History of the CNL

Remarks Delivered by AACN President Kathleen Ann Long at the Business Meeting on Monday, October 27, 2003

I. Brief History

In 1999, nurse educators were faced with the fifth consecutive year of declining enrollments in baccalaureate nursing programs. At the same time, the Institute of Medicine released its landmark report, To Err is Human: Building a Safer Health System, which called on health care systems to reorient their efforts to reduce medical errors and improve patient safety. In this climate, the AACN Board of Directors identified some primary concerns related to care delivery.

Board of Directors Concerns

  • In general, we have not succeeded in differentiating practice of RNs with different educational preparation.
  • In general, numerous reports have shown that care provided to patients is not high quality (series of reports, IOM, AHA, JCAHO, RWJ and our own experiences as patients or family members of patients). Every general trend has exceptions and, in some places, excellent patient care is available.
  • The knowledge base for nurses has increased dramatically (e.g., genetics, pharmacology) and delivery system is much more complex.

Based on these 3 complex issues, the AACN Board of Directors was compelled to take action and formed the Task Force on Education and Regulation for Professional Nursing Practice #1 (TFER #1).

Task Force on Education and Regulation for Professional Nursing Practice #1 - Seeking Answers

  • The task force developed new educational models, including a "New Nurse" graduate, educated beyond a 4-year baccalaureate program, with a new license and legal scope of practice.
  • After consultation with nurse executives, regulators and others, TFER #1 determined that a new role was needed in order to differentiate scope of practice and create a new license.
  • NCSBN declined to create a separate license for associate and baccalaureate degree graduates since entry-level roles are not well differentiated across the board.

Task Force on Education and Regulation for Professional Nursing Practice #2 - Moving Forward

In July 2002, the AACN Board created the TFER #2 task force to continue the work begun by TFER #1.

  • TFER #2 members focused on what nurse competencies are needed in current and future health care system to improve patient care.
  • The task force examined what the "New Nurse" role might look like. This work resulted in the publication of the draft white paper on The Role of the Clinical Nurse Leader in May 2003.
  • Representatives from education and practice were invited to participate in a discussion of the new nursing role at AACN's Fall Semiannual Meeting in October 2003 and at other stakeholder meetings.

II. Follow-up Activities from the October 2003 Meeting

The AACN Board of Directors appreciates the valuable input received at the October 2003 pre-conference and will use this information as it takes these next steps:

  1. Transcribe meeting tapes and summarize notes.
  2. Locate an external reviewer to help identify themes and conclusions from the meeting (a report will go to all members).
  3. Develop one-page talking points papers on key issues such as licensure and the fit of new education approaches with existing ones (e.g., fit with practice doctorate).
  4. Seek external funding to support pilot projects for schools and practice partners that wish to participate in new models.
  5. Move forward with developing 1, 2 or maybe 3 education models partnered with practice (participants in October 2003 meeting were asked to indicate their preferred model).
  6. Be sure that evaluation of patient outcomes is built into each model.
  7. Encourage the placement of articles in the Journal of Professional Nursing which explore issues related to the new nurse and foster regional forums to engage and inform more nurses, nurse administrators and educators in the process.
  8. Plan a follow-up conference in March 2004 with clear direction for the roll out of the pilot programs.

We hope that many schools and practice settings eager to move forward will wait until March 2004 or be willing to adapt their approach to one of the models that is adopted at that time. This will allow for adequate evaluation of new education and practice approaches and avoid the "N of 1" phenomena.

Last Updated February 2008

Program History

  • As healthcare evolves and changes, there is a need for master’s prepared nurses (certified Clinical Nurse Leaders) to focus on safety and quality of service.
  • The need for the Clinical Nurse Leader skillset was confirmed through discussions between the American Association of Colleges of Nursing (AACN), nurse executives, and other healthcare leaders. In addition, reports released by the Institute of Medicine, the Robert Wood Johnson Foundation, and the American Hospital Association all cited the need to make
    changes in health care delivery and the education of health professionals to improve patient outcomes.
  • In 2007, the AACN Board of Directors created the Commission on Nurse Certification (CNC). CNC is an autonomous certifying body of AACN to oversee the policies and procedures for the CNL Certification Program.
  • More than 5,500 nurses are now CNL-certified. CNC’s CNL Certification Program is accredited by the National Commission for Certifying Agencies.

