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The American Association of Colleges of Nursing (AACN) is committed to advancing professional nursing roles and highlighting the connection between well-educated nurses and quality health care. As a leading supporter of academic institutions that educate advanced practice registered nurses (APRNs), AACN is keenly aware of the direct link between graduate-prepared nurses and both patient safety and positive outcomes.
Within the APRN community, Clinical Nurse Specialists (CNSs) play a unique role in the delivery of high quality nursing care. These clinicians are experts in evidence-based nursing and practice in a range of specialty areas, such as oncology, pediatrics, geriatrics, psychiatric/mental health, adult health, acute/critical care, and community health among others. In addition to direct patient care, CNSs also engage in teaching, mentoring, consulting, research, management and systems improvement. Able to adapt their practice across settings, these clinicians greatly influence outcomes by providing expert consultation to all care providers and by implementing improvements in health care delivery systems. AACN supports the full definition of the Clinical Nurse Specialist outlined in the American Nurses Association's 2004 publication titled Nursing: Scope & Standards of Practice. (See Attachment A).
Further, the growing body of research on CNS outcomes shows a strong correlation between CNS interventions and safe, cost-effective patient care. CNS practice has been directly linked to reducing hospital costs and lengths of stay, reduced frequency of emergency room visits, improved pain management practices, increased patient satisfaction with nursing care, and fewer complications in hospitalized patients (Fulton & Baldwin, 2004). Given this strong connection to patient safety, AACN encourages hospitals and other health care providers to expand the use of Clinical Nurse Specialists and to engage these clinical experts to a greater extent throughout the health care arena.
AACN believes that Clinical Nurse Specialists play an important role in the provision of nursing care that does not duplicate the emerging role of the Clinical Nurse Leader (CNL). In terms of focus, CNLs are educated as generalists while CNSs are prepared for specialty practice. The CNL operates primarily on the clinical microsystem level involving small, functional front-line units, while the CNS is engaged not only within the microsystem but also at the systems levels within three spheres of influence: client, personnel and organizational systems. The CNL coordinates and implements client care, while the CNS designs and evaluates patient-specific and population-based programs. The CNL evaluates and implements evidence-based practice while the CNS has the added responsibility of generating new evidence. The CNS and CNL roles are distinct and complementary (Spross et. al., 2004). AACN envisions that these clinicians will work collaboratively to ensure that patients receive the best care possible. (See Attachment B.)
The health of our nation rests on having an adequate supply of highly qualified nurses available to render care in many different capacities. Nurses are needed both at the point of care and in advanced practice roles to deliver care that is growing intensely more complicated. Essential within this nurse staffing mix is the Clinical Nurse Specialist whose role is fundamental to provide quality, safe and cost-effective specialty care across settings.
Approved March 13, 2006
American Nurses Association. (2004). Nursing: Scope & standards of practice. Washington, DC: American Nurses Association.
Fulton, J.S. & Baldwin, K. (2004, January/February). An annotated bibliography reflecting CNS practice and outcomes. Clinical Nurse Specialist, 18(1), 21-39.
Spross, J., Hamric, A., Hall, G., Minarik, P., Sparacino, P., Stanley, J. (2004, December).Working statement comparing the Clinical Nurse Leader and Clinical Nurse Specialist roles: Similarities, differences and complementarities. Washington, DC:
American Association of Colleges of Nursing.
The American Nurses Association's definition of a Clinical Nurse Specialist:
Clinical nurse specialists (CNSs) are registered nurses, who have graduate level nursing preparation at the master's or doctoral level as a CNS. They are clinical experts in evidence-based nursing practice within a specialty area, treating and managing the health concerns of patients and populations. The CNS specialty may be focused on individuals, populations, settings, type of care, type of problem, or diagnostic systems subspecialty. CNSs practice autonomously and integrate knowledge of disease and medical treatments into assessment, diagnosis, and treatment of patients' illnesses. These nurses design, implement, and evaluate both patient-specific and population-based programs of care. CNSs provide leadership in advancing the practice of nursing to achieve quality and cost effective patient outcomes as well as provide leadership of multidisciplinary groups in designing and implementing innovative alternative solutions that address system problems and/or patient care issues. In many jurisdictions, CNSs as direct care providers, perform comprehensive health assessments, develop differential diagnoses, and may have prescriptive authority. Prescriptive authority allows them to provide pharmacologic and nonpharmacologic treatments and order diagnostic and laboratory tests in addressing and managing specialty health problems of patients and populations. CNSs serve as patient advocates, consultants, and researchers in various settings.
American Nurses Association. (2004). Nursing: Scope & standards of practice. Washington, DC: American Nurses Association, p. 15.