, instead of offering me the breastfeeding help I needed, came in over and over to ask, "are you ready to give her a bottle yet?" until she finally wore down the last bit of confidence and hope I had and I gave in. And this wasn't in the dark ages, it was the late 90s. (Actually the monitor incident was 2004. Different birth.)

Sorry but I think floor nurses could use a lot of help with evidence-based based practice.

[RosieMommy]

Here is a BIG difference I see between the two. APRNs are those four specialized nurses: nurse practitioner, anesthetist, mid-wife and specialist who have been certified by a Board and licensed by the State (government) because of which they are not just provided standing but also prestige. CNL are not licensed by the State but by a nursing body ONLY and therein lies the BIG difference.

[AllIcanbe]

... So how can anyone make a difference in a field they have never worked in? This is in regards to direct entry programs for CNLs.

[NanikRN]

The CNLs I have worked with are experienced nurses. I haven' t met any direct entry CNLs. Im wondering if they are really that common

[Jules A, MSN]

The CNLs I have worked with are experienced nurses. I haven' t met any direct entry CNLs. Im wondering if they are really that common

University of MD was pumping them out like nobodies business. Not sure if that has settled since the DNP craze hit. I was not at all impressed with the ones I worked with, with the exception of 2 they were heavy on the delegation and horribly lacking any clinical skills at all. They came out with their Masters and felt as if they should be something more than a floor nurse starting at new grad RN wages and while I get that they had no experience or background in health care WTH?

One who was actually realistic about what she didn't know and willing to work her way into a position said the college pushed her toward that track because she already had bachelors degree. I can't say 100% but I'm always suspect when schools are billing graduate tuition for undergraduate courses.

In practice there are few positions that actually let any time for actual nursing research and frankly thats what we have PhDs for, imo. Most CNLs I have worked with, many without the actual certificate, functioned more as either charge RNs or nurse managers so again no time for coming up with all the EBP research everyone is so enamored with.

[elkpark]

... So how can anyone make a difference in a field they have never worked in? This is in regards to direct entry programs for CNLs.

A lot of us wonder about that ...

[APRN., DNP, RN, APRN, NP]

The APRN's are not prepared as generalists like the CNL's are. The APRN's function in their silo's of specialty, while the CNL's work to fix workflow issues between all of the disciplines. The Clinical Nurse Leaders are educated to focus on patient care outcomes in all settings: both inpatient and outpatient. Therefore, they have more flexibility in practice environment.

[Jules A, MSN]

The APRN's are not prepared as generalists like the CNL's are. The APRN's function in their silo's of specialty, while the CNL's work to fix workflow issues between all of the disciplines. The Clinical Nurse Leaders are educated to focus on patient care outcomes in all settings: both inpatient and outpatient. Therefore, they have more flexibility in practice environment.

Maybe in that they can work as nurses or supervisors on more units but NPs prescribe so its like an entirely different profession. I'm able to work inpatient and outpatient also and I make twice what a well paid CNL makes.

[PG2018]

You know, in any other line of work a problem solver is somebody who is good at their job, creative, and reliable. In nursing, it's a meaningless certificate that doesn't make one any more qualified to do anything a RN or company man (or woman) can't do. As a CNL, your practice isn't enhanced or more broad than a APRN. You're no more a generalist than any other nurse. But kudos for wanting to learn, try something new, and put yourself out there. Me? I won't address address any work flow issues. I'll just keep the clinic open and profitable.

[PG2018]

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

This is what CNS people are tasked with in my state. They aren't employed in clinical practice, outside of academia, because they increase costs without any increase in revenue. If sirgical site infections are a problem, as an example, most hospitals here would mere ly form a committee of clinical folks to devise is a solution using research to do it. No need for a special set of initials to accomplish this. I worked with a CNS from another state who had to retest to get certified in my state. Her exam was focused on research.

[traumaRUs, MSN, APRN]

As a CNS, in many states (including IL where I practice) CNS is an APRN with the same scope of practice as an NP.

Personally, education is a product that I purchase. My education provided me with a job (APRN) but I already had a career (nursing).

The lines of nursing education have become so blurred that its laughable.