Possible new career options

Abstract

Nancy J. Girard, RN Last summer, I attended an invitational meeting in Washington, DC, sponsored by the American Association of Colleges of Nursing (AACN). The purpose of the conference was to hear a presentation and obtain buy-in for partnership pilot programs for the CNL. In addition, some information was shared on career progression from CNL to DNP. Representatives from 75 academic institutions attended along with representatives from their partner health care institutions. The concerns that prompted development of these new roles are similar to those identified by the recent AORN and National League for Nursing think tank.1 New types of nurses are needed in today's world. The nursing profession agrees that changing patient populations and treatment methodologies require new ways of practicing nursing and, therefore, new ways of educating nurses. The AACN recognizes that there is national concern about a decline in the quality of health care. Many of us can confirm these concerns with examples from our own experiences and those of our family members and friends. In addition to concerns about the quality of care, nursing has never come together to define the differences in practice between individuals with different educational preparation or agreed on one educational entry level for practice. To answer these concerns, an AACN task force proposed the new CNL master's level degree. This new practitioner will not be an advanced practitioner, and a new license and legal scope of practice will have to be defined for this role.2 More information about the CNL role can be found on AACN's web site at http://www.aacn/nche.edu. leads evidenced-based care for patients and families, creates an environment of clinical excellence, has clinical responsibility and authority for decision-making regarding patient care, and engages in peer practice with other health professionals.3 This may be an entry-level position, and the CNL will be a unit-based generalist. The CNL role will not include administrative or management duties. It will necessitate new definitions of practice and new legal requirements, such as licensure. There are many areas of the country where academic institutions already have implemented educational programs for CNLs. These include the University of Virginia, Charlottesville, Va; College of New Jersey, Ewing, NJ; Cleveland State University, Cleveland; University of Florida, Gainesville, Fla; University of San Francisco, San Francisco; and University of Iowa, Iowa City. Information about these and other programs can be found on the web sites of these organizations. Debate is growing about the CNL role.4 Some organizations support the concept and others adamantly oppose it. One organization that supports the CNL role is the American Organization of Nurse Executives (AONE). The organization published guidelines with principles for patient care in spring 2004 that are similar to those defining the role of the CNL.5 The National Association of Clinical Nurse Specialists (NACNS) has published a strong position statement against the CNL role. They state in part that “the proposed competencies of the new nurse duplicate the competencies of the CNS.”6 The DNP is a practice doctorate rather than a research doctorate.7 The research PhD is considered the “gold standard” of doctoral education. Most national and international organizations recognize this degree and accept it. Other less recognizable doctoral degrees are EdD (ie, doctorate in education), DNS (ie, doctorate in nursing science), and ND (ie, nursing doctorate). The DNP would replace the ND as a practice doctorate. The National Organization of Nurse Practitioner Faculties (NONPF) provides information on the practice doctorate resource center web site at http://www.nonpf.com/cdhome.htm.8 including but not limited to the four current [advanced practice nurse] roles: clinical nurse specialist, nurse anesthetist, nurse midwife, and nurse practitioner by 2015.9 Will all staff nurses in the future be required to have a CNL? Will all advance practitioners be required to have a DNP in the future? Will the new roles improve the quality of nursing care? What type of certification and licensure will be required? How will these roles affect third-party reimbursement for advanced and expanded practitioners? How will perioperative nursing be affected by these new roles? Will these new roles really be the answer to our problems today? Nurses should be prepared to discuss these new roles and be knowledgeable about what could happen with their careers and professional advancement. At the present time, I would advise you all to stay tuned, stay informed, and stay involved.