What Do You Want to Be When You Grow Up? Try Clinical Nurse Leader

SafetyNurse1968, BSN, MSN, PhD

IT'S A PATIENT SAFETY ISSUE

As I stated in Part 1, I just got hired as an assistant professor at the University of South Carolina Upstate (USC-U) in Spartanburg! After seven long years of working on my PhD in nursing, I finished in May of 2018 and have been looking for work since then. During my interview, I asked the dean, Dr. Gibb about the Clinical Nurse Leader Master of Nursing program offered at USC-U.1I had heard of the CNL but didn't know much about it. As a patient safety advocate, I was excited to learn that the CNL role was actually created by the American Association of Colleges of Nursing (AACN) in response to the IOM report that suggested between 44,000 and 98,000 hospitalized patients die each year due to preventable medical errors (I've written about that in several articles:

Much research resulted to address this issue and, in that context, the AACN developed a new nursing role, the CNL in 2007. There is a need for leadership at the point of care. CNLs are master's level nurse graduates with the skills and knowledge to create change within complex systems and improve outcomes while they remain direct care providers. This is exciting news! The CNL is the first master's prepared role to be added to the nursing profession in more than 35 years.3

Clinical Nurse Leader

The CNL was created to improve the quality of health care systems while controlling costs. In comparison to a nurse administrator or nurse manager, the CNL is a provider of care for individuals at the microsystem level. What does "microsystem" mean? Patients and health care providers interact at four levels:

The patient
The microsystem: a unit with a care team
The organization where the microsystem is housed
The environment: policy, payment, regulation, accreditation1

The idea behind the CNL is to retain a master's-level nurse at the clinical bedside. The CNL is an advanced nurse generalist, vs. a specialist. The CNL improves outcomes through coordination and facilitation of care. What they don't do is focus on a specific population like cardiovascular patients or patients with diabetes. Rather they focus on patients with multiple chronic disease, or those with the least financial resources. The CNL is designed to support those who require high levels of care coordination. The CNL is trained to develop, implement and evaluate evidence-based protocols to change processes. CNLs aren't involved in management, but they do play a role in cost containment and financing. The role has been met with varying stages of acceptance, for example the VA has fully implemented the CNL role throughout their system, which includes 1400 facilities.2&3

WHAT DO YOU NEED TO BE A CNL?

To begin course work as a CNL, you will need a BSN or you will need to be an RN with a BS in another field. The goal of the CNL is to expand on skills and competencies of BSN programs. Leadership courses teach skills, interpersonal development, understanding of systems, skills in communication, critical thinking. Schools with CNL programs must develop partnerships with practice sites like hospitals and clinics. The partners are actively involved in curriculum design and provide settings for the 500 clinical hours needed for the degree. CNL students are precepted 1-1 for 300-400 clinical hours. This creates a bridge between theory and practice.2&3

Graduation from a CNL program leads to certification. The CNL certification is granted for a period of five years. The CNL certification exam is a computer-based three-hour exam. The AACN website provides study modules and everything you might need to pass the exam. If you take the exam at a school of nursing it is $350, but if you take it at a testing center it costs $425.4

Some popular jobs for CNLs include Clinical liaison, clinical wound specialist and post-acute clinical navigator. The national median annual wage of $84,000. The pay grade for CNLs is much higher than that of registered nurses (average $65,470) due to their extensive knowledge and the scope of their job. The U.S. Bureau of Labor Statistics has estimated growth for all nursing professions to be 19% by 2022, but most health care facilities are looking for professionals with higher degrees (MSN and Doctorate).5

There are 90 schools of nursing with 192 practice sites in 35 states and Puerto Rico with CNL programs. As of 2011, over 700 nurses obtained CNL, but it isn't known yet how many nurses with CNL degree practice in a designated CNL role.2,3&4

According to the CNL website on the AACN webpage, there are 6,500 CNLs nationwide.

The AACN advertises a CNL Summit, Research Symposium, how to get CNL certification, and they even have a CNL day, March 19th.4

The AACN website has resources for how to find a CNL program: American Association of Colleges of Nursing (AACN) > CNL Certification > Apply for the Exam > Eligible CNL Programs

OUTCOMES

Are outcomes improving? Where CNLs are incorporated into staffing mix, results show that outcomes improve; patient, nurse and physician satisfaction increases; fall rates, pressure ulcers, and nosocomial infections all decrease; there are lower readmission rates, improved financial gains, better communication, improved hand-off care, and decreased nurse turnover.2&3

Paying for a graduate degree can be daunting, however there are multiple resources available, including grants and scholarships at the local, state and national level.6&7

For more information on the CNL degree you can send an email to CNL@aacn.nche.edu

REFERENCES

1. Stevenson, J. C. (2017). First master of science nursing degree answers growing need for hospitals. University of South Carolina-Upstate Spartans. Summer, p. 11. Retrieved from: Graduate Programs and Resources: Master of Science in Nursing | USC Upstate

2. Baernholdt, M., & Cottingham, S. (2011). The clinical nurse leader - new nursing role with global implications. International Nursing Review, 58, 74-78.

3. Stanton, M. P., Lamon, C. B., & Williams, E. S. (2011). The clinical nurse leader: a comparative study of the American association of colleges of nursing vision to role implementation. Journal of Professional Nursing, 27(2), 78-83.

4. About CNL

5. What Is The Salary Outlook For Clinical Nurse Leader? - 218 NurseJournal.org218 NurseJournal.org

6. Featured College Scholarships

7. Nursing Scholarships - Scholarships.com