A clinical nurse specialist is a healthcare worker who can provide expert
advice related to specific conditions or treatment pathways.
United States In the United States a CNS is an
advanced practice registered nurse, with graduate preparation from a program that
prepares CNSs. The National Association of Clinical Nurse Specialists announced
in July 2015 its endorsement of proposals for the Doctor of Nursing
Practice as the required degree for CNS entry into practice by 2030. According
to the Consensus Model for APRN Regulation, "The CNS has a unique APRN
role to integrate care across the continuum and through three spheres of
influence: patient, nurse, system. The three spheres are overlapping and
interrelated but each sphere possesses a distinctive focus. In each of the
spheres of influence, the primary goal of the CNS is continuous improvement of
patient outcomes and nursing care. Key elements of CNS practice are to create
environments through mentoring and system changes that empower nurses to
develop caring, evidence-based practices to alleviate patient distress,
facilitate ethical decision-making, and respond to diversity. The CNS is
responsible and accountable for diagnosis and treatment of
health/illness states, disease management, health promotion, and
prevention of illness and risk behaviors among individuals, families, groups, and
communities.". CNSs are clinical experts in a specialized area of nursing
practice and in the delivery of evidence-based nursing interventions.
A systematic review published in 2011 identified 11 studies from the US that
had looked at the possible effect of having CNS as part of the healthcare
team. The reviewers found some evidence of reduced length of stay and costs of
care for teams which included a CNS. Overview
CNSs work with other nurses to advance their nursing practices, improve
outcomes, and provide clinical expertise to effect system-wide changes to improve
programs of care. CNSs work in specialties that are defined by one of
the following categories: Population
Setting Disease or Medical Subspecialty
Type of Care Type of Problem
= Spheres of influence = There are three domains of CNS practice,
known as the three spheres of influence: Patient
Nursing personnel System
The three spheres are overlapping and interrelated, but each sphere possesses
a distinctive focus. In each of the spheres of influence, the primary goal
of the CNS is continuous improvement of patient outcomes and nursing care.
= Core competencies = Within the three spheres of CNS
practice, Sparacino identified seven core competencies:
Direct clinical practice includes expertise in advanced assessment,
implementing nursing care, and evaluating outcomes.
Expert coaching and guidance encompasses modeling clinical expertise while
helping nurses integrate new evidence into practice. It also means providing
education or teaching skills to patients and family.
Collaboration focuses on multidisciplinary team building.
Consultation involves reviewing alternative approaches and implementing
planned change. Research involves interpreting and using
research, evaluating practice, and collaborating in research.
Clinical and professional leadership involves responsibility for innovation
and change in the patient care system. Ethical decision-making involves
influence in negotiating moral dilemmas, allocating resources, directing patient
care and access to care. Although these core competencies have
been described in the literature they are not validated through a review
process that is objective and decisive. They are the opinion of some within the
profession. A set of core competencies has now been described and validated
through a consensus process that clearly defines the spheres of influence, the
synergy model and the competencies as defined by Sparacino. These core
competencies are now expected to be used in all educational programs and will be
revised in the coming years in order to be maintained as current and reflective
of practice. International perspectives
Historically, in North America, the CNS role developed within the acute care
setting. Currently, in addition to the traditional acute care setting, CNSs
practice in a variety of non-acute care settings.
In the Australian Health System, however, a clinical nurse specialist
refers to a promotional position, rather than a qualification.
References