MSN direct entry/CNL/NP questions

kate_m · Apr 16, 2016

Ahhhhhh! So I understand I am exactly 3 years late in posting but for anyone that stumbles across this post with the same question, I want to clear something up.

Being a CNL might have been the best decision of my life! (Aside from my decision NOT to go to medical school!)

I love my job! Not every now and then, not when I save a patient life, not because my units are the best ever or I work at some ridiculous, iconic hospital or live in a great city....no.... I LOVE MY JOB. I LOVE MY ROLE. I LOVE WHAT I DO ON A DAILY BASIS. And here is the thing....I work in the exact same critical care units that I worked in before with the exact same people in the same frustrating, low performing, Midwestern megaplex that I have worked in forever. And being an RN there got really old. I spent the first 7 years of my career thinking I had made the worst mistake of my life (becoming a nurse) after making the best decision of my life (not going to medical school....to which I was accepted too).

See here is what makes the difference between RNs, NPs/CNSs, MDs, PAs, DOs, and any other direct provider and a CNL. We are all at the bedside/frontlines, but while everyone else helps their patients, I help the entire patient population of my units, my department, and my hospital. What is more.....staff - all staff....LOVE this role. I aM more accepted, more welcomed, more sought out than any other person or role in my area. The nurse managers come to me, the physicians come to me, the surgeons, the staff, SW, Cas management, even people who aren't in my units! You know why? Because CNLS have the knowledge and skill set to get **** done and get it done fast, right, and impressively better than any other individual.

The CNL is an advanced medical GENERALIST not a specialist like NPs or CNSs. But that doesn't mean we have less value or competency. In fact in many cases we have more knowledge and competency because we have been taught to think outside the box, being people togethee, rapidly absorb, synthesize, and analyze info, and we are right there at the bedside with patients and providers. Have a physician who needs to prone a patient but has no idea what timing to use, what labs need monitoring, what prophylaxis is needed, or what the criteria is? Guess what? That is me.

Need to arrange a family meeting to discuss end of life care with a belligerent family? Guess what? I get it done, align with the family and guide everyone through it peacefully.

Have a high rate of hospital acquired infections or conditions? Guess what? Also me.

CNLs are a jack of all trades with the advanced knowledge to speak the language of all other disciplines, dig down to the root of the problem, solve it right then and there, and then......here is the big money shot....we take that knowledge and when it starts trending as an ongoing systems or process problem, we measure it, we fix it, and we fix it permanently.

The only downside of my job is I AM IN SUCH HIGH DEMAND that I need more help. Other CNLs. We are supposed to be one per unit. I have an entire critical care department. I carry more patients that our 3 ICU teams combined (I see recovery, psych, and acute medicine patients all that overflow into our units). I have 190 RN staff. I have 6 nurse managers/anms, roughly 40 attending physicians, 6 chief physicians, an NP, a PA, 6 CRNAs, 6 CNAs, 9 RN students, 2 graduate students, 12 to 16 interns and residents, 3 fellows, AND every ancillary clinical service that touches my patients.

But I LOVE my job.

And the people who work with me, LOVE MY ROLE.

And patients love me.

And it isn't just me or my personality. We have one in med surg, one in primary care, and one in psych. And although we almost have VERY different personalities and styles, we all do the same thing.

Clinical....patient centered...evidence based....interdisciplinary....work that focuses on improving the quality, safety, and value of care at the point-of-care.

There isn't a CNL that I know....that is not passionately in love with their job.

The reason people "don't get" what a CNL is or they throw out some half assed, ill informed or biased answer is because they have read or heard something about the role, and they have tried to pull together this image of what that looks like using traditional ideas or nursing.

For example....they hear evidence-based practitioner and they imagine their old, out-of-touch, hasn't practiced in 20 years, nursing professor.

And then they read that we improve quality and cost of care and they assume CNLs also look a bit like their nurse manager or QI officer who is always breathing down their neck.

Or they read that we are advanced generalist and thus envision some sort of glorified charge nurse who think they are too good to work the floor anymore.

When you put all that together, you get a very ugly and off-putting, nowhere close to the truth picture of what people think a CNL is.

But it isn't true. And the exact reason nursing has such a hard time envisioning or accepting the new role is because CNLs AREN'T traditional nurses. We work alongside traditional nursing roles...in partnership. Same with per disciplines. Our alliance and our alignment are with the patient. Our loyalty lies with them and the microsystem patient population exclusively. Our schedules are flexible, not rigid like the rest of clinical nursing. This is because it NEEDS to be somewhat flexible if we are going to be in the right place at the right time to provide the right care.

