(Feldman & Greenberg, 2005, p. 219) These were necessary requirement in the 90's. Now in an ever increasing age of need for more highly educated professional, the Clinical Nurse Leader armed with a Master's degree or better, is more adapted to handle a wide range of situations and create a fulcrum from which to balance all the staff in a given unit.

Literature Review

Clinical Nurse Leader

Kennedy, M.S.. (2004) Introducing the Clinical Nurse Leader. American Journal of Nursing, 104 (10), 22.

This article is a report regarding the decisions calling for a new role for nurses. The American Association of Colleges of Nursing (AACN), held an extraordinary January 2004 meeting to take action regarding recommendations of its Task Force on Education and Regulation for Professional Nursing Practice,. The result was that they passed a resolution calling for a "new nursing professional for generalist practice," (2004, 22) the clinical nurse leader (CNL), This position would be required to hold a minimum of a masters degrees. Although the AACN views the role of the CNL as different from that of the clinical nurse specialist, the National Association of Clinical Nurse Specialists does not and this has become a political hot bed of controversy regarding the roles that each play in the leadership of a department.

Mccabe, S. (2005). I Don't See No Line. Perspectives in Psychiatric Care, 41(2), 79-88

Although mainly concerned with Opsychitric care Mccabe's article assists with the understand of the CNL position as it is evolving into the new practice of medicine as well as keeping a well educated staff present in the hospitals setting without relying solely on interns and doctors for that level of care.

Perhaps we are watching the start of an evolution. An iterative process that is bringing the pendulum of masters-level nursing back to the center. National movements are calling for the development of a generalist masters-prepared nurse, the Clinical Nurse Leader degree (AACN, 2003). Discussions of a nursing practice doctorate are increasingly gaining favor (AACN, 2004). (Mccabe, 2005, p. 88)

He does note that the lines may be a little blurred at the start of the movement towards increasing the effect that a nurses may have on the overall health of patients. He does emphasize that the lines do need to be drawn between such level of supervision as charge nurses, LPN, RN and so on so that there is no misunderstanding along the way.

Mccabe, S., & Burman, M.E. (2006). A Tale of Two APNs: Addressing Blurred Practice Boundaries in APN Practice. Perspectives in Psychiatric Care, 42(1), 3-19

Here Mccabe with Burnam further address the confusion over the roles and the myriad titlesl that have appeared in the nursing community as well as the often less evident but significant confusing issue in practice, that of blurred supervisory boundaries as indicated in the previous article..

It would seem that, given the alphabet soup asserting specialization in APNs, the scope and boundaries of their specific roles would be clear. But they are not. The boundaries of APN practice are increasingly blurred, enough so that many of us are unable "to see the line" that forms the boundary of our professional practice in the real world of clinical care. (Mccabe & Burman, 2006, p. 3)

Nursing has started to evolve down a path of what appear to be extremes,. While there are very clear and succinct specialization on the one hand there is also the "decreasing specialization on the other hand with the development of the clinical nurse leader (CNL) degree" (2006, p. 16). The further development in educational priorities for nursing has also led an increase in nurses earning a doctorate in nursing practice (DNP). This further heightens the discussions of roles, standards and practices as well as what constitutes the core of APN practice.

Until we can provide an answer to the question of whether or not our artificially derived roles produce the most efficacious outcomes, we will not know where the APN future lies, nor how to best grow our science and identity. (Mccabe & Burman, 2006, p. 18)

Nelson, R. (2005)T he Clinical Nurse Leader -- Needed or Not? American Journal of Nursing, 105 (12) 24-25,

The main focus of this article is a report which explores the initiative of the American Association of Colleges of Nurses (AACN) which has the potential to change the nurses role in supervision and education creating the need for minimally a master degree as well as a doctoral degree.

The AACN proposed the development of a new nursing role, that is, the clinical nurse leader (CNL), in 2003. A CNL will require a master's degree in nursing and will have to design, implement and evaluate client care by coordinating, delegating and supervising the care provided by the health care team, including licensed nurses, technicians...

