What Does A Clinical Nurse Leader Do

Last Updated on December 28, 2022

Are you a RN and you want to be known as a clinical nurse leader? If so, then you need to have the right clinical nurse leader certifications. However, there are many CGL exams for nurses. What should you choose? Here’s an overview of what does a clinical nurse leader do and what does not.

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What is a Clinical Nurse Leader? | All Nursing Schools

The Clinical Nurse Leader (CNL) is an emerging role developed by the American Association of Colleges of Nursing (AACN) in collaboration with leaders in the nursing practice environment. A CNL makes it his or her mission to identify how to improve the quality of patient care and prepares other nurses with the skills needed to thrive in the current and future healthcare system.

Leadership Roles In

The Many Roles of a Clinical Nurse Leader

Quality care begins at the bedside and while nursing leadership is known to go beyond to the managerial or administrative level, the Clinical Nurse Leader plays an integral leadership role at the bedside, holding patient care at its core. This position is not one of administration but of action, consistently evaluating patient outcomes, assessing cohort risk, and making leadership decisions to change care plans when necessary. CNL’s have many responsibilities.

Taking on Leadership

Learning to become an effective leader is a significant skill to be developed throughout nursing education. Unlike a staff nurse, the CNL has a hand in many things. Responsibilities involve drafting healthcare plans for patients, leading processes and teams, utilizing data to design and implement evidence-based practice, and anticipating problems with colleagues or patient care. Clinical Nurse Leaders work toward bettering the care of the patient population, making recommendations as necessary based off of data they’ve collected and analyzed.

Nine principles of successful nursing leadership - American Nurse

They can also be agents of change for a healthcare facility or organization. Many facilities need a transformative leader to change nurses’ thought processes. The CNL is a master at many styles of leadership to effectively get their employees to perform at a level of excellence.

Two leadership styles include:

Democratic – allowing team members a say in critical decision-making, with the final decision resting with the leader.

Affiliative – putting the team members first and ensure their needs are met on a project.

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To ensure quality of care is at its optimum state, the nursing culture in the organization has to have leaders that promote autonomy, integrity and ongoing performance and care improvement. Helpful key behaviors include that leaders do the following:

  • Encourage followers to be actively involved in the quality control process
  • Clearly communicate expected standards of care
  • Encourage high standards to maximize quality instead of setting minimum safety standards.
  • Embrace quality improvement as an ongoing process
  • Use control as a method of determining why goals were not met
  • Distinguish between clinical standards and resource utilization standards, ensuring that patients receive at least minimally acceptable levels of quality of care
  • Support and actively participate in research efforts to identify and measure nursing sensitive patient outcomes

Improving Patient Care

The CNL focuses on the safety of patients and families entrusted into his or her care. There are seven important subcultures Clinical Nurse Leaders need to maintain a culture of safety: leadership, teamwork, evidence-based care, communication, learning, justice and patient-centeredness.

By acquiring a master’s nursing degree, the potential CNL will quickly learn the importance of creating effective patient care plans. A large part of the job involves managing patient care and coming up with the best plan or course of action.

Effective nursing leadership: How to be an effective nurse leader.

Nurses studying to become a Clinical Nurse Leader will learn how to research new surgery techniques, assess new equipment and relevant details. CNLs are also prepared to address change by learning about risk anticipation, risk reduction failure modes analysis techniques, as well as conducting root cause analyses. CNL students learn how to collaborate not just with doctors and nurses, but also with pharmacists, the patient’s family, physical therapists and social workers.

As technology increases, teamwork and interdisciplinary collaboration grow more essential to safe care delivery. The CNL education preparation includes a specific focus on communication skills targeted towards the teamwork, lateral integration of care, and conflict management needed to advocate for patient-centered, evidence-based care.

One of the early examples of the CNLs ability to provide strong evidence-based point-of-care clinical leadership was the 12-bed hospital project at Baptist Hospital in Miami, Florida. Implementation of the CNL role resulted in a 67% reduction in the fall with injury rate and a sustained pressure ulcer prevalence rate of zero for the full year. Additionally, one-year findings included increase in patient satisfaction and a decrease in staff turnover.

