As the health care landscape in America has changed, so has the role of nurses. While the primary function will always be to provide care to patients, nurses have also become a vital part of the health care delivery system.

As the providers who often have the most direct interaction with patients and families, nurses play an important in the coordination of care to ensure health care quality and positive outcomes across the spectrum of care, according to a statement by the American Nurses Association. In other words, nurses aren’t just taking temperatures and emptying bed pans, but are active participants in the diagnosis, treatment, and rehabilitation of their patients.

The growing reliance on nurses in the continuum of care means that more nurses are taking on leadership roles in health care settings. Thanks to the training they receive in advanced study programs, nurses are becoming managers, educators, and directors and playing a bigger role in both the development of heath care policy and oversight of care delivery.

However, because there is a variety of leadership roles open to nurses, there is often confusion as to what the individual titles actually mean. Case in point? Many people do not know the difference between nurse managers and clinical nurse leaders or managers. While the titles may sound similar, these two jobs are actually quite different.

Different Types of Leadership

According to the American Association of College of Nursing, there is some overlap in the responsibilities and priorities of nurse managers and clinical nurse leaders. Both roles are devoted to making decisions and developing plans to improve the overall patient care in specific health care settings. However, how each leader contributes to those processes varies.

Nurse managers tend to be administratively focused. This means that they handle human resources issues in their unit, including the hiring, firing, and training of staff, as well as schedule staff, keep staff up to date on policy changes, maintain departmental budgets, and ensure that equipment is available and in good working order. They might help staff with direct patient care when necessary, but usually their role is a consulting or supervisory one.

Clinical nurse leaders (CNL), on the other hand, oversee the entire care process for a specific group of patients. They work with other providers, including doctors, advanced nurse practitioners, pharmacists, nursing staff, and social workers to integrate all aspects of care, and ensure that patients receive the best care possible. While CNLs work at the point of care (meaning in a hospital, long-term care facility, or other setting) they don’t necessarily provide direct patient care.

Instead, CNLs work with the patient’s care team to develop a treatment plan, evaluate treatment results, (and recommend changes when necessary) and oversee the entire care process. They also provide education and support to other caregivers, and serve as a resource to those who have specific questions regarding the care of patients in the CNLs assigned cohort.

CNLs aren’t directly involved in the day-to-day operations of the unit or floor in terms of staffing and scheduling, but they are instrumental in the evaluation and development of policies and protocols. They not only identify the need for new policies and practices — and evaluate or initiate research when necessary — but also assist with the implementation of these new policies. Nurse managers also play a role in new policies and practices, primarily by educating employees about them and ensuring that staff has the tools and training needed to put them to work, but aren’t as closely involved in the actual development or research of those practices.

Paths to Leadership

Becoming either a nurse manager or a clinical nurse leader requires advanced education. While it’s often preferred that nurse managers hold a master’s degree, many nurses are promoted into the role with just a BSN.

Becoming a clinical nurse leader, however, requires a minimum of a Master’s in Nursing, preferably with a specialization in clinical nurse leadership or specifically related coursework. In addition, prospective CNLs must pass the Clinical Nurse Leader certification exam, which is only available to licensed nurses who have at least a master’s degree.

The role of CNL was developed in response to calls to improve the quality of the health care system and to better prepare nurses for the rigors of today’s health care landscape. It recognizes nurses’ important contributions to health care — and helps ensure that all patients receive the best possible care.