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Clinical Nurse Leaders Set New Standards for Education and Leadership

November 2013

In response to the Institute of Medicine’s (IOM) 1999 report discussing an increasing rate of medical errors, leaders in the healthcare industry began looking at ways in which facilities could begin to make effective changes in the workplace and roles of healthcare workers. Among those changes was a series of recommendations from the American Association of Colleges of Nursing (AACN) in 2007 that would eventually lead to the creation of the first new nursing role in 35 years – the clinical nurse leader (CNL).

According to AACN’s CNL White Paper, “the clinical nurse leader designs, implements and evaluates client care by coordinating, delegating, and supervising the care provided by the healthcare team, including licensed nurses, technicians and other health professionals.” Nearly a decade after the AACN first outlined the roles and responsibilities of the position, CNLs have started to build a presence in the nursing profession through the mission of ensuring quality patient care. Specifically, CNLs oversee the integration of care for a specific set of patients and their medical team.

Nurses in this role manage treatment alongside professionals across the continuum of care – including but not limited to doctors, pharmacists, social workers and clinical nurse specialists (CNSs). Because they work with large diverse teams, CNLs must have an advanced education, skill set and understanding of general medical practices rather than specializing in any single primary discipline.

While the role is still relatively new, CNLs are making a real difference in the lives of patients. According to two 2009 studies published in the Journal of Nursing Administration, CNL interventions positively impacted patient satisfaction in the Tennessee Valley Healthcare System, in addition to improving both health and financial outcomes.

“CNLs directly contribute to improvement at the bedside. They do this by effectively working with all levels of staff who provide patient or family care,” said Cathy Coleman, RN, MSN, OCN®, CPHQ, CNL, DNP(c), adjunct professor at the University of San Francisco School of Nursing and Health Professionals in San Francisco, Calif. “Additionally, CNLs are creative problem solvers. Over time, trust and credibility are established through our solutions, and CNLs become sought after as informal leaders in patient-centered care.”

Despite the positive metrics associated with the CNL role, incorporating the new position into existing settings and teams can be a challenge. Hospitals and universities are required to work together to design and build CNL curriculums that fit their needs, and hospitals with tight budgets have to consider the up-front costs of integrating an additional role.

For many facilities, however, the long-term benefits in regards to both patient care and the bottom line make the investment of a CNL worthwhile. "The CNL will have a significant role to play in care delivery for the facilities that integrate the role," said Lorraine R. Kaack, MS, RN-BC, Clinical Nurse Leader at the U.S. Department of Veterans Affairs in Bay Pines, Fla. "This integration has the potential to streamline coordination of care for patients everywhere, which benefits the healthcare facility and its bottom line as well."

Working in a new and emerging role, CNLs will continue to have many opportunities to grow and influence their specialty. According to Coleman, because of their advanced education and leadership skills, CNLs are also well-positioned to expand their roles as managers throughout the field of healthcare.

“Systems thinking and leadership skills are integral to the CNL role. As service delivery becomes more interprofessional and team focused, the CNL will start to see more opportunities to lead complex management projects across settings,” said Coleman. “The CNL role is all about improving patient care. As the role continues to advance, my hope is that CNLs will increase their practice of science and evidence-based medicine, which in turn will improve the quality of care.”

To learn more about clinical nurse leaders, visit

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