Another example of CNL role implementation in an acute care setting comes from a hospital in northeastern Florida. There were improvements in nurse satisfaction and retention, patient satisfaction, and physician. The presence of the point-of-care clinical leader led to a 38% reduction in restraint use, fewer falls, and a significantly reduced incidence of failure to rescue.

The Joint Commission recognizes the CNL as an important contribution towards helping to solve healthcare’s safety problems and implementation of the CNL role now occurs in several major healthcare systems across the nation.

Collaborating with Colleagues & Patients

As the bridge between numerous individuals and departments, it is important for the CNL to build strong relationships with colleagues. From the newest certified nursing assistant, to the most tenured doctor, the CNL must maintain clear communication with all stakeholders.

One of the biggest challenges in our complex, healthcare settings is that of effective and timely communication among multiple healthcare providers, including physicians, nurses, therapists, and consultants. Without this communication, care can become fragmented for the patient and family, increasing their risk of harm. A CNL role insures that patient and family needs are not only assessed, but also properly communicated with all members of the healthcare team for effective, quality care.

Nurse Manager vs Nurse Leader: What's the Difference?

Part of the position also involves listening to everyone’s concerns and ideas as they can play a role in determining an ideal course of action for a given patient. Clinical Nurse Leaders keep up on the latest technology and treatments and assess the risks and advantages with the patient’s nurses and doctors. This helps in identifying the best plan of action.

Coordination of care between settings, or ‘lateral integration,’ enables the CNL to serve as the patient advocate/care navigator, and as the stop-gap professional. This coordination ultimately helps reduce fragmentation and lapses in patient care and safety.

Motivating Your Team

A Clinical Nurse Leader must be a mentor for his or her team. As a leader, constant communication is critical, as is the ability to listen to problems and ideas from others with an open mind.

To become a leader and expert, it is important to specialize in an area of focus in healthcare. The CNL career path is ideal for established nurses who strive to be the best patient caregiver. A Master of Science in Nursing with a Clinical Nurse Leader track is the ideal path for nurses to achieve this career goal, as it is designed to prepare nurses for the CNL certification exam. Nurses wishing to work as a CNL are required to hold a master’s degree and have the potential of earning an annual salary that is almost $20,000 higher than RNs without master’s degrees.

Sacred Heart University offers a Master of Science in Nursing with a specialization of Clinical Nurse Leader (CNL), preparing students to sit for the American Association of Colleges of Nursing CNL Certificate Exam through coursework and over 348 hours of role immersion. The university’s CNL track offers seasoned RNs the needed skillset to create, implement and gauge a patient’s care, along with the management and collaboration skills for working with other healthcare professionals.

Examples Nurse Leader Role

Understanding the role of the Clinical Nurse Leader

The Clinical Nurse Leader (CNL) credential is so new that many people don’t know what it is. The CNL role emerged, after several years of research and discussion, as a way to allow master’s-prepared nurses to stay at the patient’s side to oversee and manage care delivery. Created by the American Association of Colleges of Nursing (AACN), the role was designed in collaboration with representatives from a wide range of healthcare leadership and expertise.

What CNLs do
CNLs communicate, plan, and implement care directly with other clinicians, including clinical nurse specialists (CNSs), nurse practitioners, physicians, pharmacists, and social workers. Neither administrators nor managers, we oversee lateral integration of care for a distinct group of patients. In complex situations, we may actively provide direct patient care.
CNLs are accountable for healthcare outcomes for a specific group of patients within a unit or other setting. We assimilate and apply research-based information to develop, implement, and evaluate plans of care, thus ensuring that patients benefit from the latest healthcare innovations. As clinical decision makers and care managers, we coordinate the direct care activities of other nursing staff and healthcare professionals. We also gather and evaluate patient outcomes and have the authority to change plans of care, when necessary.
The CNS role complements the advanced practice nurse (APN) role. For instance, a CNL may consult with a CNS when a specialized area of concern arises.

Educational preparation
To become a CNL, you’ll need to attend a master’s program that meets AACN requirements. (Unlike an APN, the CNL candidate doesn’t receive specialist education in a defined practice area.) After graduation, you’ll need to pass a national certification exam to use the title of CNL.

