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The Complementary Roles of Clinical Nurse Leaders and Clinical Nurse Specialists

November 2013

The emerging role of clinical nurse leader (CNL) and the evolving role of clinical nurse specialist (CNS) both offer nurses unique career advancement opportunities at the graduate level, with a dedicated focus to improving patient care. However, while CNLs and CNSs can work together to improve patient outcomes and quality of care, there are distinct differences between the roles and responsibilities of each.

The CNL is a relatively new nursing role developed by the American Association of Colleges of Nursing (AACN) in collaboration with an array of nurse leaders to help improve the quality and safety of patient treatment, as well as better prepare nurses to thrive in the complex healthcare arena. According to the AACN, the CNL role is designed for nurses who want to make significant changes in nursing while remaining at the point of care.

Although the CNL education program culminates with a master’s degree and includes advanced nursing knowledge and skills, a CNL does not practice as an advanced practice nurse. Instead, the CNL functions as a generalist, providing and managing care for patients, individuals, families and communities, and assumes responsibility for patient care outcomes by coordinating and supervising the care provided by interdisciplinary team members in a specific unit or setting.

On the other hand, the CNS functions as an expert clinician in a particular specialty or subspecialty of a nursing practice, treating and managing the health concerns of patients and populations across units. CNSs practice autonomously and integrate knowledge of disease and medical treatments into assessments, diagnoses and treatments for patients.

Clinical Nurse Leader (CNL)

While the word “leader” is used in the title of the CNL position, this role is not administrative or a managerial position. The CNL is a frontline connection between quality and practice at the bedside, utilizing communication with frontline staff members, which can include licensed nurses, technicians and other health professionals, to help improve quality outcomes and positively affect patient care.

“Clinical nurse leaders are uniquely positioned to plan and coordinate care across entire patient populations, working with the multidisciplinary healthcare team across the care continuum, and helping organizations reduce length of stay and prevent readmissions,” said Nina Swan, MSN, RN, CMSRN, CNL, director of critical care at Iredell Memorial Hospital in Statesville, N.C.

The CNL collects and evaluates patient outcomes, conducts risk assessment for patients, and evaluates the effectiveness of care plans. A nurse in this role may also serve as a liaison to physicians, communicating patient care needs and treatment to the physician and ensuring information is transferred appropriately between physicians and other healthcare providers.

According to Swan, the CNL is accountable for the healthcare outcomes of a specific group of patients, such as a cohort of patients in an intensive care unit, and identifies and addresses gaps in communication. Additionally, CNLs assimilate and apply research-based information to design, implement and evaluate patient plans of care, while communicating effectively to achieve quality patient outcomes.

Clinical Nurse Specialist (CNS)

While the CNL primarily functions within clinical microsystems, which are small, functional front-line units such as hospital units or outpatient clinics, the CNS is engaged not only within the microsystem, but also at the macrosystem level, providing a broader, vertical management of care within and across units.

“A clinical nurse specialist brings forth the evidence and best practice initiatives to all care providers in the hospital setting. They also analyze data and act as a change agent in regards to the standards of care within an organization,” said Peggy Barksdale, MSN, RN, CNS-BC, OCNS-C, clinical nurse specialist at Community Health Network in Indianapolis, Ind.

According to Barksdale, when compared to the CNL role, the CNS’s area of practice is more specialized and can be focused on population (e.g., geriatrics or women’s health), specialty (e.g., wound care or diabetes), or setting (e.g., critical care or emergency department). CNSs provide direct patient care, serve as expert consultants for nursing staff and have an active hand in improving healthcare delivery systems.

Additionally, CNSs may play a major role in program development related to patient and nursing practice initiatives, while positively influencing the organizations and systems where they are employed. Because of that, it’s important for CNSs to have excellent communication skills in order to help promote change for better patient outcomes.

Working Together

While the CNL and CNS roles are distinct in many ways, they are complementary in the mission to improve patient outcomes. Nurses in these positions may collaborate to promote best practice at the point of care and throughout the healthcare system. They can also work together to serve as leaders on interdisciplinary teams and experts in influencing change within their organizations.

Whether a nurse wants to have a broader, more general focus on quality and patient care as a CNL or to focus on a particular area of specialty as a CNS, both roles are excellent opportunities to help improve patient care and outcomes. Additionally, both positions offer opportunities in a variety of settings, including acute, outpatient, home, school and the community.

“The CNL and CNS roles bring unique expertise to the healthcare team, and together they can provide safe, quality and cost-effective patient care,” said Swan. “It’s important that CNLs and CNSs continue to work together with the shared goal of delivering comprehensive and holistic care for patients.”

To learn more about the similarities, differences and complementarities between the CNL and CNS role, visit www.aacn.nche.edu.


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