1. Running head: PREPARING THE WAY FOR THE CLINICAL NURSE LEADER 1
Abstract
The Clinical nurse leader (CNL) is the first new nursing role in 40 years. The CNL is a
nursing created position developed by the American Association of Colleges of Nursing (AACN)
in 2003. As a CNL I was asked to design a work site curriculum for a major university.
Designing a CNL curriculum differs from other nursing specialties because AACN and
practicing partners contribute to the success of this role. In addition to gaining support from the
university, commitment from a practicing health care partner is essential before proceeding with
this initiative. The first step in creating the curriculum design is to determine the community’s
readiness and need for this type of program. In this paper I will outline the steps taken to develop
a work site CNL program. When planning a curriculum for the CNL the graduate needs to meet
the requirements of the AACN and pass a certification exam after completing the program. A
capstone project and clinical immersion hours must be met prior to sitting for this exam. My
experience as a CNL influenced the curriculum design as well as my personal education in
graduate school. This work site program was tailored to meet the specific requirements of a large
university with multiple healthcare affiliations.
Key words: Clinical Nurse Leader, Educational partnerships, Curriculum design

2. Running head: PREPARING THE WAY FOR THE CLINICAL NURSE LEADER 2
The Clinical Nurse Leader (CNL) role is a new visionary nursing role developed by the
American Association of Colleges of Nursing (AACN) in 2003. In the AACN Spring annual
meeting it was reported that 90 schools of nursing and 190 health care institutions were
participating in the CNL pilot (AACN, 2006a). In this paper a proposal for a CNL program is
suggested guiding the decision whether or not to become part of this national AACN initiative.
The University is part of a large health care system and this cutting edge role could advance
professional nursing practice in this geographical area. The innovative idea for a CNL work site
program came from a university faculty advisor. Presently a successful master’s degree program
is already established at this partner site. Creating a work site program has many advantages and
is a great fit for the CNL partnership. Developing a CNL program requires a strong commitment
from practicing health care partners and the educational partners to succeed. The AACN
provides guidance and direction to the education and practice partner as they pilot the CNL
program. This CNL curriculum design is influenced by existing university requirements for
Masters Education, the AACN, and the practice partner’s resources. It takes planning, tenacity,
and stakeholder support to pioneer this program. In this paper I will expound on the steps taken
to lay the foundation for a CNL program at a major university.
Brief Introduction of the CNL role
The CNL is a new nursing role created by the American association of colleges of nursing
(AACN). The CNL is a patient advocate who practices in the clinical setting at the point of care.
The roots of this new role began to emerge in response to critical issues linked to our current
fragmented health care systems. The nursing shortage, increasing medical errors, call for
evidence based practices, an aging population, and projected future societal health care needs are
only some of the issues which precipitated this role. Although it seems as though the CNL

3. Running head: PREPARING THE WAY FOR THE CLINICAL NURSE LEADER 3
emerged out of nowhere it was the product of many years of planning and collaboration. In 2003
the first draft of the white paper defining the role of the CNL was published and subsequently
revised in 2007 (AACN, 2007). The CNL role captures skills needed to fill the gaps in our
current nursing practice. This role provides leadership and empowerment needed to propel our
profession forward into the future. This role embraces change which is essential for growth in
our current practice settings.
It is apparent that the CNL role is one answer to meet the nursing demands of the 21st century
but will it prevail? The success of the CNL role teeters on the approval and recognition of this
role by nursing administration, nurse colleagues, practice, education and service partners.
Sherman (2008) reported “A unique feature of the project was an AACN requirement that
universities and colleges interested in offering the CNL curriculum had to engage a service
partner” (p. 236). The service partner is complementary providing a niche in the institution for
the CNL to practice and expand this role. Practice partners’ create a job description, salary
incentive, tuition reimbursement, and oftentimes flexible work schedules while the student
attends college. Chief nursing officers and nursing administrators are vital to the successful
implementation of this role. The CNL cannot navigate change without strong administrative
support. Mentoring for the CNL role begins in college and continues after graduation to sustain
the momentum for this new role. The CNL will transition into this role during the clinical
immersion. Nursing colleagues will learn about this role by word of mouth and as it unfolds in
the clinical setting. The role as nurse generalist varies in each clinical site and may differ in
implementation across settings. For nursing colleagues to embrace the CNL they need to
understand the value of this role to nursing practice. In contrast to engage practice partners
requires demonstration of outcomes which appeal to the business.

