Nurses are an essential part of the healthcare system, and the versatility of a career in nursing cannot be overstated. Once a foundation of knowledge and experience is laid, a registered nurse has the ability to specialize or broaden their practice as their interests and passions grow.

Nursing at the bedside as a registered nurse (RN) can be an incredibly rewarding experience, providing patients directly with the care they require to get well. That being said, once an RN has become proficient in their chosen field, the option to pursue a master’s degree in nursing might present itself as an appealing way to further their nursing practice and achieve a higher level of autonomy and prestige. This educational undertaking has the potential to not only advance their career and earning potential as nurses, but to also make a significant difference in more patients’ lives on a systematic basis.

There are many paths available for RNs to obtain credentials that expand their scope of practice, and the rapidly changing landscape of healthcare has necessitated the creation of new designations within the field of nursing to meet emerging patient needs. An example of that necessary evolution was the creation of the designation of Clinical Nurse Leader, or CNL.

Below we take a look at both the role of registered nurse and clinical nurse leader and highlight key differences between the two.

What do RNs do?

Registered nurses are responsible for providing direct care to patients. Exactly what this means will depend on where the registered nurse is employed, but will often include responsibilities such as:

  • Recording a patient’s medical history and symptoms as necessary
  • Conducting patient assessments and observations
  • Collaborating with the broader medical team to create a patient care plan
  • Administering the prescribed treatments and medications
  • Performing wound care (i.e., changing bandages, etc.)
  • Drawing blood, urine samples, etc. for laboratory work
  • Educating patients (and relevant family members) about how to best manage an injury, condition, or illness
  • And more

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What do CNLs do?

The role of a clinical nurse leader is a relatively new designation in the nursing world. Created in 2003 and instituted in 2007 by the American Association of Colleges of Nursing (AACN), this designation was conceived to better protect patients from medical errors and improve patient outcomes: Namely through quality and safety improvements. The creation of this specialization sought to meet a need in nursing for general advanced clinical practice and coordination of care.

CNLs serve as care facilitators between various medical specialties, and also serve as a professional and educational resource to other nurses. They endeavor to ensure that medical best practices and organizational policies are adhered to within the facilities where they are employed.

While a CNL is an advanced form of credentialing for an RN, CNLS are not technically Advanced Practice Registered Nurses (APRN), even though both types of nursing specializations require at least a master’s degree to qualify for their respective examinations. There are only four types of APRNs as defined by the National Council of State Boards of Nursing (NCSBN): Certified Nurse Practitioner (NP), Certified Nurse Specialist (CNS), Certified Registered Nurse Anesthetist (CRNA), and Certified Nurse Midwife (CNM). In the case of each of these designations, the responsibilities of an RN expand regardless of whether they become APRN or a CNL, but the nature of those responsibilities differ quite a bit.

Differences Between CNLs and RNs

1. Roles and Responsibilities

The key difference between RNs and CNLs is that registered nurses are responsible for providing direct care for their patients. While CNLs are capable of providing direct care, their role is typically more supervisory in nature. Instead of providing care, they coordinate care.

CNLs are meant to serve as leaders on a given unit; they are advanced generalists of nursing practice who coordinate the delivery of efficient and effective care, always with the advancement of quality and safety in mind. Their focus is on the operational aspects of nursing. They monitor interventions and their respective outcomes for all patients on their unit, anticipating patient-specific risks and challenges to desired outcomes and identifying trends from patient data. They have the authority to implement evidence-based techniques and technologies and, if necessary, can change plans of care so that they may better serve particular patients.

Because a CNL must stay abreast of new findings in nursing research, they also serve as educators for nurses and staff on the most up to date methods of best practice. CNLs are not just leaders in name, but are also clinical mentors, offering support and advocating for their point-of-care colleagues when necessary, all in the name of maintaining quality and safety.

In addition to all this, CNLs serve to create a more cohesive team from an increasingly fragmented healthcare system. CNLs utilize a lateral integration of care, which is designed to improve communication and cooperation between nurses, physicians, and all other members of the clinical team in order to address and plan for the oftentimes complex needs of patients. The CNL maintains this communication by rounding with interdisciplinary teams, identifying needs and offering support and guidance to physicians, nurses, and ancillary staff on the unit to best deliver care that is patient-centric and safe. They exist to solve contemporary healthcare problems through optimization of the healthcare team and its resources.

2. Training and Education

Registered nurses must hold at least an associate’s degree in nursing in order to do the job. It is becoming increasingly common for a full Bachelor of Science in Nursing (BSN) to be required.

A clinical nurse leader must first be a licensed Registered Nurse (RN) before attempting to pursue the designation of CNL. They must also complete a master’s degree in nursing on a CNL track (MSN-CNL), as opposed to a master’s program designed for nurse practitioners (MSN-NP). Once this degree is obtained, they must also pass a CNL certification exam in order to obtain accreditation.

It’s worth noting that while both CNLs and NPs are trained to work in the clinical setting, an NP specializes in a particular clinical practice such as pediatrics, oncology, or family health, and provides direct patient care. There is some overlap in the curricula of a CNL and an NP: both are required to have additional knowledge in pharmacology and health assessment and physiology as compared to an RN. However, CNLs don’t necessarily provide hands-on or direct patient care in the way that a staff nurse would, and do not diagnose, treat, or prescribe medications to patients like an NP.

3. Salary and Outlook

As of 2021, the median annual salary of registered nurses was approximately $73,000 according to the US Bureau of Labor Statistics. As previously stated, the CNL designation is a relatively new one, and their implementation in clinical settings is not yet ubiquitous due to their still evolving role and duties. The nationwide average salary for a CNL is currently around $92,000, but it is reasonable to assume that as the successful implementation of CNLs proves their value to the healthcare system, the average salary for a CNL will increase in the coming years.

Not Necessarily an Either/Or Decision

As mentioned above, in order to become a CNL, you will first need to become a registered nurse and maintain your RN license. With this in mind, most CNLs first begin their careers as practicing RNs before deciding that they would like to advance. As seen above, doing so can be incredibly rewarding.

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