Question: What Is a CNL Degree?

Answer: CNL stands for Clinical Nurse Leader, the formal designation for a Registered Nurse (RN) who has completed a Master of Science in Nursing (MSN) program that provides specialized training in advanced clinical nursing practice and systems leadership. CNL programs are designed to prepare RNs for CNL certification, which indicates that an RN has completed the training requirements and possesses the knowledge necessary to fulfill the clinical and administrative responsibilities associated with the CNL role.

The Role of the CNL

Clinical Nurse Leader (CNL) is a relatively new innovation in nursing that originated in 2003 with the American Association of Colleges of Nursing (AACN) in response to a perceived demand for RNs who possess advanced proficiencies in several areas: evidence-based clinical practice; healthcare safety and risk reduction; and efficiency improvements in the delivery of patient services. CNLs are trained to work in what the AACN refers to as “clinical microsystems,” which encompass hospital units, community clinics, and other settings where small teams of nurses and other clinicians provide direct patient care.

The role of the CNL is to coordinate and manage the delivery of care in these microsystems and to promote more effective and efficient treatments based on the latest medical research and innovations in clinical practice. CNLs learn to apply organizational management and communication skills in order to provide leadership and guidance to other nurses, and to coordinate the actions of small teams of healthcare professionals in the delivery of patient care services. Rather than specializing in one area of clinical nursing, such as acute care, psychiatric care, or midwifery, CNLs are trained in general clinical practices and are prepared to work in a broad range of clinical settings.

CNL Degree Programs

CNLs receive their training in specialized Master of Science in Nursing (MSN) programs that offer a curriculum outlined by the AACN in its Competencies and Curricular Expectations for Clinical Nurse Leader Education and Practice. This curriculum encompasses the general master’s-level coursework provided by all MSN programs, as well as advanced clinical training in direct patient care and a minimum of 400-hours of supervised clinical practice through formal practicums and internships. The specific CNL competencies delineated by the AACN include:

• Clinical leadership for patient-care practices and delivery, including the design, coordination, and evaluation of care for individuals, families, groups, and populations.
• Participation in the 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 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.
• Stewardship and leveraging of human, environmental, and material resources.
• Advocacy for patients, communities, and the health professional team.

Students in a CNL program take courses in clinical practice areas, which typically include pathology, physiology, and pharmacology, as well as in management and professional communication. They study informatics and IT systems, theories of leadership, and healthcare policy, and learn to apply this knowledge in clinical settings in order to improve patient care services. CNL programs also focus on the latest research in the field of nursing and how it can be used to assess and enhance current nursing practices. Typical CNL courses include:

• Foundations for Clinical Nurse Leadership
• Pathophysiology Across the Lifespan
• Health Promotion & Assessment for Advanced Clinical Practice
• Advanced Concepts in Pharmacology
• Research, Evidence, & Best Practices in Healthcare
• Education & Mentorship in the Clinical Setting
• The Business of Healthcare
• Healthcare Infrastructure & Informatics
• CNL Clinical Immersion Capstone

Admissions Criteria for CNL Programs

The primary qualification for acceptance into an MSN program that provides CNL training is a valid, state-issued RN license. Other admissions requirements vary by program and may include a minimum undergraduate grade point average, one or more years of professional nursing experience, letters of recommendation, and a personal goals statement.

There are several pathways to earning a CNL degree that are available to RNs depending on an applicant’s prior level of educational attainment. The main pathways are as follows:

• BSN-to-MSN: Graduates from accredited Bachelor of Science in Nursing (BSN) programs have the shortest route to earning an MSN with a CNL specialization. The majority of CNL programs are set up to accommodate graduates from BSN programs.
• RN-to-MSN: For RNs who received their training in associate’s degree in nursing (ADN) or hospital-based nursing diploma programs there are CNL programs the provide a completion curriculum of BSN courses in addition to master’s training in CNL competencies. These programs take longer to complete than BSN-to-MSN programs.
• BA/BS-to-MSN: Some CNL programs accept RNs who have a bachelor degree in a non-nursing field. These programs provide students with what is often called a “bridge” curriculum of bachelor’s-level nursing courses in preparation for the MSN curriculum.
• Post-Master’s Certificate: The CNL post-master’s certificate is available to RNs who already have a master’s degree in nursing. The curriculum in these programs typically omits general MSN coursework and focuses exclusively on CNL proficiencies, depending on the courses a student completed in a prior MSN program.

CNL Certification

Formal certification for CNLs is overseen by the AACN’s Commission on Nurse Certification (CNC), which administers the computer-based, three-hour CNL Certification Exam. The exam consists of 140 questions, 120 of which are scored, and candidates must achieve a minimum passing score of 350 out of a possible 500 in order to qualify for certification. The broad knowledge areas tested in the exam are nursing leadership, clinical outcomes management, and care environment management. In order to be eligible to sit for the exam, candidates must hold a valid RN license and an MSN or post-master’s certificate from an accredited CNL program that is approved by the AACN. Graduates from programs that aren’t listed in the AACN’s directory of Eligible CNL Programs may petition the AACN for eligibility by having the dean of their program submit a CNL Education Program Verification Form. CNL certification is good for five years, after which it must be renewed through the CNC.

The CNC publishes an online CNL Certification Guide and provides a Self-Assessment Exam for those preparing to take the CNL Certification Exam. There are additional resources about the CNL role, CNL careers, and CNL certification on the AACN website.

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