Clinical Nurse Leader (CNL) is a relatively new designation for professional nurses who play a specialized role in today’s integrated healthcare system. Some of the primary responsibilities for CNLs include coordinating, evaluating, and delivering patient-centered, front-line care across the nursing profession, with a focus on improving outcomes, reducing risks, and containing costs. Training for CNLs takes place at the master’s degree level, and the American Association of Colleges of Nursing (AACN) oversees formal certification for CNLs. Online CNL programs, like their campus-based equivalents, are designed to offer registered nurses (RNs) the didactic instruction and clinical training needed to advance into a career as a CNL.
The CNL role was created by the AACN in 2003 to meet a pressing need in the nursing profession for an evidence-based approach to reducing risk, implementing better safety measures, and improving the overall efficiency and effectiveness of healthcare. To address these concerns, the AACN introduced the CNL as a generalist practitioner with training in both the clinical and the operational aspects of healthcare. Instead of focusing on a narrow area of clinical care, like neonatal, psychiatric, or acute care nursing, CNLs are prepared to function across the various specializations in nursing. They work within what the AACN calls “clinical microsystems,” such as hospital units, community clinics, and home health agencies, providing, managing, and directing patient care. While CNLs do engage in day-to-day patient care, they are also responsible for coordinating the efforts of other nurses in order to more efficiently delegate nursing resources and facilitate better outcomes. In this capacity, CNLs are meant to bridge the gap between nurse executives and administrators, who handle larger healthcare management issues, and the front-line nurses tasked with providing daily care to patients.
Online CNL programs are Master’s of Science in Nursing (MSN) programs tailored to curricular guidelines established by the AACN in Competencies and Curricular Expectations for Clinical Nurse Leader Education and Practice. The CNL training protocol combines advanced clinical proficiencies with instruction in theories of healthcare management for nurses working at the clinical level. It also includes a supervised clinical component in the form of practicums and/or internships that are overseen by designated preceptors. The CNL curriculum, which typically incorporates at least 400 clinical practice hours, is designed to prepare graduates to sit for the Commission on Nurse Certification (CNC) CNL examination, which is required by most employers for CNL positions.
CNL programs that are offered online deliver all or most of the classroom instruction through distance learning platforms that do not require students to be on campus. However, students in these programs must make arrangements to complete clinical practice hours in person at an approved healthcare facility, which may require some travel. In addition, some online CNL programs include mandatory campus visits as part of the curriculum. These sessions, which are sometimes called immersions or intensives, are instructional tools that give students the opportunity to meet with instructors and classmates, receive hands on instruction or training on specific procedures, collaborate on group projects, and network with professionals in the field. Not all online CNL programs have mandatory on-campus visits, and OnlineEducation.com does not classify CNL programs that require more than three campus visits per year as online programs. At this time, only programs that are classified as online are included on the site.
The CNL curriculum encompasses several key areas of nursing practice, including team leadership and management, healthcare policy, clinical assessment tools, and quality control strategies. The goal of the CNL curriculum is to prepare graduates to deliver nursing services and coordinate patient care across a broad range of clinical settings. CNLs receive training in clinical practice areas like physiology and pharmacology, as well as in areas of administrative concern, like human resources management, organizational communications, and healthcare information systems technologies. Graduates from CNL programs are expected to possess the knowledge and tools necessary to implement and maintain evidence-based programs and strategies for improved patient-care outcomes.
