So You Want to Be a Clinical Nurse Specialist? Choose the Right Program

Melanie Kalman, RN, CNS, PhD; Ann E. Hendrickson, BS, MS, CNS (Adult/Geriatric) Student

Disclosures

March 18, 2013

In This Article

What Is a Clinical Nurse Specialist?

How much do you know about clinical nurse specialists (CNSs)? A CNS is an expert clinician who guides the care of the most complicated patients, mentors nurses, and promotes change within an organization. A CNS is a registered nurse who has graduated from a program of study at the master's or doctoral level that prepares the graduate to lead the organization in promoting quality, cost-effective care.

The knowledge and competencies required for this role include advanced clinical expertise, leadership, application of best evidence, collaboration, coaching, and the ability to implement change.[1] The CNS is a clinical expert in a particular area: for example, diabetes, wound care, critical care, or cardiac disease. CNSs practice in many different settings, such as hospitals, health departments, hospices, clinics, and private practices.

Role Confusion and Clarification

The nurse who wants to go back to school for more nursing education must decide whether the CNS role is the right match for his or her career goals. The CNS is one of many options for advanced nursing practice.

The CNS role was established at end of World War II, when Armed Forces nurses were permitted to pursue education under the GI Bill. At that time, if a nurse was an expert clinician, he or she was promoted away from the bedside. The CNS role was established to improve patient care by keeping clinical experts at the bedside.[2]

Because of similar-sounding names and some role overlap, other nursing roles, such as the recently described "clinical nurse leader (CNL),"[3] are sometimes confused with the CNS, yet these roles fundamentally differ (Table).

Table. A Comparison of the CNL vs CNS Role

Characteristic CNL CNS
General description
  • Clinician who brings a high level of clinical competence and knowledge to the nursing unit and serves as a resource for nurses.

  • Brings the newest evidence to nurses to ensure that patients benefit from innovations in care delivery.

  • Evaluates patient outcomes and has decision-making authority to change care plans when necessary.

  • Expert clinician in a specialized area of nursing practice.

  • Implements improvements in organizations and healthcare delivery systems.

  • Provides direct care to patients or expert consultation to nursing staff.

  • Integrates nursing practice with medical diagnosis and treatment of disease, injury, and disability.

  • May be part of a medical team.

Advanced practice nurse No Yes
Educational preparation Master's degree Master's or doctoral degree in a CNS program
Area of practice Nursing unit or area (eg, medical-surgical) Population (eg, geriatrics, women's health);
Specialty (eg, wound care, diabetes); or
Setting (eg, critical care, emergency department)
Primary focus Nurses, patients Nurses, patients, organizations

The CNS is an advanced practice registered nurse (APRN) who is educated at the master's level or higher as a clinical specialist. The CNS typically manages clinical issues on more than 1 nursing unit, with an organization-wide focus.[1] In contrast, the CNL is a generalist and is unit-based, where he or she typically takes patient assignments.[3]

The CNS as Advanced Practice Registered Nurse

The CNS is 1 of 4 APRN roles, along with certified registered nurse anesthetist (CRNA), certified nurse-midwife (CNM), and nurse practitioner (NP). The goal of the CNS is continuous improvement of nursing care and patient outcomes. Although the CNS might have direct contact with patients, the primary focus of the role is on providing leadership and education and identifying needed changes in nursing practice. In contrast, NPs work directly with patients in the hospital or clinic setting, providing comprehensive care and diagnosing, treating, and managing patients with acute and chronic illnesses. NPs also provide health promotion and counseling to patients.[4]

The Value of the CNS in the Current Healthcare Climate

Administrators employ CNSs because in the current healthcare environment, CNSs promote patient safety, facilitate evidence-based nursing practice, and promote staff retention. Administrators recognize that with the Centers for Medicare & Medicaid Services reductions in reimbursement for preventable injuries, the knowledge and skill sets of CNSs are needed. Furthermore, CNSs frequently lead the hospital's efforts to attain Magnet status, promote change to improve quality in an organization, provide cost-effective patient outcomes, and reduce length of stay and complications.[1]

In a critical review of the literature, Moore and McQuestion[5] reported that patients receiving breast care from a CNS reported significantly higher levels of satisfaction than those receiving care from general practitioners. Several studies showed that length of hospital stay was significantly shorter, with fewer readmissions, in patients who were managed by a CNS. A CNS-led team of nurses reduced central-line associated bloodstream infection rates from 1.5 per 1000 persons to zero by implementing several prevention strategies.[6]

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