Introducing the Certified Clinical Nurse Leader

Fundamental aspects of CNL practice include:

  • Clinical leadership for patient-care practices and delivery, including the design, coordination, and evaluation of care for individuals, families, groups, and populations.
  • Participation in identification and collection of care outcomes.
  • Accountability for evaluation and improvement of point-of-care outcomes, including the synthesis of data and other evidence to evaluate and achieve optimal outcomes.
  • Risk anticipation for individuals and cohorts of patients.
  • Lateral integration of care for individuals and cohorts of patients.
  • Design and implementation of evidence-based practice(s).
  • Team leadership, management and collaboration with other health professional team members.
  • Information management or the use of information systems and technologies to improve healthcare outcomes.
  • Stewardship and leveraging of human, environmental, and material resources.
  • Advocacy for patients, communities, and the health professional team.

CNL Education and Integration into the Health System

  • The CNL skillset is currently being implemented through education and practice partnerships involving more than 190 practice settings and over 130 nursing schools. AACN is inviting new schools and practice sites to join this national effort and further engage the CNL in healthcare delivery.
  • Currently, more than 90 master’s degree programs are available at schools of nursing to prepare Clinical Nurse Leaders.
  • More than 100 education-practice partnerships are active around the country integrating the CNL into a variety of practice settings.
  • CNL preparation includes the core graduate education (clinical assessment, pathophysiology, pharmacology and research), data management, project management, disease management, implementation of EBP, clinical leadership, inter-professional communication, and care coordination.
  • The Veterans Health Administration, the nation’s largest employer of RNs, has embraced the CNL and has introduced it into many VA hospitals nationwide.

The Impact of CNLs in the Practice Setting

  • Practice settings utilizing CNLs have reported the following:
    • CNLs are quickly making significant progress on raising patient, nurse, and physician satisfaction; improving care outcomes; and realizing sizable cost-savings.
    • CNLs elevate the level of practice for all nurses on the unit by promoting critical thinking and innovation in nursing care. CNLs empower other nurses to ask questions and seek the best solutions possible.
    • CNLs are essential to decreasing fragmented care and are prized for their expertise in enhancing communication, improving care hand-offs, and laterally integrating care.
    • CNLs constructively manage change and promote a team-based approach to care.
    • The CNL looks at the bigger picture, including outcomes and patient satisfaction, when considering next steps, needed changes, and improvements to the setting.
  • Findings from the Robert Wood Johnson Foundation Innovative Care Delivery Model Study include the following points about the impact of CNLs in practice:
    • CNLs act as the "red thread" for the patient, arranging and coordinating complex care needs for patients and families. They truly are information-flow managers.
    • CNLs serve as a clinical resource and connection point to interlink patient safety and unit strategic goals into practice.
    • The CNL serves as a patient and family advocate by involving them through interdisciplinary rounds/approach. They ensure that patients and families are informed of all diagnostic procedures, medical consultation, and available
      resources. CNLs bridge the communication gap between all health service providers, which permits a seamless transition through the healthcare continuum.
    • CNLs collaborate with the direct care providers to ensure a safe environment for patients where needs are prioritized and individualized, and evidence based nursing is utilized. They also serve as mentor, coach, educator, and resource to all direct care providers to assist them in providing care to complex patients.

CNL Talking Points - Published Outcomes of the Clinical Nurse Leader

March 2017
March 17, 2017 has been designated as Certified CNL Day (due to March 19th falling on a Sunday).

February 2017
2017 CNL Research Symposium, CNL Summit and Master’s Education Conference held February 22-25, 2017 in Atlanta, GA.

