Clinical Nurse LeaderSM
Guiding Principles for the Partnership Model
June 2004
Role
The Clinical Nurse Leader oversees the clinical plans of unit-based clients to improve care and
reduce cost. This responsibility includes improving clinical or client outcomes and enhancing
nursing practice through the identification and application of evidence effective care to clients
and families. The Clinical Nurse Leader is accountable for a defined group of patients within a
clinical unit. The CNL is a formal leader and provides horizontal leadership to foster lateral
integration of care.
The highly effective CNL possess the expertise to be an exemplary nurse leader in the provision
of nursing care to groups of patients. He/she maintains a comprehensive understanding of
patient situations with the ability to access appropriate resources to obtain additional theoretical
or technical information as needed. The CNL knows how to complete or supervise treatment
modalities including pharmacological management. Knowledge of agency standards,
professional issues and health care policy enables the CNL to make decisions that are congruent
with professional concerns. Most importantly, he/she knows that her role is one of facilitating
and assuring quality patient care. Through role modeling, coaching and demonstration, the
highly effective CNL promotes health and reduces illness for a specified group of clients while
fostering the learning of nurses and other health care providers.
Thus the CNL
 Leads individualized, evidence-based, highly effective care to patients and families
 Creates an environment of clinical excellence that results in improved individual and
group clinical outcomes on an identified care unit (e.g. hospital unit, public health track,
school, occupational setting, etc.)
 Has clinical responsibility and authority for decision-making regarding patient care
 Engages in peer practice with other health professionals for coordination/collaboration of
the total care dynamic
The CNL has accountability for the identification and improvement of outcomes for practice
unit-based clinical populations, e.g. patient categories (persons with COPD, diabetes, etc.),
developmental groups (newborns, aging populations), or whole communities.
The CNL participates in making patient assignments, develops nursing orders and participates
with peer partners in the overall plan of care for groups of clients on a unit. Given his/her
knowledge and clinical competency, the CNL engages in autonomous and accountable evidence
based practice to make critical decisions about the care of patients. The CNL asks pertinent
questions, completes assessments and uses critical thinking to ascertain patient priorities. He/she
delegates care effectively and helps other nurses and health care providers to integrate essential
information so they can prioritize and provide care to maximize outcomes.
AACN Guiding Principles for the Partnership Model, June 2004
The CNL provides clinical leadership within the unit by developing and guiding a clinical team,
e.g. promotion of professional development, assurance of continuing education,
acknowledgement of clinical excellence and collegiality.
 Assumes leadership in self-governance activities
 Assumes leadership in unit-based planning
 Engages staff in review of cost data and implementation strategies to improve costeffectiveness and reduce inefficiencies, including product-testing
This CNL possesses effective communication skills needed to educate and interact with patients,
nurses, and other members of the health care team. The CNL garners respect from others as
he/she oversees care provided to groups of patients and collaborates in orchestrating
multidisciplinary interventions. In all clinical situations she brings the necessary skills for
reporting and documenting patient care, thus she can appropriately assist nurses in thorough
follow-through with this responsibility. To accomplish this function, the CNL must:
 Delegate, educate, and guide staff nurses and other assisting nursing personnel on the
clinical/care team
 Manage information and integrate it with clinical practice (collection and review of data)
 Review research and other forms of evidence regarding identified clinical problems
 Communicate research findings and other forms of evidence and assist clinical team to
incorporate this material in practice
 Review effectiveness of practice modifications in collaboration with clinical team
 Develop and review population-based care protocols, standards, and practice guidelines
The highly effective CNL is purposeful in behavior and positive in approach. The CNL’s self
confidence is evident in the organized and deliberate manner in which he/she implements her
nurse leader role. The CNL’s conversations, appearance and language illustrate a full integration
of professionalism.
Principles
• The CNL functions at the microsystems level, integrating the environment to the system
as well as the individual patient-care level and thus requires leadership as well as clinical
skills. The CNL is accountable for the unit-level, as well as the individual client care
outcomes.
•
The CNL is not an add-on to the existing staff or care delivery structure but rather a
clinically integrating role that transforms existing structures to achieve patient-centered,
evidence-based, outcome -oriented nursing practice. The implementation of the CNL
within a new practice delivery model should generate a value- added dimension with
higher clinical quality outcomes and cost-savings for the organization.
•
The CNL is a distinct career trajectory in nursing that requires master’s level education
and credentialing.
AACN Guiding Principles for the Partnership Model, June 2004
•
The CNL should be a salaried professional with accountability for unit-based clinical
excellence.
•
Practice model development should take into account patient safety and achieve the six
areas of IOM’s recommendations, i.e., safe, effective, patient centered, timely, efficient,
and equitable patient care.
•
The CNL will function as a lateral integrator facilitating continuity of care and
relationship based practice.
•
The CNL will have clear responsibility and authority for decision making regarding
designing and directing patient care.
Annual Outcomes Portfolio of the Clinical Nurse Leader
The development of an Annual Outcomes Portfolio is strongly recommended for each CNL as a
means of evaluating and documenting effectiveness and outcomes of practice.
How do you know the CNL is doing a good job?
The Clinical Nurse Leader should be evaluated using and Annual Professional Outcomes
Portfolio that includes evidence of:
1. Improved clinical outcomes such as:
 Patient/client satisfaction
 Interdisciplinary team satisfaction
 Identified goal measures, e.g. reduction in falls and infections, reduction in
recidivism, improved education of family members, worker absenteeism, outreach
improvements, clinic attendance etc.
2. The degree to which waste in the system was identified and addressed
3. The creation of well-functioning clinical teams such as:
 Knowledge of staff members re; unit-based technology and pharmaceuticals
 Well coordinated rescue events
 Reduction in absenteeism, improve retention, and professional
 development
4. The extent to which new evidence has been incorporated into practice
 Grand rounds
 Case presentations
 Clinical/Care team studies and publications
5. The degree to which clinical/health problems have been addressed and resolved
6. The extent to which leadership has been demonstrated
 Service on practice and governance committees
 Contributed to strategic goals
 Increased knowledge and skills
 Evaluated knowledge of clinical team and incorporation into practice
 Mentored new or student CNLs
AACN Guiding Principles for the Partnership Model, June 2004
7. Professional development and continuing education
8. Knowledgeable about and participates in developing and implementing corporate or
institutional philosophy, goals, strategies, results
AACN Guiding Principles for the Partnership Model, June 2004