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They're nurses, educators, strategists and excellent communicators who can bridge gaps, break down barriers and get things done.

They're clinical nurse leaders (CNL).

This emerging nursing role is catching on in healthcare settings ranging from acute care hospitals to nursing homes, rehab centers and even school health systems.

"In general, CNLs provide clinical oversight for a group of patients in a particular setting," says Joan M. Stanley, PhD, RN, CRNP, FAAN, senior director of education for the American Association of Colleges of Nursing (AACN) in Washington, DC. "We are looking at outcomes of care, quality of care and safety and the impact the CNL is making."

The CNL role evolved from a nationwide need to improve efficiency in healthcare, reduce medical errors and boost the overall quality of patient outcomes. Back in 2002, the AACN began to convene a series of task forces to examine what the nursing profession could do to address those needs.

"One of the things we found was most nurses were working at such a frantic pace and facing a multitude of tasks in a very busy system," Stanley explains. "They didn't have the time or expertise to fully understand what was going on with patients within a complex system and how to effectively make changes to improve care."

That led to a list of competencies and skills for a master's degree-prepared CNL - someone closely involved in a unit's daily clinical activities but not necessarily providing hands-on care.

This nurse would be an advanced generalist; someone to oversee and coordinate care, assess risks, evaluate outcomes and have authority to change care plans, if necessary.

Today, about 110 nursing schools nationwide are preparing Clinical Nurse Leaders in graduate-level programs, and Stanley estimates there are 1,100 certified CNLs already working in healthcare settings.

Many healthcare organizations are still trying to get their feet wet when it comes to using CNLs, says Heather M. Monaghan, MHSc, RN, president of Visioning HealthCare, a Sarasota, FL-based education and consulting firm.

"Some CNLs have actually left the role," Monaghan says, "because it might not be as clearly defined within the organization as the roles of advanced practice nurses, educators and specialists."

Clinical Nurse Leaders differ from advanced practice nurses in that CNLs are considered advanced generalists as opposed to having a specialized focus such as cardiology, oncology or diabetes.

"A CNL is more educated in physical health assessment than a baccalaureate-prepared nurses would be, but they are not specialists," Monaghan explains. "They would refer patients to someone like the cardiology nurse practitioner if they felt there was that need."

In simple terms, the CNL is a leader at the point of care.

"They don't have the hierarchical authority of an administrator," Monaghan says. "They are not managing personnel or budgets. They are truly leaders in coordinating care, and they lead through a position of knowledge and influence."

And like NFL quarterbacks, who take cues from the coach and relay them to the team, Clinical Nurse Leaders are keenly aware of the organization's agenda, policies and goals. Their job is to bring those to the unit level and see they are carried out.

They are confident in their ability to speak out and advocate for patients and nurses, being assertive without being too aggressive. And because CNLs are authorized to alter patient care plans, they can make immediate changes.

What's more, the CNL is in a position to identify risks and certain clinical outcomes that would benefit all patients.

"Because of their role as a coordinator of care and their close connection to a unit," Monaghan says, "they have the facts and the knowledge that can lead to overall change in clinical outcomes and patient safety."