A nursing career offers daily opportunities to make a difference in the lives of patients and their families in a wide variety of clinical and educational settings. A clinical nurse specialist (CNS) can impact patient care, nursing practice, and organizations or whole communities in their practice.
A Multifaceted Role
A CNS is an advanced practice nurse who is highly skilled in direct patient care, clinical research, and managing change across systems and organizations. While the field of nursing encompasses all these areas, the CNS is highly trained in each one and may practice across all three at the same time.
“The role of the CNS is unique because they have the big picture view of patient care, the health care organization and the entire field of nursing,” says Deborah Garbee, PhD, APRN, ACNS-BC, FCNS, Associate Dean of Professional Practice, Community Service & Advanced Nursing Practice, and the Adult Gerontology CNS Program Director.
A CNS typically specializes in one population, disease state or body system, or specialty area. For example, a CNS might focus on geriatrics, oncology, pulmonary, palliative care or critical care. Because of the advanced educational and clinical training a CNS completes, they are poised to demonstrate best practices in patient care and train other nurses on such practices. In these ways, a CNS can help improve the quality of nursing care provided in their department or specialty area.
Evidence-based care requires the use of the best available research to provide quality care and support changes in clinical protocols. A CNS is also trained in clinical research and various data collection and analysis methods. Whether CNSs use observations from their own patient interactions or collect data throughout a facility, a CNS can translate research findings to the bedside, tailor an individual patient’s care based on the research evidence or make systemwide decisions, including innovations in care.
“Often, CNS projects lead to decisions that impact patient outcomes and hospital budgets,” says Jennifer Manning, DNS, ACNS-BC, CNE, Associate Dean for Undergraduate Nursing Program, Program Director of the Baccalaureate Articulation Program and Associate Professor of Clinical Nursing.
Implementing change is another part of the CNS’s role in any health care organization. A CNS practices as part of an interprofessional team advancing best practices to improve patient outcomes. They are trained to understand how systems work, from departments to hospitals to entire health care organizations. A CNS will often undertake a project to identify the root causes of a problem, suggest an evidence-based solution, present that solution to the administration and implement and evaluate it once the solution is approved.
Many Opportunities to Make an Impact
The exact role of a CNS can look different in various settings. “Prospective CNS students should visit the National Association of Clinical Nurse Specialists (NACNS) website to get a true sense of all that the CNS role encompasses,” Dr. Manning says.
On any one day, a CNS might treat patients, consult on complex patient care, identify best practices, support nurses and other staff with training, conduct clinical research, meet with administrators and stakeholders and implement new protocols in a wide variety of clinical settings.
A CNS may not directly supervise staff but rather works in collaboration with people across all levels of the organization to improve nursing care and patient outcomes.
“People can get confused about the role of a CNS because it is so unique. They might wear a lab coat and attend a meeting with hospital administrators, but then they are also seeing patients and doing clinical research,” Dr. Manning says.
A CNS can have the greatest impact on health care delivery by solving problems at the organizational level. A reduction in the average length of hospital stays, for example, will almost always bring down costs. A CNS might discover that the cause of lengthy hospital stays is an inefficiency in admissions and discharges. By proposing and implementing a streamlined discharge process that does not compromise patient care, a CNS could help the hospital conserve resources it can then make available to other patients who need them. By coordinating transitions in care, a CNS can impact patients’ and families’ understanding and adherence to management plans and prevent hospital readmissions.
The Path to Becoming a CNS
The CNS program at LSU Health New Orleans School of Nursing is based on the NACNS Doctor of Nursing Practice (DNP) competencies, Adult Gerontology Clinical Nurse Specialist (AGCNS) Competencies, and the DNP Essentials. It prepares students to take the certification exam and meet requirements for an advance practice registered nurse (APRN) license and prescriptive authority.
Those who enter the Adult Gerontology CNS program must have a bachelor’s degree in nursing and at least one year of experience in acute care.
“Students have to complete the three Ps: advanced health assessment, advanced pharmacology, and advanced pathophysiology along with other core DNP courses. Then, the AGCNS students enroll in the AGCNS courses,” Dr. Manning says.
“A majority of our program is taught by specialists in their area. Students learn pathology from a pathologist and statistics from a PhD-prepared statistician. And we do a lot of individual instruction,” Dr. Garbee says, noting some of the unique features of the School of Nursing’s CNS program.
The program assigns preceptors, advanced practice professionals who guide students through the transition between learning and doing, a little differently than other programs.
“We assign preceptors instead of making students find their own. This takes a burden off the students and allows us better control over the consistency of quality education we are delivering,” Dr. Garbee says.
The option to collaborate on research studies and present posters at the NACNS conference is also part of the program. Students may attend national policy conferences and LSU Day at the Capitol. “Faculty go along with students to let them see what the experience of lobbying for health care policies is really like,” Dr. Garbee says.
Valuable Additions to Hospitals, Clinics and Communities
Many of the School of Nursing’s AGCNS students earned their bachelor’s degree at LSU and come from New Orleans or the surrounding areas. But even students who come from out of state for the program tend to stay in the area after they graduate.
“Our clinical practicum experiences give students a chance to learn in different settings and gives local employers a chance to get to know our students. Many of our AGCNS graduates have job offers by the time they graduate,” Dr. Garbee says.
Improving patient care and access to health care makes CNSs a valuable resource in any community. In communities with nursing schools that offer a CNS program, local health care facilities that serve as clinical experience sites know firsthand the value a CNS brings to the organization.
“In our CNS program, students are trained to demonstrate the fiscal impact of their work,” Dr. Manning says. “Local hospital and health care administrators have evidence that CNSs reduce costs.”
Often, changes at the clinical level can have a positive effect on the whole community.
“A CNS will take a hospital problem, like elevated fall rates, and do everything necessary to get those rates down,” Dr. Manning says. With reduced fall rates, hospital stays are shorter, patient outcomes are better and hospital costs are lower.
“There is a need and openings in our local area, and we have the capacity to grow our AGCNS program to accommodate more applicants.” Dr. Garbee says. “Providing more AGCNSs with a high-quality, hands-on education to local employers is one important way the School of Nursing impacts our community.”
Facts About Clinical Nurse Specialists
- The CNS role was developed in 1956 by Hildegard Peplau, RN, EdD, who established the first master’s degree program in clinical nursing practice.
- Clinical Nurse Specialists hold master’s or doctoral degrees (or both) in nursing.
- Approximately 72,000 Clinical Nurse Specialists practice in the United States.
- There are three spheres of impact for CNSs: Patient, Nursing and Organization/System.
- Most CNSs impact outcomes on at least one or two units if not the entire facility.
- Most practicing CNSs spend an equal amount of time providing direct patient care, teaching nurses and other staff, and consulting with other nurses.
- CNS practice outcomes can include:
- Improved pain management practices
- Reduced medical complications in hospital patients
- Reduced hospital costs
- Reduced frequency of emergency room visits
- Reduced hospital readmission rates
- Reduced hospital length of stays
- Reduced central line infection rates
- Reduced fall rates
Source: National Association of Clinical Nurse Specialists nacns.org