New Nursing Role: The Clinical Nurse Leader

How can nurses today be more competent in applying evidence-based nursing care at the bedside?  Health care reimbursement in America moves from “pay for service” to “pay for performance.”  As the nursing profession continues to promote quality and safety as well as efficiency and cost effectiveness, new options among the entry-level master’s degrees arise in today’s health care. One of that is the Clinical Nurse Leader (CNL) role.

The Need for a New Nursing Role

The American Association of Colleges of Nursing (AACN) White Paper (2007) introduced the Clinical Nurse Leader Role as an initiative to meet the challenges of the 21st Century health care. The association worked collaboratively with the academic and practice sectors to develop the CNL role (Jordan & Aureli, 2013). Clinical Nurse Leaders are masters prepared although they do not necessarily have a nursing background. They have the knowledge and skills to create change and improve outcomes as they continue to be direct care providers (Baernholdt & Cottingham, 2011). However, I think CNLs with a nursing background will have an edge in this new role.

Health care in this new era of information and technology is geared towards expertise in the clinical practice and advocacy within the Microsystems-level as well as centralized-care coordination, outcomes management, risk assessment, and quality improvement. After all, a nurse who is not only competent but is also knowledgeable and equipped with evidenced-based nursing care certainly meets the demands of this fast-paced technological world.

The CNL role must be integrated into the practice settings and AACN is facilitating efforts to make this a reality. America’s largest employer of Registered Nurses, the Department of Veterans Affairs (VA) strongly supports the CNL.  There is a need for the Clinical Nurse Leader to improve quality of health care systems while controlling costs (Jordan & Aureli, 2013).

Why Adapt the CNL Role?

The Clinical Nurse Leader does not only own clinical skills that are useful in improving the quality of health care systems but this role requires added knowledge that can be applied at system-level thinking and practice (Baernholdt & Cottingham, 2011) . To decrease cost without compromising quality is the whole point of adapting the CNL role. This innovative role will allow the delivery of quality care at the bedside in a complex and sometimes dysfunctional health care system. Nurses who have the nursing leadership knowledge and management skills will meet this goal.

How CNL was Developed

According to AACN (2009) and Tornabeni & Miller (2008) as cited by Baernholdt & Cottingham (2011), reports from the AACN and the Institute of Medicine (IOM), guided the development of the Clinical Nurse Leader. In the USA, AACN represents more than 640 schools with baccalaureate and higher degree nurse education programs. AACN reports in 2000 expressed the need to change practice environments and nursing education to keep skillful nurses at the bedside and improve patient outcomes.

In 2001 and 2003, the IOM which is a private organization published reports that suggested improvements in the health care system and health professions education. The experts who belong to this organization provide advice on health matters to the US government. AACN facilitated the development of the CNL role in coordination with schools and practice institutions.



Baernholdt, M, & Cottingham, S 2011, ‘The Clinical Nurse Leader – new nursing role with global implications’, International Nursing Review, 58, 1, pp. 74-78, Viewed 7 July 2013.

Jordan, K, & Aureli, S 2013, ‘THE CLINICAL NURSE LEADER: AN INNOVATIVE ROLE’, ASBN Update, 17, 2, p. 16. Viewed 7 July 2013.

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Freslyn Lim

About Freslyn Lim

I am a Registered Nurse currently taking my PhD in Nursing. I earned my Masters in Nursing major in Nursing Administration in March 2011 and had my clinical experience as Staff Nurse in the ICU, Pediatrics and NICU. I am presently a nurse educator/clinical instructor.