The chart below provides an overview of some of the core coursework that is part of a typical CNL curriculum:
|Applied Statistics for Evidence-Based Practice||An overview of how healthcare studies and medical research should be interpreted and applied for use in a clinical setting.|
|Pathophysiology Across the Lifespan||An examination of current theories concerning human physiology in diverse populations, and how this relates to the diagnosis and treatment of various diseases.|
|Research Methods and Biostatistics||An introduction to the use of biostatistics and other data tools in the design and evaluation of healthcare studies and healthcare policy.|
|Advanced Pharmacology||An in-depth look at the physiological effects of various drugs and pharmacological interventions.|
|The Business of Healthcare||The application of financial management principles and tools in the context of the US healthcare system.|
|Epidemiology in Action: Tracking Health & Disease||How healthcare outcomes are measured and assessed using evidence-based methods, including the use of risk-management strategies and the interpretation of various models of disease treatment and prevention.|
|Foundations for Clinical Nurse Leadership||An overview of the role of the CNL, including point-of-care management, interdisciplinary team coordination, and the microsystems theory of nursing.|
Like many MSN programs, CNL programs are designed to accommodate a range of potential applicants who are at different points in their nursing education and/or career. A baseline requirement for entering a CNL program is a valid state RN license. Some programs only accept RNs who have earned a Bachelor of Science in Nursing (BSN). Other programs accept RNs who have completed a non-nursing bachelor’s degree in addition to an Associate Degree in Nursing (ADN). There are also RN-to-MSN programs that require an ADN (or a diploma in nursing). Finally, some programs may offer a post-master’s or post-graduate certificate pathway for students who already have an MSN and want to transition to a career as a CNL. The pathways to earning a CNL degree are as follows:
MSN program admissions policies vary by school. Prospective applicants should carefully research the admissions policies for each CNL program to determine the specific requirements and ensure there is an appropriate pathway for their educational background. All CNL programs require that applicants hold a valid RN license before the program’s start date, if not at the time the application is submitted. Some of the other factors that online CNL programs may take into account as part of the admissions process include:
There are several additional factors that students applying to online CNL programs should consider. These factors can impact the time to completion, the relative convenience and flexibility of an online program, and the expenses incurred during the program. They include how online courses are delivered, part-time vs. full-time enrollment, and whether or not the program requires any campus visits. Potential applicants should carefully research the structure of each program to make sure it fits their specific needs.
Synchronous vs. Asynchronous Instruction: These are the two primary modes for the delivery of online courses. Synchronous instruction takes place in real-time and requires that students be present online at specified times in order to participate in lectures and discussions. It is the online instructional format that most closely resembles a traditional classroom setting, and it may be preferable to students who feel more comfortable in a structured learning environment. Asynchronous instruction allows more flexibility by giving students the option of viewing lectures and other course materials at their convenience. However, asynchronous instruction still requires students to meet deadlines for assignments and other course activities.
Part-Time vs. Full-Time Enrollment: Some online programs offer students the option of enrolling full-time or part-time, while others have a more rigid structure that requires students to take a certain number of classes/credits per term. The number of courses completed per term impacts the time to graduation, and may also determine the relative convenience of a particular program. Typically, a CNL program can be completed in about two years of full-time enrollment, depending on the pathway. For example, students who already have an MSN are often able to earn enough credits for a post-master’s CNL certificate in less than a year when enrolled full-time; the BSN-to-MSN pathway may take 20-24 months; and a student entering an RN-to-MSN program should expect to spend closer to 30-36 months in a full-time program. The chart below illustrates the times to completion for the different pathways.
|BSN-MSN||20-24 months||2-plus years|
|ADN-MSN||30-36 months||3-plus years|
|BA/BS-MSN||~24 months||2-plus years|
|Post-master’s certificate||8-12 months||12+ months|
Campus Visits and Clinical Practicums: Clinical practicums are a component of all CNL programs whether they are online or campus-based. The AACN recommends at least 400-hours of supervised clinical experience as part of the CNL training curriculum, and most online programs adhere to this. In most cases, online students find an approved clinical site near where they live, but this is an important consideration and students should confirm how a program handles clinical placements before applying. In addition to practicums, some online programs may have a campus-based component that requires students to travel to the school or another location for hands-on training activities and networking events with peers and instructors. These sessions typically last three-to-seven days, and they may be an impediment for students who are not able to travel due to time constraints, personal commitments, and/or the additional expense. OnlineEducation.com uses the number of required campus visits to classify programs as online or hybrid. CNL programs that require more than three campus visits per year are classified as hybrid and are not included on the site at this time.