Bruin Brief 2022-01-14: MECN-CNL Program

What Distinguishes the UCLA MECN Program is the CNL Dimension

The UCLA School of Nursing distinguishes itself among master’s-entry nursing programs. Integrated into the master’s program (MSN) are the competencies that prepare graduates for Clinical Nurse Leader (CNL) certification.  It’s a special combination suited to the needs of the clinical world. Our story has a beginning, a middle, an end, and a possible positive future.

 The Clinical Nurse Leader Role

The American Association of Colleges of Nursing (AACN) introduced the Clinical Nurse Leader (CNL) in 2003. The vision of the CNL as a masters-prepared nurse who serves as a leader was designed to improve the quality of patient care. Specifically, CNL competencies center on:

• Care coordination

• Participation in identification and collection of care outcomes

• Lateral integration of care for individuals and patient cohorts

• Accountability for evaluation and improvement of point-of-care outcomes

• Interprofessional communication and team leadership

• Risk anticipation for individual and patient cohorts

• Design and implementation of EBP

• Use of information systems and technologies to improve healthcare outcomes

• Stewardship and leveraging of human, environmental, and materials resources

• Advocacy for patients, communities, and the healthcare team

  • AACN (2013) Competencies and Curricular Expectations for CNL Education and Practice

The Beginning

MECN-CNL curriculum

UCLA School of Nursing crafted the MECN curriculum to prepare students as CNLs and welcomed the first MECN class in 2006. Graduates are eligible to sit for the Clinical Nurse Leader (CNL®) certification examination.

Initially, four leadership courses were part of the MECN curriculum. These courses were:

• N266: Health Systems and Organization

• N267: Health Policy

• N268: Health Systems Leadership

• N269: Population-Based Quality of Practice

 The Middle

MECN curriculum changes

In 2017-18, based on student feedback and faculty analysis of the leadership courses, faculty voted to incorporate content from N266 Health Systems and Organization into N269 Population-Based Quality of Practice.  It just made sense. The new course was retitled N269 Quality Improvement and Population-Based Quality of Practice. Course sequences were also revised. Students focused on developing leadership skills in N268 Health Systems Leadership (summer between 1^st and 2^nd year), learned care quality and patient safety measures and the QI process in N269 Quality Improvement and Population-Based Quality of Practice (fall 2^nd year), then proceeded to plan and implement a QI project during their Immersion course (winter 2^nd year), and finally enrolled in N267 Health Policy during their final quarter.

 When does a MECN graduate become certified as a CNL?

Students can take the CNL certification exam after they graduate, or they can take the exam in their final quarter of the MECN Program.  If they wait until after graduation, there is no time-limit on exam eligibility, so they can enroll for the CNL exam years after graduation if they choose.

 How does a MECN graduate become certified as a CNL?

The application is available on the Commission on Nurse Certification website.  After approval from the national office and a signed educational completion form from the school, the student is approved to take the exam.  The exam is offered at sites and times convenient for the student.  Registration for the next exam is March of 2022 with the exam “window” April 18, 2022-May 13.2022 The initial cost of taking the exam is $425.00; retakes cost $325.00 each and fees are subject to change.

 What are the exam components?

Students must prepare for specified content areas. Several resources for study are listed on the website under “exam resources”.

 Domain #1: Leadership (32% of exam) which covers:

• Horizontal leadership

• Healthcare advocacy

• Implementation of the CNL role

• Lateral integration of care services

• Patient assessment

• Ethics

• Domain #2: Clinical Outcomes Management (23%):

  • Illness-disease management

  • Health promotion and disease prevention and injury reduction / prevention management

  • Health care policy

• Domain #3: Care Environment Management (45%):

  • Knowledge management

  • Healthcare systems / organizations

  • Interprofessional skills and collaboration

  • Team coordination

  • Quality improvement and safety

  • Evidence-based practice

  • Healthcare finance and economics

  • Healthcare informatics

 The exam consists of 140 questions of which 130 are scored for the exam.  The other 10 are practice questions but the student will not be able to identify which questions are scored and which questions are practice. All questions should be answered.  The exam is reported on a scale between 150-500; a candidate must achieve a minimum passing scaled score of 350 or equivalent to 70%.

The End

We’re Not Meeting Program Benchmarks

The SON is not currently meeting our stated program outcome for CNL certification exam pass rates as stated in our program evaluation plan. Furthermore, few students are taking the exam.

 In summary, we have not met our benchmark of 80% of students taking the exam.

And we have a spotty record of students meeting the 70% pass rate when they do take the exam.

 The Possible Positive Future: Action Plan to Improve CNL Outcomes in the MECN Program

1. Analyze all MECN courses including assignments to map where and how CNL concepts are taught.

2. Increase faculty emphasis on CNL competencies in all MECN coursework. (Possibly include CNL competencies in all course syllabi).

3. Consider whether to require incoming MECN students to purchase the exam preparation book or app to use throughout the program.

4. Offer an exam prep to the students in spring after Comps are due

5. Consider appointing a seasoned faculty member certified as a CNL to serve as the CNL exam coordinator to increase students’ interest in taking the exam and improve student preparation for the exam.

6. Consult with the Curriculum Committee on whether the MECN program should be revised to become a Masters-Entry RN program instead of a program designed to prepare students for the CNL role.

Stay Tuned:  CNL outcomes will be reassessed in spring 2022.