CNL vs. CNS: What’s the Difference?

What is a CNL?

The American Association of Colleges of Nursing (AACN) created the CNL position to address the need to improve patient outcomes and increase the quality of care. CNLs tend to work in care coordination, transitions of care, risk assessment, and quality improvement.

What is a CNS?

CNSs are advanced practice registered nurses who typically hold leadership roles. Depending on the setting, they can diagnose, treat, and manage patient care. They also provide expertise and support to nurses caring for patients at the bedside, help implement practice changes throughout an organization, and ensure best practices and evidence-based care are used in patient care.

What Does a CNL Do?

As generalists, CNLs often work within a research capacity, following a cohort of patients while analyzing and implementing evidence-based best practices in the areas of quality, safety, risk assessment, and cost-efficiency.

CNLs can work with all patient populations within a variety of practice settings. Some CNLs operate under the title of nurse manager of a nursing unit. Overall, some of the major responsibilities of a CNL include the following:

• Design, implement, and evaluate the delivery of patient care plans
• Incorporate data from evaluations to update procedures and practices
• Collaborate with physicians and other providers to discuss and develop care plans for patients
• Incorporate information systems and technology to improve healthcare outcomes
• Anticipate and assess risks to patient care to ensure safety protocols are in place and effective

What Does a CNS Do?

The primary focus of a CNS is to improve the healthcare system from within the medical community. CNSs do this by making sure nurses can safely and efficiently take care of their patients. They evaluate programs and facilities to identify ways nurses can positively influence the delivery of care. Overall, some of the major responsibilities of a CNS include, but are not limited to, the following:

• Provide consultation services, monitor care, and evaluate general delivery of healthcare
• Optimize patient care by working directly with the nursing staff
• Evaluate procedures and review alternatives while educating staff on new practices
• Provide expertise and support to the nursing staff
• Educate patients and their families on the best ways to manage medical conditions

In some states, CNSs can practice and prescribe independently.

How to Become a CNL

Becoming a CNL begins with earning a BSN and obtaining an RN license. RNs must then enroll in an MSN program with a CNL specialization accredited by the AACN. Nurses with an associate degree in nursing (ADN) need to earn their BSN before enrolling in an MSN program, or complete an RN-to-MSN program for CNLs.

Upon completion of their graduate program, RNs must pass the certification exam offered by ACCN’s Commission on Nursing Certification to qualify for certification. The content of the exam focuses on clinical outcomes management, care environment management, and leadership. Once they have earned their certification, CNLs must renew their license every five years.

How to Become a CNS

To become a CNS, nurses must first become an RN through the completion of a BSN program. CNS programs are offered at the graduate level and require nurses with an ADN to earn their BSN before being accepted into a CNS program. Prospective CNS should also have at least 2 years of experience in their desired specialty to be eligible for most CNS programs.

Interested nurses should apply to programs accredited by the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN). Once in the program, nurses can choose from a variety of specialties including intensive care, acute care, medical-surgical, oncology, psychiatric and mental health, gerontology, or pediatrics.

Upon completing an MSN program and accumulating 500 faculty-supervised clinical hours, graduates are eligible to take the CNS certification exam administered by the ANCC. The content of the exam differs based upon the nurse’s chosen specialty. Once they have earned their certification, CNSs must renew their license every five years.

CNL Salary and Career Outlook

According to Payscale, an average annual CNL salary comes to $89,710 per year; however, base earnings can range between $69,000 and $118,000 depending on experience, practice setting, and location.

States such as New York, Texsas, and Massachusetts provide some of the highest-paying positions, while the need for CNLs in long-term care facilities and home health agencies also offer higher wages.

CNLs are currently in high demand, especially due to the increased dependency on data and the evolution of medical technology. While the Bureau of Labor and Statistics (BLS) does not track CNLs specifically, they project a 6% employment increase for RNs through 2032.

CNS Salary and Career Outlook

According to PayScale, the average yearly salary for a CNS is $100,392 with a base salary that can range from $73,000 to $130,000 depending on the nurse’s specialty. The top CNS specialties that net nurses some of the highest wages include working in intensive care, acute care, or medical-surgical care. Geographically, CNSs who work in larger cities tend to earn higher salaries than those in small communities.

As advanced practice registered nurses (APRNs), CNLs are generally in high demand. While the BLS does not track CNLs specifically, they project a 38% employment increase for APRNs through 2032.