How To Become a Clinical Nurse Leader (CNL)

Overview

By Sarah Maurer
Nurse helping an elderly man in a wheelchair

If you like the idea of blazing new trails, a career as a Clinical Nurse Leader (CNL) could be for you. This relatively new nursing role was developed by the American Association of Colleges of Nursing (AACN) to improve patient safety and health outcomes and boost the quality and cost-efficiency of American health care.

CNLs are highly trained nurses who plan, direct and supervise patient care. They're generally responsible for health outcomes within a certain group or community, whether it's a hospital unit, a home health agency or an elementary school. Whatever the setting, the CNL ensures that patients and populations receive high-quality, research-based and appropriate medical care and health promotion services.

The duties and competencies of the CNL role were laid out by AACN in a 2007 white paper. These include:

  • Develop and implement best practices for care delivery
  • Assess patient and population health
  • Formulate plans of care that are supported by research and data.
  • Supervise and educate nurses and technicians as they deliver care
  • Work with outside clinicians and community resources to meet patients' health needs.
  • Deliver complex care directly to patients
  • Evaluate and report patient outcomes, costs of care and other quality measures
  • Identify and correct areas of waste and inefficiency
  • Share research outcomes and best practices
  • Strive to eliminate racial, ethnic and language disparities in care and patient outcomes
  • When appropriate, use distance technology to deliver patient care and monitor health status
  • Collect and analyze data to support future care decisions.

While the role is still relatively new, early evidence demonstrates that patients under a CNL's care are safer, spend less time in the hospital, and are less likely to return with the same condition. Nurses working under a CNL report higher job satisfaction. Results are so promising that the US Veteran's Health Administration has committed to having at least three CNLs in each of its facilities by 2016.

Work Environment

The CNL role is designed to be flexible and appropriate for all types of clinical settings. At present, most CNLs work in hospitals, including intensive care units and general medical surgical units. Other common employers include doctors' offices, urgent care centers and home health agencies. The Veterans Health Administration is currently the largest employer of CNLs.

CNLs are also well suited to work in government and regulatory agencies, community health agencies, and higher education. The AACN predicts that more CNLs will enter these fields in coming years as the role becomes better known.

Like most nurse leaders, CNLs generally work full-time. In hospital settings, where patients need 24-7 care, they take on rotating shifts that cover days, nights and holidays. Those working in doctors' offices and home health can also expect some evening and weekend hours to accommodate patients' schedules.

Success as a CNL requires a strong ability to lead and work with people. In addition to patients and their families, CNLs interact with professionals from many other disciplines. In hospitals, this usually involves working closely with the unit nurse manager and supervising the work of nurses and technicians. CNLs must also work collaboratively with people who are not under their direct supervision, including physicians, social workers, therapists, housekeeping staff, transport staff and many others.

A key role of a CNL is to use data to support clinical decision-making. For this reason, these professionals must be comfortable using technology, including information systems and electronic medical records, in their everyday practice.

The job also involves some potential health hazards. Like all healthcare professionals, CNLs are at increased risk for infectious disease. Following safety rules around immunizations, infection control and protective clothing is essential to minimize these risks.

Requirements

Education

To obtain certification as a CNL, candidates must be registered nurses and must hold a master's degree from an approved training program. Preparation generally requires four years of study at the bachelor's level plus about two years of graduate school. Special programs are available to help RNs with an associate degree "bridge" to the master's level, and some universities offer special programs for students who hold a bachelor's degree in a non-nursing field.

CNL programs cover very specific criteria and competencies laid out by the AACN. In this way, they're generally more rigorous than a standard master's of science in nursing (MSN) program. Coursework and training emphasize care delivery systems, leadership, healthcare technology and finance. Candidates also complete advanced clinical courses like assessment, pathophysiology and pharmacology.

The AACN maintains an online list of accredited educational programs that are approved to prepare students for CNL certification.