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The CNL role takes time to develop and transform clinical practice. The educational partner
is crucial to the success of the CNL project as they provide an environment to practice core
competencies vital to this evolving new role.
Engaging Partners
One of the unique challenges to developing a CNL curriculum is that the program cannot
exist without a practice partner. And it must demonstrate business value to the key stakeholders.
Can a practice partner be persuaded to join forces with an academic institution to develop the
CNL role? Developing the CNL role requires strong leadership, academic creativity, and
tenacity. The first step prior to adopting the CNL curriculum plan is to determine the community
need and student interest. Keating (2006) recommends “A needs assessment ensures the
relevance of the program to a community need and its eventual financial viability” (p. 108). It
would be irresponsible to not evaluate the projected financial costs for the university and
partners. The work site program was selected because full time employees of this healthcare
institution receive tuition reimbursement. I met with the Chief nursing officers (CNO) of two
healthcare institutions to introduce the CNL role and determine interest for participating as a
practice partner. Both healthcare institutions were selected because of their affiliation with the
University. Neither CNO seemed to have prior exposure to this role. One chief nursing officer
expressed interest in piloting the CNL role but requested additional evidence to support the value
of this role. I also attended a university sponsored educational information session at this work
site where some students expressed interest in the CNL role. In the course of my employment I
casually discussed the CNL role orienting physicians, colleagues, and administration. Several
colleagues at this work site are enrolled in my Doctorate of nursing practice program and I
introduced them to the role through classroom discussion and presentations. One way to prepare

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an organization for a new nursing role is through education. I provided a nursing presentation
titled The Clinical Nurse Leader for the current Masters degree students enrolled in the work site
program which was well received. I realized that in this large medical complex with three major
hospitals in close proximity to one another that I was the only CNL employed in this area.
Although, not for long because one of the major hospitals in this area has recently partnered with
another university to join the CNL initiative (X, personal communication, September, 9, 2009).
Gaining buy in from key stakeholders is one of the most important steps to achieve before
adopting a CNL program. Once a University–stakeholder partnership is achieved the secondary
goal of finding interested student candidates will follow. Stanley (2007) found “Factors that must
be taken into account when considering any potential partnership include such things as the
location, availability, public or private status of potential partners, competition from other
sources for resources, funding, and decision-making processes and philosophy of both parties”
(p. 69). The CNO who agreed to pilot the CNL in a few clinical units shares a nursing
philosophy which is in alignment with the School of Nursing. Now that a partner has accepted
the challenge to pioneer this role it is reasonable to plan the curriculum.
Planning the Curriculum
I contacted the AACN to determine what steps were needed to form a CNL educational
partnership. I contacted Dr. Joan Stanley who is the AACN Senior Director of Education policy
at AACN for guidance and permission to proceed in the development of a CNL program. Dr.
Stanley directed me to the AACN web site to download the CNL toolkit, curriculum framework,
and Whitepaper (J. M. Stanley, personal communication, July 13, 2009). Preparing a CNL
curriculum design requires methodical detailed planning. Educational partners are challenged to
develop a graduate program within the parameters of the AACN guidelines. The AACN (2006b)

