Advanced Practice Nursing

My Ideal Role: A Critical Care Clinical Nurse Specialist

Angela C. Larson, PhD, MSN


December 01, 2017

Are you a clinical nurse specialist? If so, there is an important note at the end of this article about the new draft national CNS competencies. Your input is needed!

Seeking a Greater Challenge

Since I was a little girl, I have had a passion for providing care and support to those in need. I can recall the stories my mother shared with me about her time spent as an operating room nurse. I found her stories fascinating and acknowledge that these stories influenced my decision to purse a nursing career.

Angela C. Larson, PhD, MSN.
Courtesy of Angela Larson.

After I graduated from nursing school, I practiced in critical care for 7 years as a bedside nurse. I realized during this time that I wanted more out of my practice. I wanted to combine caring for patients with leadership, quality improvement, teaching, and research. I was confident that this was what I wanted, but I was unsure what that job looked like. Did that type of job exist?

As I looked into my options, I discovered that I wanted to be an advance practice registered nurse (APRN). I could focus on making system and population changes to improve patient care and outcomes, while promoting the autonomy of the nursing practice.

The Clinical Nurse Specialist Role

Becoming a clinical nurse specialist (CNS) was the answer. CNSs are one of the four types of APRNs. We have graduate-level preparation (a master's or doctoral degree) in nursing. Like other APRNs, CNSs are trained in physiology, pharmacology, and physical assessment, but CNSs are also trained in a specific specialty. A CNS's specialty may be defined by:

  • Population (such as pediatrics, geriatrics, or women's health);

  • Setting (such as critical care, or emergency department);

  • Disease or medical subspecialty (such as diabetes or oncology);

  • Type of care (such as psychiatric or rehabilitation); or

  • Type of problem (such as pain, wounds, or stress).

I began my coursework in 2008 at Widener University in Pennsylvania on the emergency care/critical care CNS track. I knew I had found the perfect career for me because being a CNS would allow me to combine all of the elements I love about the nursing profession while remaining in a hospital setting and continuing to work on practice; research; and improving quality at the system, population, and unit levels, which I am truly passionate about.

In May 2017, I graduated from Widener University with my PhD in nursing science and research. After 6 years of hard work and perseverance, I achieved my ultimate goal of combining my enjoyment of the CNS role and love of research. Now I'm able to simultaneously pursue my passion for research and an understanding of the influences and perceptions of proficiency in new critical care nurses.

My Practice as a CNS

My CNS career began in Pennsylvania, where I was first a unit-based critical care CNS. Today, I'm a systems/population CNS in the adult intensive care units (ICUs) at the University of Florida Health Shands Hospital in Gainesville. I work closely with unit-based clinical leaders and assess their quality and practice issues. We focus on reducing hospital-acquired infections, falls, and pressure injuries, and on improving patient and nurse satisfaction and engaging in evidence-based practice initiatives and research projects. Our performance improvements are measured annually and are based on national benchmarks, and my responsibility is to make sure we meet these criteria.

Angela (left) with colleague Jill Bertrand, a Shands surgical clinical nurse specialist.
Courtesy of Angela Larson.

As a CNS, I help prepare the organization, nursing leadership, and staff for accreditation, regulatory compliance, and site surveys. I lead interdisciplinary and nursing teams, and I am an integral member of the nursing executive leadership team.

Much of my job is based on my ability to influence and collaborate. A day as a CNS at Shands includes working in each of my assigned ICUs to help ensure that we are delivering exceptional patient care. I also work on system-wide initiatives that will make an impact on care delivery, patient safety, and nursing practice.

Although there's never a typical day, week, or month in the life of a CNS, I'm proud to be one of the 70,000 CNSs working across the country today!

Editor's Note: Public Comment on the Draft CNS Competencies

The National Association of Clinical Nurse Specialists (NACNS) has opened the public comment period for its 2017 Draft CNS Core Competencies. CNSs are one of the four types of APRNs, and these competencies will help shape CNS education and practice for years to come.

The NACNS Task Force for the Revision of the NACNS Statement on Education and Practice, a panel of CNS experts in education, practice, and research, developed the draft competencies, streamlining them while incorporating new concepts and language.

The individual competencies are oriented to align with the Consensus Model for APRN Regulation: Legislation, Accreditation, Certification and Education (2008) and differentiate CNS practice from that of non-APRN doctors of nursing practice (DNPs) and clinical nurse leaders.

We'd like CNSs from around the country to provide feedback. To do so, follow the link to this news release on the comment period, where you can leave your comments. The public comment period will close January 8, 2018.


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