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For more than 50 years, clinical nurse specialists (CNS) have helped develop and advance the practice of nursing. Since the creation of the clinical nurse specialist advanced practice registered nurse (APRN) role, the profession has evolved along with changes in healthcare systems delivery models, the science of nursing, and patient needs across the continuum of care.
What remains constant, however, is that clinical expertise based on advanced knowledge of nursing science and a responsibility to identify areas of improvement and promote change within the healthcare delivery system are central to the clinical nurse specialist role.
The clinical nurse specialist profession ranked second in CNNMoney’s 2013 survey of the “Best Jobs in America,” thanks to the fact that salaries for these advanced clinicians generally range between $86,500 and $126,000, and because the US Department of Labor expects this advanced practice role to experience a job growth rate of 26 percent over the ten-year period leading up to 2022.
According to Johnson & Johnson’s Campaign for Nursing’s Future, clinical nurse specialists remain in high demand because they can provide specialized patient care for less than the cost of hiring a physician.
The Clinical Nurse Specialist Career: Spheres of Influence and Objectives
Clinical nurse specialist is counted among the four advanced practice registered nurse (APRN) roles, along with nurse practitioner, nurse-midwife and nurse anesthetist. What really sets the CNS role apart from other advanced clinical roles is that in addition to providing for the advanced clinical needs of patients, CNSs are also focused on designing, implementing and evaluating processes within the clinical environment with the goal of positively influencing the delivery of healthcare services.
Because clinical nurse specialists are experts in applying science to the nursing practice, their work includes the prevention and early detection of illness. These APRNs design new interventions that treat symptoms, functional problems, and complications of disease treatment. In fact, innovation in illness diagnosis and treatment remains one of the major hallmarks of the CNS practice, according to the National Association of Clinical Nurse Specialists (NACNS).
The clinical nurse specialist job is built around three major spheres of influence in which CNSs work to affect positive change:
- Patient/family
- Staff nurses
- Health organizations/systems
Their goal is to provide expert care to patients with complex conditions, guide other staff members to embrace process improvements, all with the ultimate goal of enhancing healthcare delivery within their immediate sphere of influence and for the entire patient population they serve. This is all accomplished by:
- Designing innovative, evidence-based interventions
- Influencing nursing practice
- Encouraging the healthcare system to support independent nursing practice
Clinical Nurse Specialist Roles and Patient Population Foci
Clinical nurse specialists influence and transform systems—whether influencing the healthcare system through process improvements in the clinical environment, or influencing the political-organizational system through policy changes. They consistently focus their work on achieving quality, cost-effective patient care in settings across the healthcare delivery continuum.
Clinical nurse specialists are able to be influential in many capacities and through many roles, including:
- Direct patient./family care
- Clinical supervision
- Consultation
- Systems leadership
- Teaching/coaching/mentoring
- Research
- Patient advocacy
- Performance improvement
- Leadership and professional development
Most CNSs jobs including working within a defined specialty population, such as:
- Population (pediatrics, women’s health, geriatrics, etc.)
- Type of care (psychiatric, end-of-life, rehabilitative, etc.)
- Type of problem (wound care, pain management, etc.)
- Disease/medical subspecialty (oncology, diabetes, etc.)
- Setting (critical care, operating room, emergency department, etc.)
Regardless of their patient population or specialty focus, CNSs use their clinical expertise to influence processes, policies, and the nurses they work with.
Clinical Nurse Specialist Job Description: The Duties, Responsibilities, and Competencies of the CNS
Clinical nurse specialists are licensed registered nurses that possess a graduate degree at the masters and/or doctoral level, and depending on the state, usually an APRN license. This advanced clinical training and authority puts them in a unique position to deliver care while also keeping an eye on opportunities for improving processes and interventions.
The National Association of Clinical Nurse Specialists (NACNS) recognizes that CNSs are responsible and accountable for the diagnosis and treatment of illness/suffering and risk behaviors among the individuals, families, groups, and communities they serve.
Where They Work, What They Do
A 2010 survey conducted by the NACNS revealed that more than 70 percent of all CNSs work with adult patients between 19 and 85 years of age.
The most common areas of practice identified by CNSs include:
- Cardiovascular
- Diabetic
- Psychiatric mental health
The NACNS survey also revealed that about 70 percent of all CNSs work in some type of inpatient hospital setting, while about a third worked in some form of adult acute/critical care clinical practice. Other clinical locations identified by survey respondents included:
- Home healthcare
- Long-term care/nursing homes
- Public health centers
- Ambulatory care
Clinical Nurse Specialist Core Competencies
According to the NACNS Statement on CNS Practice and Education (2004), all clinical nurse specialist jobs, regardless of specialty, should include performing the following Core Competencies:
- Using their knowledge of differential illness diagnoses and treatment in the holistic assessment of patients
- Designing, implementing, and evaluating individual and/or population-based programs of care to ensure quality and cost-effective outcomes
- Serving as leaders, consultants, mentors, and change agents to advance the practice of nursing among other nurses and across organizations
- Applying advanced nursing practice through specific evidence-based interventions and practice guidelines to direct the care of nursing personnel and other providers of healthcare to improve health outcomes
- Leading multidisciplinary groups in an effort to facilitate collaboration with other disciplines and improve outcomes across the continuum of care
- Providing leadership to ensure the successful delivery of nursing care
- Pursuing scientific knowledge and skills to expand the practice of nursing and maintain expert clinical competencies
- Focusing on health policy and/or resource management to ensure quality, cost-effective outcomes of nursing care
CNS Advanced Clinical Knowledge and Skills
The NACNS also recognizes that all clinical nurse specialists should also possess:
- Clinical expertise in a specialty, including advanced expertise in:
- Evidence-based assessments, risk behaviors, and treatments of illnesses
- Comprehensive assessment, differential diagnosis, and interventions to treat or prevent illness or disease
- Health promotion
- Human and organizational factors that affect cost and quality across the continuum of care
- Public policy and resources
- Leadership skills
- Collaboration skills
- Consultation skills
- Professional attributes, which include:
- Personal integrity
- Valuing and supporting diversity
- Knowing one’s strengths and weaknesses
- Honesty
- Ethical conduct
- Professional citizenship for the CNS specialty and in the profession of nursing, which includes contributing to healthcare policy at the local, state, and national levels