The Evolution of Clinical Nurse Leaders


In 2007, The Association of Colleges of Nursing (AACN) proposed the introduction of the clinical nurse leader role. Facing troubling statistics from all over the country about the number of medical errors leading to patient injury or death and rising costs due to these errors, the AACN members recognized that something had to be done to improve patient outcomes in the various healthcare environments.

In the AACN’s 2007 “White Paper on the Education and Role of the Clinical Nurse Leader” proposal, the organization outlined the main functions that the clinical nurse leader would fulfill when integrated into the healthcare system. Along with these functions, the AACN also outlined the key focal points that should drive the curriculum of any educational system designed to prepare students to take on this role.

One of the main objectives that the AACN listed in the white paper was increasing the ability of patients to maximize self-care and make decisions about their own healthcare. To that end, clinical nurse leaders must be able to educate patients (and their families) about how to be proactive about reaching and maintaining a healthy lifestyle. But patient education isn’t the only role that CNLs fulfill. They also are tasked with teaching other direct care providers so that they, too, will be able to encourage health literacy within families and the community as a whole.

As technology continues to advance, making significant changes to the way that the healthcare industry operates, CNLs must adapt and use new resources to maximize patient care. In addition to face-to-face interaction, CNLs may use electronic channels, such as email and video chat, to develop and maintain relationships with patients and monitor their illnesses. Efficient and effective use of technology is another objective of CNL training.

As the name implies, clinical nurse leaders are also expected to take on a leadership position among their team members in their particular healthcare environment. The American Nursing Association makes the point that “if a healthy work environment is to be achieved at the unit level, current and future nurses in these unit-level roles and the nurse manager role will need development and mentoring to develop the leadership skills needed to support the development of health work places.” Since the clinical nurse leader is tasked with working with the interdisciplinary team, a high level of leadership and communication skills are required. Therefore, training in these areas needs to be a part of any CNL degree program.

The clinical nurse leader is also expected to take a critical look at the way that a system is functioning, provide the evidence for why something needs to be changed in order to be improved upon, and then take an active role in developing changes in policy for an organization. This process is not solely relegated to within the team; often times, implementing these kinds of systematic changes can entail presenting these objectives to elected officials and proposing changes that support the upholding of equality and justice within the world of nursing. Again, leadership and communication skills are essential for the CNL to become an effective healthcare change agent.

As the role of the clinical nurse leader has evolved and the value of the CNL role has become more evident, and the demand for clinical nurse leaders has grown. As a result, clinical nurse leaders have been able to find careers in a wide variety of healthcare environments, including hospitals, healthcare facilities, institutionalized healthcare environments, rehabilitation centers/hospitals, medical centers, and more.

Throughout the development of the clinical nurse leader’s position in the healthcare industry, the ways in which nurses are educated has also evolved to include the advanced medical, leadership, and technology skills necessary to successfully fulfill the CNL role. Degree programs ultimately culminate with a comprehensive test of the knowledge and skills. Successful students are then able to integrate what they have learned into their daily work as clinical nurse leaders. They are also able to help educate and mentor both team members as well as those colleagues who aspire to a role as a CNL.

The AACN’s white paper concludes with a direct and indisputable message:

Significant positive impact on the healthcare system and the resulting improvement in patient outcomes cannot reach maximum potential until there is partnership and collaboration between the education and practice arenas. Since 2007 when the white paper was published, both parties have worked to do just that. Clinical nurse leaders now have the opportunity to make a significant contribution to improving patient care and the health care system as a whole.


American Nurses Association, “Growing Future Nurse Leaders to Build and Sustain Healthy Work Environments at the Unit Level.” (accessed November 1, 2011)

American Association of Colleges of Nursing, “White Paper on the Education and Role of the Clinical Nurse Leader.” (accessed October 29, 2011).


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