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curriculum framework outlines detailed academic requirements necessary to fulfill the
competencies for the CNL role. Tailoring the CNL curriculum to meet the AACN guidelines,
and finding faculty to implement this new role requires creative innovative across-the-board
planning. It is a challenge to create a curriculum to meet these imposing standards.The Clinical
nurse leader conceptual framework can serve as a guide when planning the CNL curriculum
(Maag, Bucccheri, Capella, and Jennings, 2006). I met frequently with Dr. X. university faculty
advisor who informed me that several university courses must be built into the curriculum as
they are required core courses. Roche, Demartinis, and Henneman (2009) caution “Programs that
requied mainly existing course work, with a CNL immersion course to integrate all the CNL
competencies, could fall into the trap of merely tweaking an existing program” (p. 103). For this
reason I felt that the curriculum should include core courses which would incorporate all the
elements of the CNL as outlined by AACN. The courses were designed to follow a sequential
pattern of learning building upon each successive course. Young and Paterson (2007) found
“The design of instruction should logically flow from the other major elements of the
curriculum”. Students are required to complete an evidenced based capstone project. Partners can
be instrumental in offering suggestions for capstone projects and the outcomes will be of mutual
benefit to the organization. The clinical immersion experience was planned for the last semester
as it is hoped that the employee will smoothly transition into this role at that time. Planned
seminars will accompany the capstone and clinical immersion to render support and guidance to
students. It is hoped that clinical preceptors will develop bonds with the students and provide
future mentorship as the role evolves. Once the university agrees to proceed with this program
the next step in this process is to design the course syllabus with the entire curriculum team. It is
suggested that the course syllabus include all the essentail curriculum elements of the CNL.

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Students will be eligible to take the CNL certification exam at the conclusion of the program if
the capstone, clinical immersion, and core curriculum competencies have been met.
Curriculum design
Curriculum design was developed using the AACN Curriculum framework (AACN, 2006a) .
The goal was to develop a curriculum model which fits the current part time nursing on site
program at the University affliated healthcare center. The reasons to pilot the CNL at a work site
are (a) employer tuition plan, (b) convenient location for partners, (c) convenient class hours for
employees, and (d) ability to transition into existing curriculum. The length of the program
would be sequential part-time study for two years. The GRE would be exempt as in the existing
work site program. This program would provide 30 nursing credits.
The curriculum is designed for students to sequentially complete the courses. A CNL course
is offered every semester with the exception of the Spring semesters. Threading CNL concepts
thoughout each course is suggested to provide opportunities to embrace this role. The practice
immersion and capstone will include seminar face to face meetings throughout these semesters.
Opportunities to prepare for the CNL exam will be interwoven into the courses. The informatics
course is ideal for providing an opportunity to practice the CNL simulation style exam on line.
Threading exams similar to the CNL certification exam throughout this program will help
students to succeed in passing this test.

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Curriculum Sample
Fall # 1 NUR 645 (MSN) CNL Core # 1 Introduction to the role & core competencies
*NUR 644 (MSN) Leadership and Professional Development in Nursing
Spring # 1 *NUR 608 (MSN) Concepts for Advanced Practice for the CNL
*NUR 630 (MSN) Research Methods & Evidenced-based Practice
Summer #1 NUR 650 (MSN) Capstone with seminar (100 hours)
Fall # 2 *NUR 612 (MSN) Physiology/Pathophysicology for Advanced Practice
NUR 646 (MSN) CNL Core # 2 Informatics, Global & Health Disparities
Spring # 2 *NUR 613 (MSN) Advanced Health Assessment
NUR 647 (MSN) Healthcare systems Finance, Economics, and Politics
Summer# 2 NUR 649 (MSN) Clinical Immersion with Seminar (300 hours)
*Core courses required for the Masters Education program
Development of a work site CNL program
Developing a work site CNL program requires commitment from the practicing partners to
provide classroom space, job creation, and students. The worksite setting will require
technology to support class lectures as well as possible IT support if equipment malfunctions. In

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addition University faculty must be flexible to teach courses outside of the university setting and
at flexible times. The advantages for a work site CNL program are numerous as this degree is
based on the premise that practice partners benefit with improved patient outcomes, cost savings,
and employee satisfaction. The worksite environment offers opportunities for the partners to
contribute to the educational program tailoring it to address individual institutional needs. The
geographical location for this University work site nursing program provides opportunities to
recruit students from several major healthcare institutions. The university is affiliated with
several of these institutions which can potentially lead to new practice partners. A major benefit
to the work site program is student networking and brainstorming which undoubtedly will
improve patient outcomes. The CNL can lead the way to create a professional nursing think tank
for the practice partner.
Drawbacks
A work site setting may be difficult to attend for students who live and work outside of the
practicing partners’ geographical area. Students may miss out on the university campus
experience. The practicing partner will be expected to offer job placement at the completion of
this program which may cause shifts in staffing. The work site partner may wish to pilot the
program before they officially make a decision to adopt it thus not making a full commitment.
Changes in administration can affect the commitment to this new role. Will the new
administration share the enthusiasm for this clinical practice model? The class size will require at
least twelve to fifteen students per cohort to demonstrate cost effectiveness. Can this particular
work setting accommodate all of these students into CNL positions after graduation? Gabuat,
Hilton, Kinnaird, and Sherman (2008) reported “Designing the curriculum was not as
challenging as planning for the incorporation of a new role into the practice setting” (p. 303). It