Also, we aren't administrators. We take patient loads. Our patient load is every patient in our microsystem. We aren't always wiping butts, drawing blood, or doing skills....but we are in there...educating, assisting in the facilitation of goals of care, leading family meetings, leading the interdisciplinary rounds, bridging communication gaps, fixing care delivery issues, doing advanced assessments, evaluating the efficacy and side effect profiles of medication regiments, evaluating the effective s's or interdisciplinary plans of care, thwarting errors, supporting staff....all staff....by educating them on clinical issues or facility processes that they are struggling with. And i do it all in a timely, compassionate, kind, and HIGHLY RELIABLE way.

I would caution you in taking advice from people who have never worked intimately with CNLs in the clinical setting or who aren't a CNL themself. If I had listened to all the skeptics, the ill-informed, and the general pot-stirrers then I would have missed out on what I consider a truly great job.

It has been my experience, and the experience of CNLs across the country, that our greatest barrier to role integration and early adoption has come from our own profession. The evidence on the value of a CNL and the rapid adoption and integration of the CNL role by other disciplines was surprising. CNLs are highly respected and sought after. People from other areas, other departments, even the community, often know me by name before I even have a chance to introduce myself. I think the last place people expected resistance to come from was within nursing itself. Which is unfortunate.

CNLs may be most closely aligned with patients, but the fill a tremendous gap in nursing and they ease the workload, both directly and indirectly, for all involved, but primarily for nursing. CNLs also have a very supportive role. Again, they are in partnership with nurses, not in authority over them. CNLs coach, guide, educate, and assist nurses in complex care, patient needs, and the implementation and actualization of share governance, unit goals, and personal goals.

Studies have shown significant improvements in workplace environments, staff satisfaction, and patient satisfaction with the addition of just a single CNL to the area.

I don't know how many NPs, CNSs, or CRNAs you know that can do all and still perform and publish research at the same time. But this is what a CNL does.

And anyone who doesn't seriously look into it when considering advanced clinical tracks, is doing themselves and healthcare a disservice.

If you have a passion for changing and improving healthcare, continued self growth and education, research, EBP, clinical care, and interdisciplinary collaboration, or any combination of these.....or if you simply just want to make a difference....then being a CNL is for you.

And for the skeptics who believe that speculating about the relevancy, competency, skill set, qualifications, or valye of the role....I can tell you....the evidence and the numbers are already proving them wrong. The federal government was an early adopter of the role while private hospitals and organizations hung back and waited to see what happened. Well that was a decade ago. Within a decade, and despite federal commitment and funding for the role, the private sector has, in the last three year alone, overtaken the federal government in terms of CNL employment. And the gap is widening rapidly.

I went to an beginner CNL program. A good school, but still, a program that was itself still trying to nail the CNL role down. I have several year experience and a handful of cohort studies published, but from 3 months I have received head hunter calls from those aforementioned iconic, nationally recognized hospitals interested in hiring me.

The offer is always tempting. ALWAYS. But family commitments require I stay where I am. And I am happy with where I am.

And that is another thing....I am pretty sure there aren't many NPs who are receiving quarterly calls from MD Anderson, Johns Hopkins, Wakeforest, and UAB.

So yeah, being a CNL IS awesome. And if you decide you want to be an NP later it isn't like you have to start all over again. 2 of your 3 years of NP program is already done. 1 year and you are done....but with more credentials, an impressive resume, and awesomely powerful skull set.

Work smarter, not harder.

kmd1005 · Sep 30, 2016

@kate_m

Thank you, thank you, thank you so much for your detailed post regarding the CNL role. I am non-nursing (non-BSN) graduate, and I've been (excessively) researching on this role, the CNS, and NP.

One of the schools I'm applying to offers an entry-level MSN-CNL program. This is one of the schools who just recently opened this program (maybe 2 years old). Your feedback has given me the guidance I have long sought after as the school itself doesn't have much information. I can definitely see how very demanding (and rewarding)this role could be, especially of the number (and level) of responsibilities that a CNL has. It's so unfortunate that it's considered a traditional nursing role, but I'm confident that will change. I'm hoping after a few years as a CNL I'll get back into completing a post-masters to be a FNP, but given what the CNL role entails, I'm in no rush.

Best,

Kris

yli08 · Mar 6, 2018

Has anyone seen an increase in CNL roles?

aniretake, MSN, RN · Jun 28, 2018

I am having all the same questions and in the process of applying for MSN-CNL for Fall 2019 (I have bachelors in Chemistry) and later down the road becoming an NP