CNL Talking Points

AACN Board Decisions Regarding the CNL Initiative

At a special meeting held January 14, 2004, the AACN Board of Directors made a number of significant policy decisions based on recommendations from the Task Force on Education and Regulation for Professional Nursing Practice 1 and 2 (TFER 1 and TFER2). These decisions are not to be considered in isolation but were made as a comprehensive review of the framing principles that will guide the association's work to assure the highest quality nursing workforce for our nation's health care needs. The board's actions relate to AACN's consensus-building initiative to create a new nursing professional called the Clinical Nurse Leader (CNL).

Motions Passed by the AACN Board

These motions were acted upon in the aggregate and should not be considered in isolation.

  • The AACN board of directors does not believe it is feasible and productive, at this point in time, to engage in efforts to differentiate the license for the current BSN and ADN graduates.
  • The AACN board does not believe that the set of expectations, as outlined in the report of TFER2, can be achieved in a four-year baccalaureate nursing experience.
  • The AACN board supports the continuation of baccalaureate nursing education, at a minimum, as the entry-level for the professional Registered Nurse.
  • The AACN board accepts the draft White Paper on the Role of the Clinical Nurse Leader, May 2003, as a working paper.
  • AACN will continue to provide leadership and invest resources in the creation and evaluation of a new model, or models, of nursing practice and nursing education at the master's degree in nursing level that results in a new nursing professional (CNL).
  • The model(s) to be created and evaluated will result in a new nursing professional for generalist practice, as described in the CNL paper, who is prepared at the master's level. 
  • The AACN board approved models as a starting point for model development.
  • AACN will assume leadership and engage appropriate stakeholders to ensure the development of a new legal scope of practice and credential for the new nursing professional as described in the CNL working paper.

Talking Points

The AACN board has determined that we will not commit resources to pursuing a separate license for baccalaureate-prepared nurses that would be distinct from the license currently shared by all entry-level registered nurses (BSN, ADN, diploma). AACN does recognize, however, that education makes a difference in nursing practice and patient outcomes and, we will continue to advocate for a more highly educated nursing workforce.

The board's decision regarding the educational preparation of nurses is consistent with AACN's position statement titled The Baccalaureate Degree in Nursing as Minimal Preparation for Professional Practice which was introduced in July 1996 and updated in December 2000. Though AACN recognizes that entry-level nurses will continue to be prepared at the diploma and associate degree levels, the organization supports the four-year baccalaureate degree as the minimum credential for professional nursing practice. AACN encourages differentiated nursing practice based on educational preparation and supports efforts to move ADN and diploma graduates into baccalaureate and graduate degree programs.

AACN's support for the baccalaureate preparation is consistent with the findings of the National Advisory Council on Nurse Education and Practice (NACNEP), policy advisors to Congress and the U.S. Secretary of Health and Human Services. NACNEP found that baccalaureate education with its broader and stronger scientific curriculum provides the best foundation for addressing today's complex health care needs. Outcomes research from Dr. Linda Aiken confirms that patient mortality rates are significantly improved when care is provided by health care teams with higher percentages of nurses prepared in baccalaureate and graduate degree programs. 

Nurse executives, the military, leading nursing organizations, health care foundations, Magnet Hospitals, minority nurse advocacy groups, and the US Department of Veterans Affairs, the nation's largest employer of registered nurses, all recognize the unique contributions that baccalaureate-prepared nurses make in the practice setting and their connection to safe patient care and improved patient outcomes. 

The AACN board confirmed its support for the creation of a new nurse role to enhance care delivery titled the Clinical Nurse Leader (CNL). The CNL is a generalist clinician with education at the master's degree level. This nurse leader must be prepared to bring a high level of clinical competence and knowledge to the point of care and to serve as a resource for the clinical nursing team.

The CNL is a generalist in contrast with the specialized focus of the practice by clinical nurse specialists and nurse practitioners. AACN is in discussion with the advanced practice community to clearly differentiate these nursing roles. 

The CNL oversees the care coordination of a distinct group of patients and actively provides direct patient care in complex situations. This clinician puts evidence-based practice into action to ensure that patients benefit from the latest innovations in care delivery. The CNL collects and evaluates patient outcomes, assesses cohort risk, and has the decision-making authority to change care plans when necessary. This clinician functions as part of an interdisciplinary team by communicating, planning, and implementing care directly with other health care professionals, including physicians, pharmacists, social workers, clinical nurse specialists and nurse practitioners. 

The development of the CNL is a collaborative process, and AACN will continue to work with and welcome input from the nursing community, stakeholder groups and leaders in the practice community.

A cooperative effort is necessary to ensure that the CNL is adequately prepared for practice and possesses a distinct legal scope of practice. AACN is in discussions with nursing leaders to create a separate credentialing process and is working with nurse executives and administrators to ensure congruence between educational preparation and practice roles.

Evaluating CNL outcomes is a critical component of this initiative. AACN is working with experts in outcomes measurement to build evaluation criteria into the education-practice models.

In June 2004, AACN convened a conference between nurse educators and practice partners committed to advancing the Clinical Nurse Leader initiative. At this meeting, education-practice models and curriculum were discussed and finalized and an implementation timeline was developed. A total of 77 education-practice partnerships registered their interest in piloting a CNL program. 

Last Updated: July 9, 2004