Some nursing leaders and organizations have embraced it, but others have questioned its validity and usefulness. (2005, p. 25)
Education

Feldman, H.R. & Greenberg, M.J. (Eds.). (2005). Educating Nurses for Leadership. New York: Springer.

Feldman and Greenburg have written a seminal book on the topic of supervision and nursing tht help to expand and explain the necessary educational components of this evolving field. There are many types of systems and truing for this field, however, the authors promote the use of the case method:

using real life case studies in the classroom and clinical set- tings (Ashby, 1999; Wilson & Porter-O'Grady, 1999). This complex and progressive learning is a continuous process that occurs throughout one's career (Aroian, Meservey, & Crockett, 1996; Grossman & Valiga, 2000; Wilson & Porter-O'Grady, 1999). (Feldman & Greenberg, 2005, p. 6)

The authors realize that not all case studies can cover all scenarios so there have been many improvements by nursing broads and colleges to create clinical scenarios based on specific events to attempt to broaden their educational venues. For a clinical nurse leader this is crucial since there will be more to that role than merely facts and prescriptions, but also necessary will be the ability to cope with various multi-dimensional situations.

Leadership skills, such as visioning, strategic planning, embracing diversity, fostering interprofessional relationships, and networking, take on critical significance for the rural nurse, physician, or public health professional. These professionals are often alone or part of a small team of experts available within a geographic region. To succeed in improving health, professionals must be able to work together effectively and collaborate with community members in a mean- ingful way. The community-based (Feldman & Greenberg, 2005, p. 192)

In the current environment of the medial profession it is imperative that the person in the role of professional nurses acquire the leadership skills necessary to positively influence this new and constantly chaining environment.

These skills are vital for them to make an impact, considering the powerful relationship between leadership strength and influence. One characteristic of effective leaders is attainment of for- mal preparation and educational credentials in addition to work and life experience. (Feldman & Greenberg, 2005, p. 219)

Staff Nurses. (2007). Nursingworld.org. Retrieved February 15, 2009, from American Nurses Association Web site: http://nursingworld.org/EspeciallyForYou/stafftesting.aspx

Clinical nurse leader general

This site provided a great deal of general insight and information into the postion of clinical nurse leader that is already in place. The Registered Nurse / Clinical Leader supervises the delivery of nursing care provided by professional and support nursing staff on a designated unit. The Registered Nurse / Clinical Leader prescribes, coordinates and delegates care utilizing the nursing process which is integrated into the multidisciplinary treatment team plan of care. The Registered Nurse / Clinical Leader is accountable for nursing care activities on a shift basis and is responsible for promoting and enhancing professional nursing practice on the unit.

Women & Children Care

Knorr, R.S., Condon, S.K., Dwyer, F.M., & Hoffman, D.F. (2004). Tracking Pediatric Asthma: The Massachusetts Experience Using School Health Records. Environmental Health Perspectives, 112(14), 1424-1439.

This article concerned a specific case study regarding pediatric asthma and the various and complex needs of the patient from diagnosis to maintenance. It involved a survey of children with asthma in grade k to 8 Academic year in the Massachusetts public school system. The schools in the Essential School Health Service (ESHS) program are required to have a full-time master's-prepared district nurse leader coordinating the health activities of that district's schools.

The target population included 958 public schools in 173 cities and towns (111 school districts) serving more than 395,000 children, or approximately 57% of Massachusetts's K-8 students.

Mitchell-DiCenso, a. And Guyatt, G. (1996) a Controlled Trial of Nurse Practitioners Ii Neonatal Intensive Care / Pediatrics 98 (6), 1143.

The article by Mitchell-DiCenso and Guyatt reviews the economic reasoning behind using Nurse practitioners, Nurse Leaders, etc. In the neonatal department of a hospital. While in a perfect word economics should always be the last resort in providing adequate heatlh care, the authors are practical and review the findings by comparing nurse leaders in charge vs. internists and pediatric residents. There are two major factors at play in these decisions. One is the fact that…