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is after graduation that many challenges may arise as students establish this new nursing role.
Additional faculty time and resources are needed to guide the practice partner and students as
they move forward with this initiative.
Challenges for the CNL
As a Clinical nurse leader I have experienced firsthand the challenges faced with introducing
this new role into the healthcare community. In my university setting and amongst my colleagues
the clinical nurse leader was a foreign concept. In my attempts to advocate and describe this role
I was met with opposition. Pioneering the CNL role is challenging at my work site because I am
the only clinical nurse leader. I am not currently working as a CNL in my facility because this
job description does not exist. Creating a new nursing job description for students is essential to
the success of this new role. Healthcare systems facing financial constraints may be reluctant to
add another nursing role. Goudreau (2008) raises strong concerns that CNLs too could be
considered at risk for extinction when fiscal solvency threatens the healthcare institution. Nurses
have been historically oppressed as a professional group (Roberts, 2006). Are healthcare
institutions ready for empowered professional nurse leaders? Roberts (2006) found that
“Freedom comes from rejecting the negative images of one’s own culture and replacing it with a
sense of pride in the group’s characteristics and abilities” (p. 24). The CNL is challenged to be
the change to lead nursing out of oppression.
Conclusion
The Clinical nurse leader partnership provides a clinical ladder for nurses who desire to
remain at the point of care. The CNL benefits all partners as it provides a model for excellence
in patient care. The CNL role is designed to meet current and future health care challenges.

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The AACN offers guidelines, education and support for partners who pilot this new nursing
position. Joint commission and other regulatory agencies have a vested interest in this role as it
promotes safe practice. The CNL is a nurse generalist who can adapt to any clinical setting. The
CNL is complementary to other nursing roles and supports interdisciplinary teamwork. A work
site designed currriculum will benefit the student, university and practice partner.
The university and health care partner mutually contribute to the education of the CNL
student. The work site program offers value to both education and institution as they work
together to meet the demands of a rapidly changing fragmented health care system. Nursing
excellence, creative solutions, safe patient care, cohesive interdisciplianary teams and
empowerment will result. Most importantly CNL leaders redirect nursing focus back to the
patient, family, community, and health care system. The CNL practices the art of nursing whilst
demonstrating core nursing values at the point of care. Caring empowered nurse leaders can help
the nursing profession advance into the 21st century.

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References
American Association of Colleges of Nursing (AACN). (2006a). Update on the Clinical Nurse
Leader. PowerPoint presented at the AACN Spring Annual Meeting, March 2006,
Washington, DC. Retrieved from http://www.aacn.nche.edu/CNL/tkmats.htm
American Association of Colleges of Nursing (AACN), (2006b). Preparing graduates for
practice as a Clinical Nurse Leader draft curriculum framework. Retrieved from
http://www.aacn.nche.edu/CNL/pdf/currlefrmwk.pdf
American Association of Colleges of Nursing (AACN). (2007). White paper on the education
and role of the Clinical Nurse Leader. Retrieved from
http://www.aacn.nche.edu/Publications/Whitepapers/CNL2-07.pdf
American Association of Colleges of Nursing Clinical Nurse Leader Tool Kit Retrieved from
http://www.aacn.nche.edu/CNL/tkmats.htm
Gabuat, J., Hilton, N., Kinnaird, L. S., & Sherman, R. O. (2008). Implementing the clinical
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302-307.

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Goudreau, K. A. (2008). Confusion, concern, or complimentary function: The overlapping roles
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Harris, J. L., & Roussel, L. (2010). Initiating and sustaining the clinical nurse leader role, A
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