Advancing Nurse Practice — Clinical Nurse Specialists , For Example By Robin Koeppel and Amanda Williams
Registered nurse ( RNs ) have many prospects for growth and professional advancement . Opportunities include advancing at the bedside , progressing in nursing leadership , and becoming an advanced practice nurse . This article will review the advanced practice nurse role , specifically the role of the Clinical Nurse Specialist ( CNS ), and will feature personal stories of two CNSs .
What is an Advanced Practice Registered Nurse ? An advanced practice registered nurse ( APRN ) is a RN who is master ’ s or doctoral prepared for a specific role and population . There are four roles that a nurse may choose to become an APRN : Nurse Practitioner , Nurse Midwife , Nurse Anesthetist , and Clinical Nurse Specialist . The APRN is a licensed independent provider who practices within a scope and standard of practice that is established by a licensing body and may practice in many environments including the hospital setting , community , and outpatient clinics ( DeNisco , 2021 ). APRNs are an important part of the healthcare team and allow the RN greater practice autonomy .
Why Choose the Clinical Nurse Specialist Role ? The CNS is a critical APRN role that has been part of the healthcare system for more than 60 years ( NACNS , 2021 ). Supported by the National Association of Clinical Nurse Specialists , the CNS role has an impact on care in three spheres of influence : the patient / family , the nurse / nursing practice , and organizations / systems . The spheres of influence are intended to define the pertinent stakeholders and consumers of CNS services .
The CNS is an expert clinician whose practice may focus on population ( neonatal , pediatrics , geriatric , women ’ s health , etc .), setting ( critical care or emergency room ), a disease or medical subspecialty ( psychiatric or rehabilitative ), or a type of problem ( pain , wounds , stress ) ( NACNS , 2021 ). The CNS has unique and advanced level competencies to meet the increased needs of vulnerable populations , improve quality of care , and reduce cost in the healthcare system ( NACNS , 2018 ). Meeting those needs requires knowledge and experience to provide clinical expertise with advanced knowledge , skill , and leadership . The CNS advances nursing knowledge and practice to improve patient outcomes . The care provided by the CNS can vary widely from direct care ( diagnosis , treatment , and ongoing management of patients ), health promotion and teaching , improving and role modeling evidence-based nursing practice , driving practice changes at the bedside and throughout the organization , and acting as change agents to transform systems .
CNS practice authority varies from state to state based on each state ’ s adoption of the APRN Consensus Model ( NCSBN , 2021 ). In some states , the CNS has full practice and prescriptive authority and may see patients independently . Other states have written agreements specifying the scope of practice of the CNS . Find more information about your state ’ s CNS practice authority on the board of nursing website .
Why would YOU choose to be a CNS ? The CNS role is the ultimate clinical nursing practice expert . CNSs are passionate about all aspects of patient care ; from best practice to prevent a central line-associated bloodstream infection ( CLABSI ) to implementing innovative modalities for patient education . The CNS is the person who questions the “ why ” of routine nursing care practices and the “ how ” of evidence-based practice protocols . The CNS provides both direct patient care and impacts care indirectly by modeling / mentoring other RNs . If your passion is bedside nursing care practice , the CNS role is for you !
What are the challenges in performing the role ? Working within complex systems can be challenging and at times frustrating , especially for the fastpaced work of the CNS . Impacting clinical outcomes takes patience and perseverance ; the job is a marathon , not a sprint .
The CNS improves patient outcomes , according to multiple published reports . For example , CNSs have been associated with decreasing complications following cardiac surgery in adult patients ( Soltis , 2015 ) and implementing quality improvement projects to decrease hospital acquired infection ( Gabbard et al ., 2021 ). In the NICU ( and in other