A day in my life as a CNL
The CNL role is implemented variably from one setting to the next. I’ll use my own job activities to illustrate how some facilities implement it.
I work in a 24-bed medical unit at Wolfson Children’s Hospital in Jacksonville, Florida, which implemented the CNL role in January 2006. At this 180-bed pediatric hospital, which partners with a large academic institution, the CNL is considered lateral to the nurse manager and has 24-hour accountability for all clinical care provided on the unit.
I spend most of my time on the unit with nurses and patients, but don’t take a direct patient assignment or handle management issues. My work complements that of the CNS who serves this unit. My sole focus is the unit, whereas the CNS focuses on several units. I act as the bedside resource, whereas the CNS designs formal educational programs for staff. I’m closely involved with patients on the unit; the CNS is available to consult when needed.
Each day, I briefly review medical records for all patients on the unit. This gives me a chance to assess each patient’s plan of care for the upcoming shift and to plan for the patient’s entire hospital experience. From this review, I identify the day’s “hot spots,” such as patient discharge needs, procedures, or plan-of-care clarification.
Next, I collaborate with each staff nurse on the unit, quickly reviewing concerns for each patient as well as daily discharge planning. After assessing data from the chart reviews and nursing staff, I participate in physician rounds.
I assess the most critically ill patients, participate in family education, and go on daily rounds with each patient and family. During these rounds, I review the plan of care with the family. Frequently, the family has questions about their child’s condition, which I can address or arrange for members of other disciplines to address.

Integrating care laterally
Integrating the plan of care laterally with other disciplines is a key component of my role. I present the concerns of multiple disciplines as well as those of the patient and family (if needed) to the discipline that needs to take action. For example, nursing concerns about feeding issues can be addressed with the speech therapy and nutrition departments, whose recommendations can be taken to the physician.
Recently, a child on my unit needed a magnetic resonance imaging (MRI) scan with sedation. She was living with her grandmother while her mother was out of state. To ensure that consent was obtained rapidly so the procedure wouldn’t be delayed, I coordinated with the social work, MRI, and anesthesia departments as well as the child’s mother. My actions allowed the bedside nurse to spend more time with patients.

Navigator, patient advocate, and problem solver
As an expert clinical resource for the unit, I help staff nurses navigate the complex hospital system. I help staff nurses identify potential patient problems, including deteriorating physical conditions that need immediate attention. In one case, a child returned from surgery with a chest tube. The nurse had no experience caring for a child with a chest tube—but I was available to help her assess the patient and teach her about patient care.

UTMB School of Nursing | Clinical Nurse Leader Program | Graduate Programs  | UTMB School of Nursing | UTMB Health

Seeing the big picture
Beyond my daily unit responsibilities, I assess the “big picture,” initiating changes when necessary and identifying areas where staff members need additional education. My CNL preparation enables me to evaluate and change system processes that don’t function as they should. Where staff nurses look for ways to solve immediate problems, I seek a solution to solve the problems for all similar patients by repairing the process.
I also review unit policies to ensure they’re based on best practice and evidence, and have updated or developed multiple policies. For instance, I developed an oral hydration maintenance protocol for nurses and have worked closely with physicians to create an order set based on evidence for bronchiolitis. I also created a quick-reference notebook for nursing care of patients with complex respiratory problems. The notebook includes policies, up-to-date reference articles, and “to do” lists for patient admission, each shift, and during transport. Using these lists has relieved staff anxiety over meeting patient care needs. For more formal education needs, I refer staff to the CNS.

Challenges of the CNL role
One of the most challenging things about being a CNL is defining my role within the organization—and standing firm. CNLs have diverse and valuable skills that can be applied in many areas away from the unit. They must commit to staying on the unit, helping nurses and patients, for the vast majority of their time.

Clinical Nurse Leader - Morningside University

Positive staff response
At Wolfson, response to the CNL role has been positive. Physicians are enthusiastic about the input I provide during rounds. I’ve gotten positive feedback from other professionals, too, because my actions allow them to get involved in care earlier during patients’ hospital stays.
Overwhelmingly, staff nurses on my unit support the CNL role. I provide consistency to care in a unit where most nurses work 12-hour shifts. I fill in gaps for them, stay available on the unit for support and answers, and handle complex patient issues. The CNL role has been well integrated into this pediatric acute-care setting, and is being implemented on three other hospital units.

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