Question: What Are the Differences Between a Clinical Nurse Leader and Nurse Administrator?

Answer: Clinical nurse leaders (CNLs) and nurse administrators receive separate training, have different responsibilities, and have distinct roles within the healthcare system. CNLs are clinicians who graduate from specialized master of science in nursing (MSN) programs, and who are tasked with delivering and coordinating patient care. Nurse administrators do not typically offer direct patient care; their primary responsibilities include staffing, budgeting and other aspects of operations management.

CNL vs. Nurse Administrator

Clinical Nurse Leader is the formal designation for licensed RNs who have completed an MSN-CNL program, passed the CNL certification exam, and been assigned to coordinate point-of-care patient services in clinical settings. Nurse administrator is a less formal designation for licensed RNs who occupy managerial and/or executive positions in hospitals, clinics, and other healthcare organizations.

The CNL is a relatively recent innovation: it was formulated by the American Association of Colleges of Nursing (AACN) in 2003 and implemented in 2007 in response to a perceived need for non-specialist nurse clinicians with advanced training in evidence-based practice, risk reduction, quality control, organizational communications, and healthcare technologies. In contrast, nurse administrators may have little or no direct patient contact. Instead, they are primarily responsible for the oversight and management of staff, budgets, and facilities, and for other organizational and operational aspects of nursing. Nurses who occupy administrative positions can have a range of titles, including but not limited to Chief Nursing Officer, Director of Nursing Operations, Nurse Manager, and Head Nurse.

Training and Degree Programs for CNLs and Nurse Administrators

CNL master’s programs were created in response to the AACN’s recommendation that the CNL role be integrated into the nursing profession, and that CNLs should be trained in specialized MSN programs prior to being certified by the Commission on Nurse Certification (CNC). While the AACN is not an accreditation body, guidelines for the didactic and clinical instruction offered by MSN-CNL programs are outlined by the AACN in its Competencies and Curricular Expectations for Clinical Nurse Leader Education and Practice. These programs offer advanced clinical training in pharmacology, physiology, and patient assessment, as well as instruction in leadership skills, including team coordination and communication, staff and resource management, and the implementation of new healthcare techniques and technologies to improve patient outcomes. CNL programs typically include at least 400 hours of supervised clinical work.

Nurse administrators have traditionally risen up through the ranks of practicing RNs, so there are technically no formal training requirements for nursing administration positions beyond a bachelor of science in nursing (BSN) degree and some amount of professional experience. However, it is now common for nurse administrators to receive advanced training in specialized nurse administer and nurse executive leader MSN programs. These programs differ from CNL programs in that they do not provide the same amount of clinical training. Instead, the MSN curriculum for nurse administrators focuses on navigating the complexities of the modern American healthcare system, and the challenges of managing personnel, budgeting, IT systems, and other resources in large hospitals and healthcare organizations. These MSN programs have various designations, including but not limited to:

• MSN in Nursing Administration and Leadership
• MSN – Executive Nurse Leader
• MSN in Health Systems Management

Unlike CNL programs, which incorporate 400 or more hours of clinical experience, MSN in nursing administration programs may or may not require students to complete a clinical practicum.

All MSN programs, including MSN-CNL programs and MSN in nursing administration programs, may seek accreditation from one of two national bodies: the Accreditation Commission for Education in Nursing (ACEN) and the Commission on Collegiate Nursing Education (CCNE).

Licensure and Certifications for CNLs and Nurse Administrators

Licensure for nurses is handled at the state level, and each state has its own nurse licensure criteria. While there are currently no specific licensure requirements for CNLs at the state level, all nurses who provide clinical services, including CNLs, must hold a valid RN license issued in their state of practice. A valid RN license is also a prerequisite for admissions to MSN-CNL programs.

Similarly, most states do not have a separate license for nurse administrators, nurse managers, or nurse executives. However, states and most employers require nurses in administrative positions to hold a valid state RN license, and RN licensure is a prerequisite for admissions to MSN programs for nurse administrators.

Certification is a process separate from licensure that can be helpful in career advancement and that some employers may prefer or require. CNL certification is relatively straightforward: graduates from approved MSN-CNL programs may sit for a CNL exam administered by the AACN’s Commission on Nurse Certification (CNC). Nurses who pass that exam are then certified CNLs.

Certification for nurse administrators is somewhat more complex, as there are three organizations that offer professional certifications in nursing administration and leadership. The American Organization of Nurse Executive (AONE) and the American Association of Critical-Care Nurses Certification Corporation (AACN Certification Corporation) jointly offer a Certified Nurse Manager and Leader (CNML) certification, and AONE also offers a Certified in Executive Nursing Practice (CENP) certification. The American Nurses Credentialing Center offers two certifications: Nurse Executive-Board Certified (NE-BC) and Nurse Executive, Advanced-Board Certified (NEA-BC).

Detailed information on the various professional certifications for nurse administrators, nurse managers, and nurse executives is available from each of the organizations that offers them. AONE provides details about CNML certification and about CENP certification. The American Nurses Credentialing Center provides details about NE-BC certification and NEA-BC certification.

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