Question: How Do You Become A Clinical Nurse Leader (CNL)?

Answer: A common pathway to becoming a licensed CNL begins with earning a Bachelor of Science in Nursing (BSN) degree and attaining licensure as a Registered Nurse (RN). RNs may then enroll in a Master of Science in Nursing (MSN) program with a CNL specialization. Graduates from CNL programs are eligible to sit for the Commission on Nurse Certification (CNC) CNL exam. Candidates who pass the exam are certified as CNLs. RNs who receive their initial training for licensure in an associate degree in nursing (ADN) program or hospital-based nursing diploma program can become CNLs via two paths: either by earning a BSN and then completing an MSN program for CNLs, or by enrolling in a designated RN-to-MSN program for CNLs, which may or may not confer a BSN as part of the program. RNs who hold an MSN degree in a non-CNL specialization can qualify for CNL certification by completing a post-MSN CNL program and then passing the CNL exam.

What Is a CNL?

CNLs are a relatively new innovation in the practice of nursing, initiated in 2003 by the American Association of Colleges of Nursing (AACN) in response to a demand for general practice nurses with advanced training in the latest improvements in healthcare delivery systems, safety protocols, and quality assurance measures. Unlike Advance Practice Registered Nurses (APRNs), who receive specialized training for work with specific patient populations, CNLs are prepared to offer direct patient services while coordinating the activities of other nurses and allied health professionals in what the AACN defines as “clinical microsystems.” A clinical microsystem is comprised of small teams of healthcare professionals who work together to provide front-line patient care. CNLs work as part of these teams, providing treatment to patients and direction to other team members.

MSN in CNL Programs

Professional training for CNLs takes place in specialized MSN programs that meet curricular guidelines established by the AACN in its Competencies and Curricular Expectations for Clinical Nurse Leader Education and Practice. In addition to 400 hours of supervised clinical experience, this include coursework in the following areas:

• Clinical leadership for patient-care practices and delivery.
• 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.
• Design and implementation of evidence-based practices.
• Team leadership, management, and collaboration with other health professional team members.
• Information management and the use of information systems and technologies to improve healthcare outcomes.

The AACN maintains a database of Eligible CNL Programs as a resource for RNs who are looking for programs that meet the organization’s curricular guidelines.

CNL Certification

While there are currently no provisions for state licensure of CNLs, the AACN’s CNC oversees a program for the certification of CNLs that provides the necessary credential for most CNL positions. Qualified candidates can apply to sit for the CNL exam, which consists of 140 questions that test for knowledge and proficiencies in nursing leadership, clinical outcomes management, and care environment management. Candidates must receive a score of 350 out of a total 500 points to pass the exam, after which they receive their CNL certificate.

In order to sit for the CNL exam, candidates must meet the following requirements:

• Hold a valid an unencumbered state-issued RN license
• Complete an MSN degree from an AACN-approved CNL program or post-master’s CNL certificate program

Note: Graduates from programs that aren’t approved by the AACN may petition for eligibility by having the dean of the program submit a CNL Education Verification Form.

Steps To Becoming a CNL

Meeting the requirements for CNL certification is a process that has several pathways, all of which culminate in graduating from an MSN program and passing the CNL certification exam. There are essentially three different routes to becoming a CNL for RNs, with three distinct starting points:

For RNs with an ADN or a Diploma in Nursing

1. Earn a BSN through an RN to BSN completion program, or enter an AACN-approved RN-to-MSN program that provides CNL training.
2. Complete master’s-level training and instruction for CNLs, which should include at least 400 hours of supervised clinical experience.
3. Pass the CNL certification exam administered by the AACN’s CNC.

For RNs with a BSN

1. Begin CNL training in an MSN program for CNLs that offers a curriculum approved by the AACN.
2. Complete master’s-level training for CNLs, including at least 400 hours of supervised clinical experience.
3. Complete the CNL certification exam administered by the AACN’s CNC.

For RNs with an MSN

1. Complete a post-master’s certificate program for CNLs that is approved by the AACN and that includes at least 400 hours of supervised clinical experience.
2. Pass the CNL certification exam administered by the AACN’s CNC.

Additional information about the role of the CNL and CNL certification is available from the AACN.

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