Objective: The Institute of Medicine's Future o f Nursing report identifies the Clinical
Nurse Leader (CNL) as an innovative and necessary new role for meeting higher
healthcare quality standards. The American Association of Colleges of N ursing CNL
White Paper defines core competencies necessary for practice. The lite rature
documents preliminary evidence of im proved outcom es associated with CNL
integration into clinical microsystem s. However, the CNL role is n o t y e t clearly
defined in term s of fundamental activities and responsibilities necessary to produce
outcom es. Lack of practice claritylimits the ability to articulate, implement, and
m easure CNL-specific practice and outcom es. The p urpose of this stu d y w as to
clarify CNL practice components contributing to improved quality care standards.
Methods: An interpretive synthesis w as conducted to integrate th e e x tan t CNL
literature into a coherent understanding of CNL practice. A literature search w as
conducted in CINAHL, Pubmed, Dissertations and Theses, and Google. Results w ere
review ed and included if they described aspects of CNL practice in action. Thirty
implementation reports, eight qualitative/mixed m ethods studies, three
quantitative studies, and 254 conference abstracts were included. G rounded theory
methodology w as utilized to reanalyze primary CNL evidence and identify domains
and components of CNL practice.