What is a Clinical Nurse Leader?

A clinical nurse leader (CNL) takes on high-level leadership responsibilities and works to improve patient outcomes across an entire unit. It is a relatively new role in nursing.

Career Fast Facts

What you'll do: Lead at the unit level to improve patient outcomes.

Where you'll work: Larger hospitals, medical centers, and specialty care centers.

Degree you'll need: Master of Science in Nursing (MSN).

Median salary: $117,960 (BLS median for medical and health services managers, the closest tracked category).

The American Association of Colleges of Nursing (AACN) created the CNL role in 2004 to address quality-of-care problems. It has grown fast. In 2006 there were 84 certified CNLs in the United States; by 2020 there were 8,175.

CNLs use their nursing experience and advanced education to oversee patient care, spot problems, find solutions, and put new policies in place. They bring a nursing perspective to healthcare leadership, often acting as a bridge between nursing departments and hospital administration.

Stephen Ferrara, DNP, FNP-BC, FAANP, associate dean of clinical affairs at Columbia University's School of Nursing, puts it this way: "Unlike the familiar nurse-patient relationship in which one nurse is overseeing several patients, the CNL looks at the whole unit as a population."

What Do CNLs Do?

CNLs improve patient outcomes on a large scale. They are usually part of multidisciplinary teams, working with physicians, therapists, social workers, and other professionals. Typical tasks include:

• Making sure patient care plans are appropriate
• Meeting with providers to discuss care plans
• Communicating nursing reports and observations to other providers
• Coordinating patient procedures and making sure patients get to them
• Working to ensure every patient on the unit gets the right care

The CNL role is distinct from other nursing roles in a unit. CNLs do not normally provide direct patient care, and they focus on the unit rather than a specific patient.

"Traditional bedside nurses are providing care for their patients. They are focused on caring for that number of patients for that day, and they are rarely able to look outside of those six or seven patients," Ferrara says. "What the clinical nurse leader is doing is really looking at the unit as a whole."

That sounds like a charge nurse or nurse manager, but the difference matters: CNLs do not lead by supervising other nurses, they lead by directing care. They interact with nurses to ensure quality, but they do not manage them.

CNLs are also distinct from nurse case managers. Case managers oversee patient care and work on interdisciplinary teams, but they carry a set number of assigned patients. A CNL oversees care for the entire unit.

"They're the point person to help coordinate and communicate the care that's happening to the patient," Ferrara says. "One of the great potentials of this role is the way they're able to open those lines of communication and ensure everyone is on the same page when it comes to the care of any individual."

Is a CNL Part of the APRN Family?

A CNL is an advanced role that requires at least an MSN, but it is not an advanced practice registered nurse (APRN) role. Only four nursing roles fall under the APRN umbrella: clinical nurse specialists (CNSs), nurse anesthetists (CRNAs), certified nurse midwives (CNMs), and nurse practitioners (NPs).

CNLs are easy to confuse with CNSs, who also lead, but the roles differ. A CNS always specializes in a patient population, such as pediatrics. A CNL is always a generalist who can bring their skills to any unit. And unlike APRNs, CNLs cannot prescribe medication or serve as primary care providers. A good way to think of it: CNLs focus on care coordination, APRNs focus on direct patient care.

A CNL does:

• Oversee an entire unit
• Work to improve patient care
• Coordinate care with other healthcare professionals
• Make sure care plans fit each patient
• Keep all departments communicating
• Make sure discharges go smoothly

A CNL does not:

• Manage other nurses like a charge nurse or nurse manager
• Specialize in a patient population like a CNS
• Give direct care like most RNs and APRNs
• Prescribe medications
• Perform treatments
• Coordinate care for only a few patients like a case manager

What Degree Do I Need?

You need at least a master's degree plus an RN license. An MSN is the most common path, but if you already hold a master's in another field, some schools offer post-master's certificates. Either way, you must be an RN in good standing before you apply. You will generally need a BSN before entering a CNL program, though some universities offer RN-to-MSN bridge programs for associate-degree nurses.

What You'll Study

Your MSN tracks to the work you will actually do. You focus less on clinical skills and more on care coordination. MSN programs for an NP or CNS include pharmacology and a clinical specialty; a CNL program does not need those elements, since CNLs do not specialize or prescribe.

Your MSN or post-master's certificate must come from a CNL program approved by the AACN. You cannot apply for CNL certification otherwise. If you already hold an MSN from a school that is not on the approved list, you will need a post-master's certificate from one that is.

CNL Certification

You must be certified to work as a CNL, and certification comes through the AACN. To be eligible, you need to:

• Graduate from, or be in your last semester of, an approved CNL program
• Hold an active RN license in good standing
• Have your CNL program director submit proof of your education to the AACN

Once approved, you take the CNL exam and get an instant pass-or-fail result. If you pass, your official score and certification arrive by mail within 60 days. Certification renews every five years. Renewal requires a current RN license, at least 2,000 hours of professional practice, and at least 50 continuing education hours. Those hours can be the same ones used to renew your RN license and do not need to be CNL-specific.

How Long Does It Take?

Your first step is your RN license, which takes two to four years depending on your degree. An ADN runs about two years; a BSN about four. From there, timelines depend on your path:

• ADN-to-MSN bridge programs: three years
• MSN programs: two years
• Post-master's certificates: one year to 18 months

How Much Does a CNL Make?

The Bureau of Labor Statistics (BLS) does not track CNLs as a separate profession. Available data puts CNL pay in line with the BLS category of medical and health services managers, which has a median of $117,960. Your salary will depend on your employer, location, and experience.

What's the Job Outlook?

CNLs fill a critical need, and as healthcare grows more complex, the role becomes more important. The Centers for Disease Control and Prevention reports that 40% of American adults have two or more chronic conditions, and multiple conditions usually mean care from multiple providers. A CNL coordinates that care to keep it safe and effective.

Demand is strongest in higher-complexity facilities: transplant and cancer centers, academic medical centers, and other places where many specialties intersect. But the need is not limited to large hospitals. CNLs also bring value to rural hospitals, nursing homes, assisted living, and other community settings.

"It's really the continuum of care," Ferrara says. "This is where these clinical nurse leaders could really play a critical role."