Why is AACN developing new role " Clinical Nurse Leader"????

[NRSKarenRN]

the clinical nurse leader

| download pdf version |

the clinical nurse leader or cnl

is a new nursing role being developed by the american association of colleges of nursing (aacn) in collaboration with leaders from the education and practice arenas. aacn is advancing the cnl to improve the quality of patient care and to better prepare nurses to thrive in the health care system. the cnl role emerged following research and discussion with stakeholder groups as a way to engage highly skilled clinicians in outcomes-based practice and quality improvement.

in practice, the cnl oversees the care coordination of a distinct group of patients and actively provides direct patient care in complex situations. this master's degree-prepared clinician puts evidence-based practice into action to ensure that patients benefit from the latest innovations in care delivery. the cnl evaluates patient outcomes, assesses cohort risk, and has the decision-making authority to change care plans when necessary. the cnl is a leader in the health care delivery system, and the implementation of this role will vary across settings.

http://www.aacn.nche.edu/cnl/about.htm

gee, i thought this was the cns role in a hospital facility...why the need for another practioner.....i must be getting old.

[elkpark]

It's sad that our profession is doing this to itself. By creating all these new role, titles, and degrees, we are creating a confusing mess that will need to be sorted out eventually. That sorting out will be messy.

Not only that, but also tempting uninformed people into expensive graduate programs with unrealistic expectations about their career prospects.

[touchhealth]

Not only that, but also tempting uninformed people into expensive graduate programs with unrealistic expectations about their career prospects.

I'm a second degree student who has been weighing all the options for Nursing school. Ideally I want to complete a BSN, and to start working in the field. But it's just so complicated, and sometimes grad school is actually the cheaper option.

1) The communicaty college down the street has a waiting list of at least 2+ years, IF you get pulled for the lottery.

2) The accelerate BSN programs in my area are all private schools w/ a tuition of over $50,000.00, so I'd be done in a year but weighed down w/ some hefty debt (you CAN get funding for s 2nd Bachelor's, but in this economy that seems crazy!)

3) I learned about a direct-entry CNL program at a state school that is 18months of non-stop study & clinical rotations, that is a fraction of the $...less than half the cost for the accelerated BSN programs. But then it gets even more confusing...

I don't really understand the CNL role either. I did work for risk management at my hospital and saw many, many, examples of serious problems that came from members of the care team not coordinating.

From the website for the program, they clearly say the direct-entry CNL's work as bedside nurses anyways, with the same pay. It's such a loosely defined, in-between role....

The CNL program is still the best option of the three. Lower cost and gets me licensed and working quickly. I definately love research and education (I come from a family of teachers) so from that standpoint I see the value of extra work in research, and graduate level coursework. But from a clinical standpoint it still would put me at the same level as an AA, or BSN prepared RN, just with some different letters, and an extra test (as if the NCLEX won't be stressful enough). It's very confusing....

[Southern Magnolia]

I am in a similiar situation as touchhealth. . . I have a BA in another field and have been working on prerecs for a 2nd degree BSN program in my area . . . seemed like the best route to becoming an RN (local community college AA degree seems silly when for the same amount of time and a bit more $ I can have a BSN) . . . I also want the option to pursue graduate work/ DNP program in the future.

Well, I'm about to wrap up my prerecs and my husband is being transferred to another state. The new state doesn't have a second degree BSN option . . .but does have a direct entry MSN-CNL program. More money than I'd like but looks like my choices are this MSN-CNL program or an AA at the local community college and later going for an RN to BSN.

I'm thinking that even if I get the CNL certification I'll basically be walking in as a "green" nurse doing what I would have done with the 2nd degree BSN anyway. Other than the extra $ that doesn't bother me because I can still go on to a DNP program later and will in the meantime hopefully find a niche using the CNL.

Is there a flaw in my logic . . . speak up folks . .. am I being overly optimistic at my options with the CNL. I am a "go getter" type so I'm not concerned with how hard I've heard the MSN programs are . . . just worried about the program providing enough clinical experiences to walk in prepared after graduation. Any of you had experience working with new CNL grads . . . are they up to par clinically if they were direct entry?

Thanks

[touchhealth]

Hey NomadMamma,

I just wanted to add that some NP/CNS programs allow entry if you have an associates degree and a bachelor's in another field. I know that UCSF allows that, and there may be other programs that do that too. Look into what is offered in your area, because if your competitive enough to matriculate into a graduate program that way, it's the best in terms of cost! I'd totally do that but I've got some additional time constraints. Ugh. What a complicated process and so many hoops to jump through!!!

All the best!

[Southern Magnolia]

Time is a problem here too. I have two toddlers . . .

