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J Prof Nurs. 2014 Mar-Apr;30(2):110-23. doi: 10.1016/j.profnurs.2013.08.006.

The current evidence base for the clinical nurse leader: a narrative review of the literature.

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  • 1Lecturer, University of San Diego Hahn School of Nursing and Health Science, San Diego, CA; Outcomes Research Specialist, Outcomes Research Institute, Sharp Healthcare, San Diego, CA. Electronic address:


The clinical nurse leader (CNL) is a relatively new nursing role, introduced in 2003 through the American Association of Colleges of Nursing (AACN). A narrative review of the extant CNL literature was conducted with the aim of comprehensively summarizing the broad and methodologically diverse CNL evidence base. The review included 25 implementation reports, 1 CNL job analysis, 7 qualitative and/or survey studies, and 3 quantitative studies. All CNL implementation reports and studies described improved care quality outcomes after introduction of the role into a care delivery microsystem. Despite preliminary evidence supporting the CNL as an innovative new nursing role capable of consistently improving care quality wherever it is implemented, CNLs are still struggling to define the role to themselves and to the health care spectrum at large. Although the AACN CNL White Paper provides a concise model for CNL educational curriculum and end competencies, there is a compelling need for further research to substantively delineate the CNL role in practice, define care delivery structures and processes that influence CNL integration, and develop indicators capable of capturing CNL-specific contributions to improved care quality.

© 2014 Elsevier Inc. All rights reserved.


CNL; Clinical nurse leader; Review

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