Training

All CNL education programs involve supervised practical and clinical experience. Hospitals interested in implementing the CNL role often partner with universities and serve as clinical training sites.

Because CNL is a leadership role, most employers prefer candidates with several years of clinical experience in nursing.

Licensing and/or Certification

To obtain a CNL credential, you must be licensed and certified as an RN in your state. This usually requires graduation from an accredited training program and passage of the National Council Licensure Examination for Registered Nurses (NCLEX–RN).

Clinical Nurse Leader (CNL) certification is administered by the Commission on Nursing Certification. To obtain the credential, candidates must hold a degree from an approved CNL master's- or doctoral-level training program and pass a knowledge exam.

Necessary Skills and Qualities

The CNL is an advanced role that requires prior nursing experience. Candidates need sufficient knowledge and clinical judgment to assess patients, create plans of care, supervise other practitioners and deliver direct patient care when necessary.

By definition, CNLs are excellent critical thinkers and problem solvers. They must be able to envision care delivery as a complex system. The adjustments they make to that system are designed to improve quality and efficiency. Also, when a plan of care isn't working, the CNL must be able to recognize the problem and make appropriate adjustments.

Leadership skills are also essential. CNLs must be confident in providing direct supervision to a diverse team of professionals. They also need to collaborate effectively with people who are not under their direct supervision.

The CNL role emphasizes evidence-based practice. These professionals must have the background to understand, evaluate and implement new research findings. They also need to be comfortable testing new systems and interventions and sharing their findings.

Technology is part of every CNL's daily experience. These professionals use information systems to gather and organize data and support decision-making. Some also use telemedicine (distance technology) to deliver care and monitor their patient populations.

Finally, CNLs should have an appreciation for social justice, because recognizing and eliminating racial, ethnic, economic and language barriers to health is fundamental to their work.

Opportunities for Advancement

Nursing is a very flexible profession, especially for those with post-bachelor's education. CNLs' advanced generalist training prepares them to work in all healthcare settings as well as non-clinical fields like health insurance, case management and government and community agencies. CNLs with doctoral degrees are qualified to teach and conduct research at the university level.

If you would like to gain the necessary education to become a clinical nurse leader, we highly recommend that you check out our free School Finder Tool located HERE.

Salary

According to the US Bureau of Labor statistics, the median annual wage for all registered nurses (including CNLs) is $67,490. Reported salaries range from $46,360 (10th percentile) to $101,630 (90th percentile).

Average CNL salaries most likely will hover within the higher part of this RN range. The CNL role is still relatively new, but so far, their salaries appear to be on par with those of other nurse leaders. In February 2014, The Campaign for Nursing's Future lists average CNL salaries as ranging from $51,000 to $73,000. The University of San Francisco’s School of Nursing and Health Professions, meanwhile, suggests that a typical CNL salary is roughly $84,000, which is relatively consistent with the $82,000 average salary among the CNL job postings on Indeed.com as of May 2016.

As with all registered nurses, CNL salary varies by location, with New York and Los Angeles paying the best (but also having a high cost of living). Salaries are generally best in government hospitals, including VA facilities.

In unionized hospitals, nursing salaries are closely tied to years of professional experience.

Job Outlook

According to the Bureau of Labor Statistics, employment is expected to grow by 16 percent between 2014 and 2024, considerably faster than average. However, the CNL role is so new, it's uncertain whether hiring of CNLs will match this trend.

So far, indications are positive. The CNL role has been embraced by the United States Veterans Health Administration, which has committed to having three CNLs at every facility by 2016. The fact that relatively few nurses are trained and credentialed should also help job prospects for the next few years.

One of the best ways to improve job prospects is to enter the CNL role with a solid foundation of clinical experience. Because this is a leadership role, employers generally favor candidates who have been on the front lines.

Nurse.com maintains a comprehensive job board for nurses in all specialties, including CNLs. VA Careers is another good bet. Hospitals who are partnered with a CNL training programs may also be looking to hire CNLs.

Further Reading

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