Editorial


 7

Editorial 
 

WINDS OF CHANGE IN NURSING EDUCATION 
 

Marietta Stanton 
 Editorial Board Member 

 
 

I wanted to highlight changes that are occurring in nursing especially with regard to 
nursing education. One initiative which is gathering much support and adoption is a role 
proposed by the American Association of Colleges of Nursing (AACN). It is called the 
Clinical Nurse Leader (CNL). According to AACN, the role has been created in response to 
the Institute of Medicine’s 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 addition AACN perceived that in nursing we have not succeeded in 
differentiating practice of RNs with different educational preparation. Numerous reports have 
shown that care provided to patient is not high quality. In addition AACN believes that the 
knowledge base for nurses has increased dramatically. Based on these three complex issues 
this new role was created. AACN appointed a task force to examine new educational models 
that would develop a “New Nurse” graduate, educated beyond a four year baccalaureate 
program with a new license and a new license and scope of practice. 

In concept the CNL oversees the care coordination of a distinct group of patients and 
actively provides direct patient care in complex situations. This master’s degree prepared 
generalist clinician will put evidenced based practice into action to ensure that patients benefit 
from innovation in care delivery. The CNL will evaluate patient outcomes, assess cohort risk 
and has the decision making authority to change plans of care when necessary. The role will 
vary across settings and facilities. To support the creation of this new nursing role, AACN has 
launched a national project involving almost 90 education-practice partnerships in 35 states 
and Puerto Rico. Educational and service partners are working together to develop master’s 
programs to prepare CNL’s, integrate this nurse into the health care system and evaluate 
outcomes. Nurses from within the partner agency attend the program full-time and return 
there for an intense clinical experience during the program. This program has been 
implemented in many nursing schools across the country. 

In addition to the CNL role, the AACN Educational Task Force has also called for a 
transformational change in the education required for professional nurses who practice at the 
most advanced levels of nursing practice. This new degree program will be the Doctorate of 
Nursing Practice (DNP). In essence these DNP programs will be the preparation for nurse 
practitioners, clinical specialists, nurse anesthetists, and midwives as well as nurse executives 
in the future. This transformation is supposed to occur in and around 2015. However, there 
are some schools that have already implemented a program preparing for this role. Although 
there has been much discussion about both roles and the changes in educational preparation, it 
does not appear to be a “what if” situation but more a “when “question. This truly has 
implications for all nurses but especially those nurses who work in rural areas. Access to 
quality educational preparation will truly be an issue. After attending the regional meeting on 
the DNP hosted by AACN, it became very apparent that many in our ranks are not aware of 
this paradigm shift in nursing education. For additional information on the CNL and DNP 
roles visit http://www.aacn.nche.edu.  

 Online Journal of Rural Nursing and Health Care, vol. 5, no. 2, Fall 2005
 

http://www.aacn.nche.edu/