With Sonoma County’s rich diversity and resources, it represents an important environment to monitor, address, and promote the improvement of a health care system frequently considered broken and ineffective. The University of San Francisco offers a graduate nursing degree at its Santa Rosa campus to focus on developing Associate and Bachelor Degree Nurses into Clinical Nurse Leaders at the Master’s level.

The Clinical Nurse Leader role is the first new nursing leadership role to be introduced in 40 years and is designed to bring leadership to the micro-system level of the health care system. Clinical Nurse Leaders are not managers but rather expert bedside nurses who provide leadership and problem-solving skills in addressing institutional, unit-based, and patient health care outcomes. Clinical Nurse Leaders focus on the delivery system to prevent fragmentation and discontinuous care.

The University of San Francisco North Bay’s MSN program for nurses is designed to prepare graduates in the role of the Clinical Nurse Leader (CNL). Graduates of the CNL program will understand the rationale for care and competently deliver this care to an increasingly complex and diverse population in multiple environments at the point of care across the lifespan with particular emphasis on health promotion and risk-reduction services.

The American Association of Colleges of Nursing (AACN) has called the Clinical Nurse Leader “the key to positive patient outcomes.” Clinical Nurse Leaders provide efficient and cost-effective patient care services as well as the leadership needed to repair fragmented care delivery across settings. Clinical Nurse Leaders are having a measurable impact on the quality of nursing services with practice settings reporting that Clinical Nurse Leaders are quickly making significant progress on raising patient, nurse, and physician satisfaction; improving care outcomes; and realizing sizable cost-savings.1

In 2008-09, USF CNL students provided Bay Area facilities with special project implementations in the areas of patient safety and falls prevention, patient and staff medication error reduction, patient-family outreach and education, wellness programs in the elementary school setting, infection-control monitoring, and health promotion for seniors. Each graduate student is required to spend 300 supervised clinical hours in the CNL role in order to graduate from the program and to apply for national certification as a CNL.

The University of San Francisco views the addition of trained Clinical Nurse Leaders to the local nursing workforce as a major step forward in the improvement of health care regionally. As current USF CNL student Sarah Mena notes, “Changing how nurses practice and provide care is the key to transforming the delivery of care system, increasing positive patient outcomes, and quality of care. These changes are vital to aligning health care fiscal goals with patient outcome goals. The new skills at the core of change within the current nursing system include clinical microsystems thinking, outcome management, and understanding of populations at risk and complexity of care.” North Bay CNL student and Santa Rosa Memorial Hospital RN Beth Harlan asserts, “I think you owe it to your patients to try and be as knowledgeable as you can, and you owe it to your profession.”

In a study published in the September 24, 2003 issue of the Journal of the American Medical Association (JAMA), Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a “substantial survival advantage” if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.2

In response to the evidence that higher-educated nurses lead to better patient outcomes, the University of San Francisco School of Nursing chose to be early adopters of the Clinical Nurse Leader role and decided to take the Clinical Nurse Leader master’s degree program to its downtown Santa Rosa campus in order to better serve the health care needs of Sonoma County. Currently 14 local nurses from Sonoma County hospitals are enrolled in USF’s Clinical Nurse Leader program and will graduate with a Master of Science in Nursing degree in summer 2010.

Nurses with an Associate Degree in Nursing may enroll in the program in January 2010, and those with a Bachelor’s Degree join the program in May 2010. For more information, please contact the University of San Francisco – Santa Rosa campus at (707) 527-9612 or www.usfca.edu/regions.

Judith F. Karshmer, Ph.D., APRN, BC is Dean and Professor, School of Nursing, University of San Francisco.


1. http://www.aacn.nche.edu/cnl/pdf/Brochure.pdf

2. http://www.aacn.nche.edu/Media/FactSheets/ImpactEdNP.htm