What is a Clinical Nurse Specialist (CNS)?

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Clinical nurse specialists (CNS) are advanced practice registered nurses (APRNs) that serve as experts in evidence-based nursing practice within one of a number of different specialty areas. They integrate their advanced knowledge of disease processes in assessing, diagnosing, and treating patient illnesses, but their role extends beyond providing patient care.

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The fundamental goal of clinical nurse specialists is to provide safe, qualify, and cost-effective specialty care, all while working to improve the healthcare system from within. The American Association of Colleges of Nursing (AACN) recognizes clinical nurse specialists as playing a unique role in the clinical environment, as they have a decided focus on trying to identify new ways to positively influence healthcare delivery.

Clinical nurse specialists work in a variety of clinical practice areas, specializing in one or more of the following:

  • Population (pediatrics, women’s health, geriatrics, etc.)
  • Type of care (psychiatric, rehabilitation, etc.)
  • Type of problem (wound care, pain management, etc.)
  • Disease/medical subspecialty (oncology, diabetes, etc.)
  • Setting (critical care, emergency, etc.)

The Value of Clinical Nurse Specialists to the US Healthcare System

As direct care providers, clinical nurse specialists perform health assessments, order diagnostic and laboratory tests and, in some cases, prescribe medications and provide pharmacologic and nonpharmacological treatments. However, the main focus of the profession is on designing, implementing, and evaluating both patient-specific and population-specific programs of care, providing leadership in multidisciplinary groups, and implementing alternative solutions that address problems and/or patient care issues.

Research shows a strong connection between the presence of clinical nurse specialists within a healthcare facility and safe, efficient patient care. The AACN reports that CNS practice has been linked to:

  • Reduced hospital stays
  • Reduced frequency of emergency room visits
  • Improved pain management practices
  • Fewer complications for hospitalized patients
  • Increased patient satisfaction

Clinical nurse specialists improve clinical outcomes by providing direct patient care and by serving as liaisons between the healthcare team and the patient and patient’s family, providing:

  • Consultation services
  • Care coordination
  • Expert communication
  • Quality monitoring

In addition to helping patients through direct patient care, the scope of practice for clinical nurse specialists includes diagnosing and treating illnesses, injuries, and disabilities.

Clinical nurse specialists also serve as expert consultants who lend their expertise to improve healthcare delivery within individual facilities, hospital systems, and integrated health systems. They also serve as researchers who oversee evidence-based practice studies and develop new research standards and protocols while striving to bring the newest knowledge into the clinical environment, bridging research findings and patient care.

Clinical Nurse Specialist vs. Clinical Nurse Leader: What’s the Difference?

Clinical nurse specialists (CNS) tend to be one of the more misunderstood APRN roles. One of the biggest reasons is that people tend to confuse clinical nurse specialists with clinical nurse leaders (CNL). While the focus of both CNSs and CNLs is on improving patient outcomes, they have distinctly different roles.

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A clinical nurse leader is a graduate-prepared RN that is focused on patient safety through evidence-based practice and quality improvement. As part of the interdisciplinary medical team, CNLs plan and implement care for the patient. Their job duties include providing population-appropriate care and serving as patient advocates. CNLs serve as leaders in the clinical environment, executing outcomes-based practice and quality improvements and managing the healthcare needs of clients.

Unlike the CNL, whose focus is on the microsystem (hospital units, outpatient clients, home health agencies, etc.), the focus of the CNS is on the macrosystem, which involves the patient, the practice of nursing, and the healthcare system as a whole. Therefore, CNSs usually manage clinical issues on more than one nursing unit, with an organization-wide focus, and assume a leadership role in the greater healthcare delivery system as well as the clinical environment.

While the CNL serves as a nursing generalist, the CNS serves as a specialist with advanced practice licensure, which in many states grants them prescriptive and diagnostic authority.

Further, while the CNL oversees the plan of care for individual clients or for a group of clients at the microsystem level, the CNS does the same while also keeping an eye on process improvements and potential health problems for the entire patient population they specialize in serving. In this way, clinical nurse specialists always give attention to considering new and more effective ways to approach complex problems.

Similarly, while the CNL oversees nurses within a unit, the CNS takes on more of a mentoring and consulting role with nursing professionals, communicating at the macrosystem level and across organizational systems. In this way, the CNS builds upon evidence-based practice to advance the nursing profession and translate evidence-based research into practice.

Clinical nurse leaders and clinical nurse specialists work harmoniously in a variety of settings, where patients would benefit from the expertise of both CNLs and CNSs.

What are the Credentials and Practice Requirements to Become a Clinical Nurse Specialist?

As APRNs, clinical nurse specialists must possess a Master of Science in Nursing (MSN) or higher to be eligible for national certification and state licensure.

The Commission on Collegiate Nursing Education (CCNE) accredits graduate-level CNS programs in the U.S. CCNE-accredited programs ensure the MSN program’s didactic and clinical components meet the minimum eligibility standards for taking the appropriate national certification examination.

Depending on state board of nursing licensing requirements, clinical nurse specialists would earn national certification in their chosen CNS population focus through either the American Association of Critical-Care Nurses (AACN) or the American Nurses Credentialing Center (ANCC):

  • Adult/gerontology
  • Family/individual across the lifespan
  • Neonatal
  • Pediatrics
  • Psychiatric/mental health
  • Women’s health/gender-related

Because clinical nurse specialists are licensed at the state level, each state board of nursing determines the scope of practice for clinical nurse specialists, including their authority to practice as independent providers and their prescriptive authority.

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