January 2017
CNC celebrates 10 years of offering the CNL Certification ExaminationSM and also the establishment of the Commission on Nurse Certification. New CNC logo unveiled.

CNC launches www.discoverCNLs.org as a site geared to Nurse Executives and Healthcare Facilities to learn about the value of the certified Clinical Nurse LeaderSM.

2017 CNL Visionary Leader, CNL Vanguard Award and CNL Educator Vanguard Award winners announced.

December 2016
The Item Writers Committee begins reviewing exam items and writing new items for the new CNL Certification ExaminationSM.

November 2016
CNC released the updated CNL Exam Blueprint/CNL Exam Content Outline to be used on exams administered beginning April 2017.

May 2016
The CNL Job Analysis Survey is released to all CNC constituents.

April 2016
CNC along with Schroeder Measurement Technologies, Inc. begin the CNL Job Analysis process April 11-12, 2016 in Clearwater, Florida. The CNCBOC approved 12 CNLs as members of the Job Analysis Committee. A new CNL exam based on the updated Exam Content Outline will be administered in Spring 2017.

March 2016
March 19, 2016 has been designated as Certified CNL Day.

January 2016
2016 CNL Research Symposium and CNL Summit held January 14-16, 2016 in Long Beach, CA.

July 2015
Yenny Caceres hired as CNC’s new Certification Coordinator.

March 2015
Healthcare providers from Kyoto University in Japan (in collaboration with Saint Anthony Medical Center in Rockford, IL) visit Mercy Health Saint Mary's to learn about the CNL skillset. Drs. Dana Dermody, Asako Katsumata of Saint Anthony Medical Center and Kazuko Nin have been instrumental in developing this initiative http://withinsaintmarys.com/international-health-careproviders-learn-about-integrated-cnl-role/.

March 2015
March 19, 2015 has been designated as Certified CNL Day. Certified CNL Day spreads awareness to recognize our certified Clinical Nurse Leaders and provide employers with an opportunity to extend their appreciation to their certified CNL staff.

January 2015
2015 CNL Research Symposium and CNL Summit held January 22-24, 2015 in Orlando, FL.

October 2014
Shantal Hall hired as CNC’s new Certification Director.

April 2014
AACN’s online CNL Certification Exam Review Course made available. Developed by practicingCNLs and academicians, the course is offered in 12 modules and may be used by individuals preparing for CNL certification or by other healthcare professionals seeking contact hours.

March 2014
March 19, 2014 has been designated as Certified CNL Day.

CNC is on the list of certifying organizations promoting the Certified Nurses Are Everywhere PSA National Campaign http://certifiednurses.org/.

January 2014
CNL Certification Program is accredited by the National Commission for Certifying Agencies.

CNC launched the Clinical Nurse Leader Channel on YouTube www.youtube.com/clinicalnurseleader.

April 2012
The revised multiple choice CNL certification exam based upon the CNL job analysis study launched.

January 2012
CNC in conjunction with the Clinical Nurse Leader Association offered the first CNL Research Symposium.

October 2011
AACN website updated to include all CNL certification and CNL implementation resources.

September 2011
The CNL Community, an online discussion board for CNL students, CNL graduates, and practicing CNLs, is launched and hosted by CNC and AACN. 

August 2011
The CNL job analysis study is completed by Schroeder Measurement Technologies, Inc. and CNC’s Job Analysis Committee.

April 2011
CNC’s new testing vendor, Schroeder Measurement Technologies, Inc., administers certification exam.

December 2010
CNC launches online discussion board for CNL faculty and education partners on http://www.nurseslounge.com/lounges/profile/16380/clinical-nurse-leader.

December 2009
CNC launched the CNL Wall of Fame and the CNL Job Bank.

September 2009
CNC launched the CNL Self-Assessment Exam.

May 2009
CNC adopted first strategic plan (FY2010-2013).

January 2009
Recertification guidelines and application made available online.

December 2008
New certification exam administered.