I'm understanding that the MSN only NP programs and CNS programs are being phased out???? Though I could be wrong. It's a challenge because the CNL is new and the CNS is phazing out and the DNP's are phazing in . . . and here I thought I was going to be an RN and it was simple and direct. HA! I know at ASU they are phasing out the MSN programs and pushing people to the newer DNP programs.

I didn't realize there were an direct entry NP programs. I'm all for saving time and money but the idea of a direct entry NP program scares me. I'm just throwing ideas around until we get moved anyway. My other issue is money . . . I'm thinking of maybe doing a CNA program to get to work in a local facility and then see if I can get some financing. I imagine that'll help me get into the direct entry MSN also.

Good luck to you . . .

[rnmi2004]

I honestly don't see my hospital spending money on a CNL, especially in this economy. I know that the recession/depression won't last forever, but right now it doesn't seem to me like a wise career move.

[Southern Magnolia]

rnmi2004-

You make a good point. I don't really expect to walk in and use the CNL certification to the fullest extent right off the bat though . . . for me it's a way to get to RN without duplicating effort (getting another bachelors degree) or really back pedaling and getting an AA degree. I really wish the area we were going to had an accelerated 2nd degree BSN . . . that's the route I'd prefer. I've got at least one more year to wait though so I've got time to figure it all out. I'm planning to wait to start school full time until my youngest starts preschool next year.

Thanks

[moonischasingme1]

The CNL on my floor is awesome! You should wish you had someone there for extra hands, it is really beneficial.

[Southern Magnolia]

I know the CNL role is still in the defining stage and varies from place to place . . . what's the scope of responsibility where you are? Do you think they are benefiting from the extra 15K worth of education?

[Franjcamp]

I did want to provide a little feedback on the last comment you made about the CNL exam. I just started this program and they state that before you can use the title of CNL you have to pass the CNL exam.The other thing that I want to add that I will be retiring in 10 years and at this point in my career I am not able to handle the physical stress of 12 hour shifts on a full time basis, but I am a very knowledgeable individual on how to handle acute care situations. I am hoping that this field will allow me to continue to work with patients and serve as an excellent resource nurse as well. I like the fact that it was a generalist degree. Isn't that what patients really are? They are not just cardiac or neuro patients they are people who might have a large variety of physical problems. I sure hope I am headed in the right direction. I still love being a nurse after 25 years.

[Flying ICU RN]

The CNL role emerged following research and discussion with stakeholder groups as a way to engage highly skilled clinicians in outcomes-based practice and quality improvement.

Letter to the Policymakers

It is my belief that the quote above is in reference to identifying me and those like me, highly skilled "street smart" practicing nurses. The idea being to improve patient outcomes with the development of the Clinical Nurse Leader role (a masters degree prepared position). I myself am a ASN prepared nurse and will remain so.

However, it would appear that I myself, and those like me, have long ago developed this role. You know us well, we are the journeyman bedside nurses (regardless of credentials) who are called upon by our peers whenever there is an unusual occurrence with either the patient, or any of the equipment used in caring for the patient. We have been performing this role since the days of Florence Nightingale.

Regardless of the presence (or absence) of either advanced education or certification we will continue to perform this role until the end of time. Nor will the presence (or absence) of duly certified CNL personnel diminish our role, as our role is determined by our peers and not by any certifying body.

Like a bad marksman you keep missing the mark. Clinical ability and credentials do not go hand in hand.

[elkpark]

Letter to the Policymakers

It is my belief that the quote above is in reference to identifying me and those like me, highly skilled "street smart" practicing nurses. The idea being to improve patient outcomes with the development of the Clinical Nurse Leader role (a masters degree prepared position). I myself am a ASN prepared nurse and will remain so.

However, it would appear that I myself, and those like me, have long ago developed this role. You know us well, we are the journeyman bedside nurses (regardless of credentials) who are called upon by our peers whenever there is an unusual occurrence with either the patient, or any of the equipment used in caring for the patient. We have been performing this role since the days of Florence Nightingale.

Regardless of the presence (or absence) of either advanced education or certification we will continue to perform this role until the end of time. Nor will the presence (or absence) of duly certified CNL personnel diminish our role, as our role is determined by our peers and not by any certifying body.

Like a bad marksman you keep missing the mark. Clinical ability and credentials do not go hand in hand.

ITA -- I've said all along (since I first started reading about the "CNL" proposals) that the description of the role sounds to me like what experienced, expert, motivated bedside nurses have been doing all these years, without any additional special education, certification, or recognition (with a little extra fluff and glamour thrown in to justify requiring a Master's degree, of course )