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Office of Nursing Services (ONS)


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Clinical Nurse Leader (CNL)

VA cnl at patient bedside

The Clinical Nurse Leader (CNL) role is designed to deliver clinical leadership in all health care settings and to respond to individuals and families within a micro-system of care. As of December 2013, over 70 VA Medical Center (VAMC) sites are participating in the CNL Initiative. The CNL is expected to address and improve the following:

  • Cost/financial outcomes such as length of stay, patient flow, readmission rate and registered nurse (RN) turnover
  • Patient satisfaction, staff satisfaction and retention
  • Quality/internal process outcomes such as medication management, patient safety, and prevention of nosocomial infections
  • Practice Model Transformation such as evidence-based and collaborative, interdisciplinary practice
This initiative is targeted towards RNs who desire to stay at the point of care and practice in a generalist role with a broad scope of practice and more complex level of responsibility.


The Clinical Nurse Leader role was developed by the American Association of Colleges of Nursing (AACN) through collaboration between academic and practice leaders in response to quality and safety issues identified by The Institute of Medicine (IOM) reports in 2000. The role is designed to address gaps in care delivery related to the growing complexity and fragmentation of healthcare. The Clinical Nurse Leader helps nurses practice more effectively and efficiently.

Frequently Asked Questions about the CNL Role

What is a Clinical Nurse Leader (CNL)? Show content
A Clinical Nurse Leader is:
  • Master’s prepared generalist nurse from a Commission on Collegiate Nursing Education (CCNE) accredited CNL program of study
  • Certified as a CNL by the Commission on Nurse Certification (CNC)
  • Point of care clinical leader focused on the delivery of quality, safe, efficient, veteran-centered care
  • Prepared to practice in any clinical area
Visit the AACN CNL page for more info.

What is the focus of the CNL role? Show content
  • Point of care
  • Patient outcomes in assigned microsystem
  • Safety, effectiveness, timeliness, efficiency, quality, and the degree to which we are veteran centered
  • Variations in clinical outcomes
  • Critical evaluation and mitigation of risk
  • Patterns of need and tailoring of interventions

How does the CNL role add value? Show content
  • Role is incorporated into the care delivery model
  • Role imbeds advanced skillset in the microsystem at the point of care
  • Role assesses and addresses issues in real time and within context of microsystem reality
  • Role observes and evaluates patterns impacting practice and outcomes
  • Role partners with nurse manager
  • Role supports direct care staff directly
  • Role influences point of care and organizational culture

How do CNLs influence care for veterans? Show content
  • Facilitate evidence-based practice as a way of practice
  • Embed quality and safety as everyday functions
  • Promote practice and practice change driven by outcomes
  • Foster inter-professional team environments
  • Partner to create learning and problem solving communities

How is the CNL role different from other nursing roles? Show content

The Clinical Nurse Leader Spread Plan Initiative

In the summer of 2011, ONS set a strategic goal of implementing a CNL at all points of care throughout the VHA system by fiscal year 2016. The CNL spread plan was developed to achieve this strategic goal, comprised of a portfolio of multi-year activities spanning from fiscal year 2011 through 2016.
The CNL Spread Plan Objectives:
  • Overcome barriers to implement and sustain the CNL role
  • Employ and fully integrate the CNL role into the patient care model
  • Objectively embed quality, safety, and efficiency, into patient care delivery
  • Enhance collaborative partnerships with affiliating schools of nursing and inter-professional teams

Clinical Nurse Leader Field Advisory Committee (CNL FAC)

The Clinical Nurse Leader Field Advisory Committee was established September 2015 by the Office of Nursing Services to support the implementation and growth of the Clinical Nurse Leader role into all clinical areas of the VHA healthcare system. The CNL FAC serves in an advisory capacity to ONS on matters related to the CNL role while simultaneously representing ONS in the field. We support the CNL role by providing resources to enhance communication and practice, identify opportunities to strengthen knowledge about the role, and monitor the progress of role implementation and practice integration within the VHA.

Claire Gangware

Claire Gangware, MSN, RN, CNL, MSRN is the Clinical Nurse Advisor for the Office of Nursing Services. She is field based at Jesse Brown VA Medical Center in Chicago IL where she works on a 30 bed Medicine/Oncology/Remote Telemetry acute care unit. She has been a certified CNL since 2007. She co-chaired her facility’s Clinical Products Review Committee and the Nursing Research council, is a member of the Nursing Practice Council, the Falls Committee, Project Red, and the Facility Lean Steering Committee.

    Other members of the CNL Field Advisory Committee:
  • Linda Borns, Dayton OH, Medicine/Tele
  • Kathy Chapman, Portland OR, N.E., ad hoc
  • Sonya Curtis, North Texas, Mental Health
  • Kristin Drager, Madison WI, CLC
  • Katherine Grasham, Oklahoma, ICU
  • Sheena Hess,Topeka, KS, CLC/Hospice
  • Heather Silva, Reno, NV, ICU-Med/Surg
  • Nadine Terese, Leavenworth KS, Mental Health


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