October 2008
CNC Board of Commissioners agreed to extend faculty eligibility waiver to December 31, 2012.

May 2008
CNL Directory made available online.

March 2008
AACN Board of Directors approved Memorandum of Understanding with CNC.

January 2008
CNC Board of Commissioners adopted CNC Bylaws. Online application launched. CNL lapel pin available (other merchandise followed to create an online store). CNL certification presence established on AACN website.

December 2007
Eligibility waiver for individuals functioning in CNL expired; waiver for faculty continued.

October 2007
AACN Board of Directors approved changing CNL Certification Advisory Board to CNC and CNC Board of Commissioners. First CNC Board of Commissioners’ officers elected. CNC Board of Commissioners approved and adopted CNL Standards of Conduct. First issue of The CNL Bulletin, an online newsletter of the AACN and CNC. CNC logo approved by CNC Board of

September 2007
First meeting of CNL Certification Advisory Board (via conference call). CNL Certification Advisory Board approved of the name change to Commission on Nurse Certification (CNC) and representatives serving as Board of Commissioners. AACN and CNC adopted CNL logo.

August 2007
“CNL” became a registered trademark of AACN.

July 2007
AACN Board of Directors approved CNL Certification Advisory Board composition and first appointments.

AACN’s Board of Directors approved the revised white paper on The Education and Role of the Clinical Nurse Leader.

May 2007
Tracy Lofty, MSA, CAE hired as Certification Director.

April 2007
CNL Certification Exam officially launched.

March 2007
AACN appointed CNL Steering Committee charged with advancing the CNL skillset and measuring the CNL’s impact on patient care outcomes.

November 2006/January 2007
Certification exam was piloted. The pilot CNL Certification Examination was administered between November 27, 2006 and January 17, 2007. One hundred twenty-three individuals at twelve schools sat for the examination.

Passing cut score adjusted by Exam Committee in conjunction with Applied Measurement Professionals, Inc. based upon the pilot exam scores.

November 2006
AACN launched online CNL discussions groups for CNL partners and for CNL students.

August 2006
Exam Committee rated items using Angoff technique in collaboration with Applied Measurement Professionals, Inc.

June 2006
AACN contracted with Applied Measurement Professionals, Inc. for test development, effective April 2006.

March 2006
AACN Board of Directors approved initial budget for development of a computer-based exam.

June 2004
AACN’s ITF sponsored CNL Implementation Conference for nurse educators and practice partners committed to advancing the CNL initiative. At this meeting, education-practice models and curriculum were discussed and finalized and an implementation timeline was developed. Representatives from 79 schools of nursing and 136 practice organizations participated.

March 2004
AACN sent a Request for Proposal (RFP) to all AACN member schools to commit to the CNL initiative by developing a master’s-level CNL curriculum.

January 2004
AACN’s Implementation Task Force (ITF) is appointed to oversee development of CNL.

Special meeting of AACN Board of Directors was conducted. Motions passed by AACN Board of Directors included:

  • AACN Board of Directors accepting the draft white paper on The Role of the Clinical Nurse Leader, May 2003.
  • AACN continuing to provide leadership and invest resources in the creation and evaluation of a new model, or models, or 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 nurse professional for advanced generalist practice, as described in the CNL paper, who is prepared at the master’s level
  • The AACN Board approving models as a starting point for model development.
  • AACN assuming leadership and engaging appropriate stakeholders to ensure development of a new legal scope of practice and credential for the new nurse professional as described in the CNL working paper.

October 2003
Representatives from education and practice met to discuss the CNL’s impact on care delivery models and educational programs. The meeting was held prior to AACN’s Fall Semiannual Meeting.

AACN’s Implementation Task Force (ITF) is appointed to oversee development of CNL.

July 2002
AACN’s Board of Directors created TFERII to identify competencies needed to improve patient care outcomes.

AACN’s Board of Directors formed the Task Force on Education and Regulation for Professional Nursing Practice (TFER). TFER identified the need for a new nurse skillset.