Leadership can be described as the willingness to take responsibility to improve either processes or people, and leading in a healthcare environment is no different. While some textbooks and speakers will use the terms interchangeably, there are differences in role and focus between that of a Nurse Leader and a Clinical Nurse Leader. While both work with interprofessional care teams, the sphere of influence may differ between the two roles.

The title of Clinical Nurse Leader has gained recent press and popularity as certifications by accrediting agencies have been developed. For example, the American Association of Colleges of Nursing has created a certification for the Clinical Nurse Leader to address the critical needs of the patients at the bedside and to support nurses in important areas such as care coordination, patient transitions, risk assessment, and quality improvement. These master's prepared nurses are being infused into care delivery models to act as liaisons between the nurse, the patient, and the executive healthcare leadership team.

The role of the Clinical Nurse Leader (CNL) is designed to provide care and support across the continuum of healthcare and therefore not required to specialize. The CNL is not an advanced practice registered nurse, which differs from the role of the Clinical Nurse Specialist (CNS) yet similar in the requirement for formal education through accredited programs. The role of the CNL is found primarily in the acute-care hospital or inpatient settings.

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In contrast, the Nurse Leader (NL) is any nurse who assumes a leadership role, whether by formal (title) or informal means. Those serving as a formal NL are responsible for overseeing the development of the people, business and processes in their purview and can emerge at any level of nursing. For example, a nurse in charge of a small rural Indian Health clinic with an ADN is considered a Nurse Leader, as is the Chief Nursing Officer (CNO) of a 500-bed teaching hospital in Chicago, IL who has earned a DNP degree. To validate and lend credibility to nurse leaders, organizations such as the American Organization for Nursing Leadership have developed certifications for nurse leaders that require formal titles in order to sit for the exam.

An informal NL can be just as, or more, influential than those with the title of a leader based on their relationship with their peers. For example, a charismatic and seasoned nurse in the ICU who has the respect of physicians, administration, and their peers, yet chooses not to step into a titled leadership role for various reasons, is still a Nurse Leader. Some experts have even gone so far as to state that every nurse is a leader because of the nature of leading patients, families, and communities towards improved health and lifestyle.

The commonalities between the roles of the Clinical Nurse Leader and Nurse Leader are the principles that both leaders have a wide range of clinical environments across the continuum of healthcare, more so for the NL position. Both types of leaders have a comprehensive and holistic nursing model of care and respond to the healthcare needs of the patients, families, and communities they serve. Where the CNL focuses on the effects of individual care plans and the NL is responsible for the balance of the business of healthcare with the clinical operations, both roles are advocates for the quality and safety of the department or unit. Both are also responsible for mentoring new leaders and supporting the development and utilization of nursing research in clinical practice.

Nurses who influence those around them to improve processes or conditions are leaders within their own right. Pursuing formal training and certifications as a Clinical Nurse Leader or board-certified Nurse Leader gives validity to the work being performed. No matter the path, influencing others to improve healthcare is a worthy career goal.

Catherine Burger, RN, BS, MSOL, NEA-BC
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