The perinatal nurse leader (PNL) is an expert nurse clinician who is accountable for patient care outcomes by designing, implementing, and evaluating processes based on evidence-based practice (EBP). The PNL collaborates across health care organizations with physicians, certified nurse-midwives, nurse practitioners, clinical nurse specialists, and additional members of the interdisciplinary team to oversee lateral integration of care.

The American Nurses Association states that the nurse leader "[p]romotes effective relationships . . . to achieve quality outcomes and a culture of safety" (American Nurses Association, 2021, p. 97). The PNL focuses on the specialties within the field of perinatal nursing to enable timely, efficient, and effective patient-centered and family-integrated care. The goal of the PNL is to help strategize ways to reduce disparities and optimize equitable outcomes.

The PNL facilitates positive birth outcomes by ensuring that evidence-based perinatal care guidelines are embedded into the standard of care expected from nursing staff. These standards are supported by leading nursing organizations, including the National League for Nursing, American Nurses Credentialing Center, American Nurses Association, Association for Nursing Professional Development, American Organization for Nursing Leadership (AONL), and Association for Nursing Leadership. The AONL emphasizes the importance of leadership development, stating, “An important component of leadership development is defining the content and scope of desired and necessary leadership competencies” (Hughes et al., 2022, p. 437).

The mission and current strategic goals of the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN, 2024a) reflect a foundational commitment to perinatal education. This commitment is demonstrated by emphasis on implementing knowledge from EBP, education, and research to empower and support nurses who care for women, pregnant and postpartum people, newborns, and their families.

As the role of the PNL continues to evolve, there is a growing need for clarity around its responsibilities and required competencies. The PNL must navigate emerging challenges, integrate new EBPs, and adapt to ongoing innovations in perinatal care. This guide serves as a valuable resource by defining the expectations for PNLs, outlining clear educational pathways, and establishing competency requirements. It promotes a baseline of core knowledge, skills, and competencies necessary for PNLs to lead quality improvement (QI) initiatives, safety programs, and regulatory compliance efforts. Additionally, the guide supports professional development, helping PNLs grow in their roles while advocating for equity and inclusive practices. By reducing variability in practice and enhancing leadership effectiveness, this guide empowers PNLs to drive higher quality care, improve patient outcomes, and elevate satisfaction in the perinatal environment.

Historically, nurse leaders, often holding titles such as lead or charge nurse, were primarily responsible for assigning shift work, and nonnursing executives managed operations and policy development in nursing. Over time, as health care evolved, the role of nurse leader expanded beyond these traditional responsibilities. Today, with limited nursing resources and a shortage of experienced leaders, often individuals with little or no obstetric (or leadership) knowledge have assumed leadership roles in perinatal settings. As a result, some may be unprepared to meet the specialty's complex and evolving needs. Modern nurse leaders are now expected to be scientists, innovators, advocates, and educators—often balancing these responsibilities simultaneously (Azar, 2021). Additionally, a PNL often is expected to work at the bedside to fill the staffing gaps. With all these responsibilities, the leader must be flexible while being focused and intentional in their movements.

Today, the role of nurse leader is recognized as having enough complexity to need specific college training to prepare the leader for service. In 2007, the American Association of Colleges of Nursing proposed the clinical nurse leader (CNL) as a formal nursing role. The association supported the development of the CNL nursing role, and academic programs demonstrated that CNL training improved nurse and patient satisfaction (Sotomayor & Rankin, 2017). However, the CNL role has not been widely adopted as a standard in health care facilities. Considering this and the long statute of limitations for neonatal malpractice and maternal-infant care claims, the leader must have a working knowledge of quality and safety measures for the practice (Evans & Reiser, 2004).

The role of the PNL requires a broad foundation of knowledge, skills, and attitudes to effectively lead perinatal teams while demonstrating expertise and earning recognition as a trusted expert among peers. The PNL may enter the role with varying levels of nursing experience, education, and leadership competencies. The PNL should obtain specific knowledge and competencies to enable effective communication and relationship management, navigate the health care environment, apply business skills and principles, and maintain professionalism (AONL, 2022). The PNL should be an expert clinician in perinatal practice.

As expert clinicians transition into the roles of PNLs, certifications and advanced degrees can help to promote their expertise in the specialty. Employers may require or recommend that individuals in the PNL position possess specialty and/or board certification.

Specialty certification prerequisites vary based on academic preparation, clinical practice hours, and specific practice requirements. Certifications that may be applicable to the PNL include but are not limited to the following:•

Inpatient Obstetric Nursing (RNC-OB)

•

Inpatient Antepartum Nursing (RNC-IAP)

•

Maternal Newborn Nursing (RNC-MNN)

•

Low Risk Neonatal Intensive Care Nursing (RNC-LRN)

•

Neonatal Intensive Care Nursing (RNC-NIC)

•

Obstetric and Neonatal Quality and Safety (C-ONQS)

•

Electronic Fetal Monitoring (C-EFM)

•

Critical Care Registered Nurse—Neonatal (CCRN)

•

International Board-Certified Lactation Consultant (IBCLC)

•

Certified Lactation Counselor (CLC)

•

Certified Nurse Manager and Leader (CNML)

•

Certified in Executive Nursing Practice (CENP)

•

Nurse Executive Certification (NE-BC)

•

Nurse Executive Advanced Certification (NEA-BC)

•

CNL Certification

The level of academic education on entry varies greatly among nurse leaders. The Master of Science in Nursing or above is the preferred degree for PNLs. Graduate-level education provides advanced knowledge to effectively manage health care teams, address health care issues in the clinical environment, and improve health care delivery. It is recognized that other nurse leaders may have undergraduate preparation of associate or baccalaureate degrees in nursing paired with extensive perinatal nursing experience and certification. Health care employers should support the continued academic advancement of nursing staff who have demonstrated expertise and are interested in leadership roles.

The PNL may hold titles such as manager, director, or similar titles to underscore their leadership capacity in clinical practice. Perinatal nurse leaders oversee all dimensions of the various perinatal services. They function to provide visionary leadership to a multigenerational workforce in the current dynamic and fast-paced health care arena. Leaders communicate clearly and build vital relationships in the professional community to effectively develop and achieve organizational, state, and national strategic initiatives. The PNL is encouraged to hold a deep understanding of the clinical practice environment and remains prepared to adjust priorities in response to emerging patient needs.

A leader will be challenged to adopt a transformational leadership style to navigate the multiple current health care crises in the perinatal setting (e.g., maternal morbidity and mortality rates, unconscious and systemic bias). Therefore, a vital component of the leader's skill set is experience with successful change management leadership.