Talking Points
AACN Board Decisions
Regarding the Clinical Nurse Leader Initiative
January
2004 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 of Directors
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
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 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 partnershipsregistered their interest
in piloting a CNL program.
Last
Update: July 9, 2004
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