FAQ: What Are the Differences Between a Clinical Nurse Leader (CNL) and a Nurse Practitioner (NP)?

Answer: Clinical Nurse Leader (CNL) and Nurse Practitioner (NP) are both formal designations for registered nurses (RNs) who have completed training associated with two distinct types of master of science in nursing (MSN) programs or, in the case of NPs, a Doctor of Nursing Practice program. CNLs receive general clinical training and instruction in certain administrative aspects of nursing. NPs undergo specialist clinical training in one of the many nurse practitioner specializations, which include adult gerontology, family, neonatal, pediatric, psychiatric/mental, and women’s health.

CNL vs. Nurse Practitioner

CNLs and NPs are separate and distinct designations for RNs who have completed MSN programs in two different nursing specializations. Both are trained to work in clinical settings, which means they offer direct treatment to patients as part of their regular practice. However, the scope of the professional responsibilities and the corresponding training received by CNLs and NPs differs greatly, as do national certification and state licensing board requirements. Specifically, CNLs are clinical generalists who are trained to coordinate patient care, while NPs are clinical specialists who receive focused training in one of a number of clinical nursing specializations.

The Roles of NPs and CNLs

The NP role has been a part of the nursing profession since 1965. It is one of the four Advance Practice Registered Nurse (APRN) designations, which also include Certified Registered Nurse Anesthetist (CRNA), Certified Nurse-Midwife (CNM), and Clinical Nurse Specialist (CNS). NPs must have at least a master’s degree in nursing, and their training can focus on a range of clinical specializations. These clinical specializations include adult/gerontology health, family health, neonatal health, pediatrics, psychiatric/mental health care, and women’s health. Adult/gerontology and pediatric health are further broken down into acute care and primary care specializations. The American Association of Nurse Practitioners (AANP) lists a number of additional sub-specialty areas for NPs, as detailed in the list below:

• Allergy & Immunology
• Cardiovascular
• Dermatology
• Emergency
• Endocrinology
• Gastroenterology
• Hematology & Oncology
• Neurology
• Occupational Health
• Orthopedics
• Pulmonology & Respiratory
• Sports Medicine
• Urology

In contrast, the CNL role is a more recent innovation. The CNL position was created by the American Association of Colleges of Nursing (AACN) in 2003 and instituted in 2007 in response to a need for RNs with training in two areas: general advanced clinical practice, and coordination of care. Unlike NPs, CNLs do not specialize in a particular area of clinical practice. Instead, their training focuses on general aspects of nursing practice. In addition, CNLs receive instruction in operational aspects of nursing, including point-of-care nursing, healthcare administration, cost management, risk reduction, and strategies for improving care in what the AACN terms “clinical microsystems.” A clinical microsystem is composed of teams of nurses and other healthcare professionals who work together within a larger entity like a hospital, a clinic, or a residential care facility.

The following table illustrates some of the differences between CNLs and NPs, as well as some of the similarities:

CNL Training vs. NP Training

The curricular objectives and training regimens for CNLs and NPs reflect the different roles and professional responsibilities that are central to these two nursing specializations. The NP curriculum, as outlined by the American Association of Colleges of Nursing (AACN), begins with a foundation in advanced physiology, health assessment, and pharmacology – three areas that are considered core training for APRNs. The AACN’s consensus model for an MSN-NP curriculum covers competencies in nine areas:

• The scientific foundations of nursing
• Crisis management and leadership
• Evidence-based practice
• Practice inquiry and investigation strategies
• Technology and information literacy
• Healthcare policy and practice
• Healthcare delivery systems
• Nursing ethics
• The independent practice of nursing

Students in MSN-NP programs choose an area of specialization in which to apply these core competencies as part of their didactic and clinical training. For example, a family nurse practitioner would likely take courses in childhood developmental, while a neonatal NP would learn about complications in pregnancy and infant care.

The CNL curriculum as laid out by the AACN in its Competencies and Curricular Expectations for Clinical Nurse Leader Education and Practice has some overlap with training for NPs in the areas of advanced clinical knowledge and skills. These include; advanced physiology/pathophysiology; advanced health assessment; and advanced pharmacology. The AACN specifies a range of competency areas for CNLs, stressing that the fundamental aspects of CNL practice include the following:

• Clinical leadership for patient-care practices and delivery, including the design, coordination, and evaluation of care for individuals, families, groups, and populations
• Participation in identification and collection of care outcomes
• Accountability for evaluation and improvement of point-of-care outcomes, including the synthesis of data and other evidence to evaluate and achieve optimal outcomes
• Risk anticipation for individuals and cohorts of patients
• Lateral integration of care for individuals and cohorts of patients
• Design and implementation of evidence-based practice
• Team leadership, management and collaboration with other health professional team members
• Information management or the use of information systems and technologies to improve healthcare outcomes
• Stewardship and leveraging of human, environmental, and material resources
• Advocacy for patients, communities, and the health professional team

CNL and NP programs may be assessed by and receive accreditation from one of two nationally recognized accreditation bodies: the Accreditation Commission for Education in Nursing (ACEN) and the Commission on Collegiate Nursing Education (CCNE).

Licensure and Certification for CNLs and NPs

Licensure and certification are two different but related processes in the field of nursing. Each state has a board of nursing that sets requirements for the practice of nursing within that state and offers licensure and specific authorizations to nurses who meet these requirements. Certifications are offered separately by several professional organizations, including the ANCC and American Association of Colleges of Nursing (AACN). In some states, nurses may be required to hold certifications as a condition for licensure or for certain authorizations like the ability to prescribe medications.

All NPs and CNLs must hold a valid state RN license as a baseline for admissions to and graduation from an MSN program. NPs must then apply for state licensure as an NP or an APRN, depending on the state. Different states provide different levels of authorization to NPs depending on what certifications they hold, their area of specialization, and how many professional practice hours they have completed. There are five NP certification bodies, each of which offers certification exams in different NP specializations.

• The American Academy of Nurse Practitioners Certification Board (AANPCB) offers Family Nurse Practitioner (FNP), Adult-Gerontology Primary Care Nurse Practitioner (A-GNP), and Emergency Nurse Practitioner (ENP) certifications.

• The American Association of Critical-Care Nurses (AACN) offers Acute Care Nurse Practitioner Certifications (ACNPC) in adult-gerontology nursing.

• The American Nurses Credentialing Center (ANCC) offers Nurse Practitioner Certifications in Adult-Gerontology Acute Care (AGACNP-BC); Adult-Gerontology Primary Care (AGPCNP-BC); Emergency Care (ENP-BC); Family Care (FNP-BC); Pediatric Primary Care (PPCNP-BC); and Psychiatric-Mental Health (PMHNP-BC).

• The Pediatric Nursing Certification Board (PNCB) offers a CPNP-PC Certification for Certified Pediatric Nurse Practitioner – Primary Care, and a CPNP-AC Certification for Certified Pediatric Nurse Practitioner – Acute Care.

• The National Certification Corporation (NCC) offers two NP certifications: Neonatal Nurse Practitioner (NNP-BC), and Women’s Health Care Nurse Practitioner (WHNP-BC).

In contrast, CNL certification is overseen by one governing body – the American Association of Colleges of Nursing (AACN) and its Commission on Nurse Certification (CNC). The CNC administers a CNL certification exam that can be taken by licensed RNs who have completed a master’s in CNL program. States do not currently offer separate licensure for CNLs, so the CNL certification offered by the CNC, along with a valid RN license, are the primary requirements to practice professionally as a CNL.

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