Clinical Nurse Leader vs. Clinical Nurse Specialist Roles

Introduction to the Clinical Nurse Leader Role

The Clinical Nurse Leader (CNL) was developed as an advanced educational and training program building on the foundation of the Clinical Nurse Specialist role. The American Association of Colleges of Nursing (AACN) created this new position as a natural progression reflecting the changing roles and diverse challenges confronting the medical profession in the twenty-first century. The CNL holds the fundamental duty of coordinating the various components and personnel within a department, overseeing the delivery of nursing care provided by professional and support nursing staff on designated units. This position ensures that care is provided in a manner consistent with both the ethical and professional standards of the medical profession, as well as the code of ethics established by the particular hospital or institution.

The AACN formally proposed the development of the CNL role in 2003. A CNL is required to hold a master's degree in nursing and must design, implement, and evaluate client care by coordinating, delegating, and supervising care provided by the health care team, including licensed nurses, technicians, and other health professionals. While some nursing leaders and organizations have embraced this role, others have questioned its validity and usefulness. This positions it as both an innovation and a point of professional debate within nursing education and practice.

Educational Requirements and Career Development

Clinical Nurse Leaders must have attained at least a master's degree in nursing and possess multiple years of career experience and on-the-job training. Indeed, there is an evolution taking place that is bringing the pendulum of master's-level nursing back to the center. As one source notes, "National movements are calling for the development of a generalist master's-prepared nurse, the Clinical Nurse Leader degree. Discussions of a nursing practice doctorate are increasingly gaining favor." In light of the expanding role of professional nurses in health care settings today, it is imperative that they acquire the leadership skills necessary to positively influence this dynamic and uncertain environment. These skills are vital for making an impact, considering the powerful relationship between leadership strength and influence.

Regarding education, these nurses should be exposed to training in classroom and clinical settings that prepares them for complex circumstances through the use of real-life case studies. This complex and progressive learning is a continuous process that occurs throughout one's entire lifetime. One characteristic of effective leaders is the attainment of formal preparation and educational credentials in addition to work and life experience. In Australia, researchers have noted that a change in skill mix may be necessary to address rising demand for health services, cost containment, and shortages of nurses and other health workers. Evidence suggests that appropriate skill-mix changes can result in cost and quality improvements, though the evidence base remains limited but growing.

Clinical Nurse Specialist vs. Clinical Nurse Leader

Leadership and general supervision are critical to care continuity for patients, and these two roles aid in that dimension, though important differences exist between them. The CNS functions as an expert clinician in a particular specialty or subspecialty of nursing practice, providing assistance and preparation of patients and reducing the workload of overall medical staff. In contrast, CNLs have more generalist training and are more patient and community focused, managing the actual point of care and assessing services and functions of staff regarding overall patient care. Both are charged with providing a more holistic overview of the patient's care and serve as advocates for the patient and their care rather than focusing primarily on staff interests.

The CNS possesses a somewhat higher level of expertise when assessing, diagnosing, and treating within the complex realm of the individual, family, and special communities, analyzing potential health problems and assisting with continued health after care transitions. The CNL, on the other hand, performs more of a risk assessment for individuals and families and designs and implements care plans for specific issues these groups may encounter. The CNL's approach operates on a "mass customization scale" to ensure clinical consistency within a population so that the quality of care is continuous and fairly dispersed. Both play critical roles in initial and ongoing care, especially when discharge plans are created as patients leave the facility.

The positions differ most significantly in their overall control of supervised staff. The CNS has traditionally held more of a mentoring role for staff under their supervision. The CNL, fundamentally, is responsible for ensuring that communication proceeds across department lines so that the quality of care for the patient is communicated equally to all those involved in their care. The CNS, while also fielding the mentor role, has more authority when it comes to the coordination of staff, providing "necessary coordination and communication with other team members within the microsystem to affect improved patient outcomes for individual patients or a specified cohort of patients in a unit or care setting."

Key Responsibilities and Leadership Functions

Research on neonatal intensive care has highlighted the practical importance of these roles. Studies examining the economic reasoning behind using nurse practitioners and nurse leaders in neonatal departments have found that several factors drive the need for these advanced positions. The shortage of pediatric residents in both the United States and Canada is one reason the Clinical Nurse Leader is becoming increasingly important on department floors. The second is the rising survival rate of smaller and smaller premature infants in neonatal wards. These factors will not change in the foreseeable future; if anything, resident shortages will increase, as will the technological capacity to treat critically ill infants. Health care planners can move forward with wider use of advanced nurse roles, confident that the process of care, parent satisfaction, and patient outcomes will be comparable with those achieved through current mechanisms of health care delivery.

While both the CNL and CNS work with multidisciplinary care teams that cross and intersect with other departments, their stratum of influence and focus over these teams may differ. The CNL works at a microsystem level to provide an overall picture to these teams to enhance the quality of care for the patient. The CNS is mostly charged with facilitating communication between teams and advising them of outcomes and strategies across a broader sphere.

Both the CNS and CNL are charged with researching their settings and using evidence-based practices and interventions to guide and affect the quality of care for the patient or population under their care. They are the primary source and focus for translating research into practical application in clinical or hospital settings. This is the reason their educational levels must be at a master's degree or higher to function well in these positions.

Evidence-Based Practice and Policy Implementation

However, the CNL plays a much more active role in community development of policies and best practices by taking an active role in the formulation and implementation of policies at the community, state, and national levels. The key activities of the CNL and CNS certainly intersect in a number of areas. Both are involved with interdisciplinary decision-making and complete planning processes regarding the patient's overall plan of care. Both develop interpersonal relationships with individual patients and their families as well as other health care professionals involved outside of their particular workplace.

In scope and focus, the spheres of influence of the CNL and CNS are slightly different. The CNS would be the practitioner that other staff as well as patients would consult on a day-to-day basis, someone who is truly in the mix of daily operations. The CNS tends to act on a consulting basis with a larger view that extends beyond just the local nursing staff and hospital or clinic to greater concerns in policy and best practice implementation. The CNL, by contrast, would be the staff member most directly engaged in the daily operations and immediate patient care environment.