1. Baldwin, Kathleen PhD, RN, CNS, ANP, GNP, CEN

Article Content


The purpose of this presentation was to describe the process used to develop a program preparing clinical nurse leaders (CNLs) who collaborated with rather than competed with the clinical nurse specialists (CNSs).



The dean of the college of nursing in a private academic institution was approached by the leaders of 2 of the 3 major healthcare systems in a large metropolitan area and asked to develop a CNL program. The director of graduate studies who developed the existing CNS program was charged with developing a CNL program. The CNL role is an emerging nursing role in today's healthcare. Many CNSs and CNS educators see it as a threat to the CNS role. Although the CNL role has not gained widespread acceptance, the number of CNLs continues to grow. Developing synergistic CNS and CNL curricula that clearly define both the CNS and CNL roles will prevent overlap between the 2 roles and infringement into the CNS role by the CNL.



In 2004, the American Association of Colleges of Nursing proposed the CNL role in response to the Institute of Medicine's recommendations for improving healthcare. Described as a master's prepared generalist, the CNL was to be a unit-based role responsible for the outcomes of a group of 12 to 16 patients. The CNS role, an advanced practice role, has existed for more than 50 years. Currently demand outstrips supply, making the CNS positions the hardest ones for healthcare recruiters to fill. Although new CNS education programs are opening, the number of graduates is still insufficient to meet needs. Hospitals are filling CNS openings with other master's prepared nurses. Some facilities are expanding the CNL role to encompass CNS competencies.



The director of a CNS program developed a CNL program, which accentuated the role of the CNL as a master's prepared generalist focused on coordinating care to improve outcomes for a generic group of 12 to 16 patients and the CNS as an advanced practice nurse focused on quality, safety, and cost-effectiveness for a specific population of patients. Competencies for both roles were used as the basis of program development. The CNL role was envisioned as a point-of-care case manager for a small group of patients who could assist the CNS in implementing CNS-designed EBP programs to meet outcomes expectations for patients. Collaboration between CNSs and CNLs was viewed as integral to the development of both roles within 2 local hospital systems.



Program development is ongoing, and the first cohort of CNL students is expected to be admitted in May 2009. A small, community hospital with 4 CNSs will serve as the beta testing site for collaboration between the CNS and CNL roles. The chief nursing officer clearly believes that both roles are needed to create the best outcomes for patients.



Many nursing administrators believe that there is room for both the CNS and CNL roles in today's healthcare systems. Finding a way to work together will benefit both roles while preserving each role's autonomy. Creating and implementing educational curricula focused on synergy between the CNS and CNL will provide a prototype for other programs.


Implications for Practice:

It is imperative that the distinction between the CNS and CNL be clearly articulated through education. There is a paucity of CNL programs in schools with existing CNS programs. Providing both programs in one institution will allow students to see the clear differences between the 2 roles. Preparing CNSs and CNLs who can practice collaboratively will improve outcomes for patients.


Section Description

The 2009 NACNS National Conference will be held in St Louis, Missouri, on March 5 to 7. More than 350 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are registered. This year's theme, "Clinical Nurse Specialists: Vision, Value, Voice," demonstrates the essential leadership skills of the CNS as well as the CNS role in implementing evidence-based practice.


Seventy abstracts were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session. The abstracts addressed CNS practice in 3 practice domains (spheres of influence), emphasizing patient safety and quality care outcomes, leadership, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into 3 spheres of influence-patients, nursing practice, organization/system-including the development of clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, CNS practice in end-of-life care decisions, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNSs' contribution to the well-being of individuals, families, communities, as well as to the advancement of the nursing profession.


The conference abstracts were published here to facilitate sharing this emerging new knowledge with those who were unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics. Watch out for next year's call for abstracts and consider submitting for presentation at NACNS' next annual conference in Portland, Oregon, on March 4 to 6, 2010.