Leading Initiatives

Brief History of the CNL

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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