General Facts about the CNS Role:
Clinical Nurse Specialists (CNS) are licensed registered nurses who have master’s preparation in nursing.
*Clinical Nurse Specialists are expert clinicians in a specialized area of nursing practice. The specialty may be identified in terms of a:
• Population (e.g. pediatrics, adult-geriatrics, women’s health)
• Setting (e.g. critical care, emergency room)
• Disease or Medical Subspecialty (e.g. diabetes, oncology)
• Type of care (e.g. psychiatric, rehabilitation)
• Type of problem (e.g. pain, wounds, stress)
Clinical Nurse Specialists may practice in a variety of health care settings (primary, secondary, and tertiary).
Clinical Nurse Specialists may provide direct patient care, however they exert a significant influence on care outcomes by consulting with nursing staffs and by implementing improvements in health care delivery systems.
CNS practice is conceptualized across three spheres in which the CNS exerts influence:
• Nursing standards and nursing personnel
One of the hallmarks of CNS practice is advanced specialization within nursing. Further, the advanced specialization is a narrowing and deepening of focus of the autonomous practice of nursing as defined and protected by RN licensure in each state. A critical attribute of all CNSs, regardless of specialty, is that they possess advanced knowledge of both the basic science and the nursing science underpinning the specialty. The CNS applies that knowledge to the assessment and diagnosis of illness, defined as the subjective experience of discomfort (ANA, 2004, p. 48).
Additionally, the following are examples of how CNS applies that knowledge in advanced practice competencies:
• Deliver, design, and test nursing interventions to prevent, lessen, or alleviate illness experiences
• Assure patient safety.
• Improve the quality of nursing care.
• Perform systems analyses.
• Conduct cost-benefit analyses.
• Advance evidence-based nursing practice.
Traditionally, professional assessment of CNS core and/or specialty knowledge and skills has been conducted through the use of national examinations with evidence of sound psychometric properties. However, alternative mechanisms exist to create additional strategies for professional validation with equivalent psychometric soundness. National Association of Clinical Nurse Specialist (NACNS) states that verification of CNS knowledge and competencies requires three (3) multilevel indicators:
1) Education: The CNS must graduate from nationally accredited masters or doctoral program that provides entry-level knowledge and competencies in a specialty area of CNS practice. All CNS education programs must provide a broad based foundation of advanced knowledge, as well as specialty knowledge.
2) Validation of core CNS knowledge and competencies: Core CNS knowledge and competencies are validated with a psychometrically sound and legally defensible assessment method. This may be accomplished through examination or other psychometrically sound and legally defensible assessment methods.
3) Validation of CNS specialty practice knowledge and competencies: Validation of the additional knowledge and competencies in the specialty practice is needed. This may be accomplished through specialty examination or other psychometrically sound and legally defensible assessment methods, such as a portfolio process administered by a testing service, like ANCC, and reported to State Boards of Nursing, like current exam scores are reported (ANA/Black, 2004).
Our curriculum is based on the American Nurses’ Credentialing Center’s (ANCC) requirements for CNS certification. Please be aware that other organizations have different requirements for certification that this program may not meet. Please visit the ANCC web site to investigate your opportunities with regard to certification.
Clinical Nurse Specialist Core Competencies (Back to Top)
NACNS has published a Statement on Clinical Nurses Specialist Practice and Education (2nd E) (2004) in which core CNS competencies are listed. The core competencies are summarized/paraphrased below and can be found on pages 25-26 of the publication.
1) Use knowledge of illness and treatments in order to prevent or alleviate illness.
2) Design, implement, and evaluate innovative programs of care to achieve desired quality, cost-effective nurse-sensitive outcomes.
3) Serve as a leader, consultant, or mentor in advancing nursing practice to achieve outcomes among nursing personnel and within an organization.
4) Use evidence based practice to direct care and improve outcomes.
5) Lead multidisciplinary teams to collaborate and attain outcomes across continuum of care.
6) Manage resources and provide leadership in a system to support the delivery of nursing care.
7) Generate nursing knowledge to maintain expert clinical competencies for desired outcomes.
8) Demonstrate fiscal responsibility in a healthcare system by focusing on health policy, resource management, and cost effective outcomes of nursing care.
(Statement on Clinical Nurse Specialist Practice and Education, pages 25-26).
Clinical Nurse Specialist Certification* (Back to Top)
The USA CON CNS program offers CNS preparation as an Adult/Gerontological. Sub-specialization for the Adult/Geron CNS in the area of advanced oncology is available through the DNP program at USA. Please see the DNP webpage for more information on that program. Sub-specialty preparation for areas such as critical care, pulmonary is not currently available. We also do not offer specific preparation for CNS certification exams available through other agencies such as the American Association of Critical Care Nurses.
The American Nurses Credentialing Center offers CNS certification exams for certain specialties. For some specialties, for example Women’s Health, no exam currently exists. If you wish specific information on the requirements for ANCC certification as a CNS, please contact that agency directly or visit their web site. For a complete list, please see the ANCC web site under CNS certification (http://www.nursecredentialing.org/).
*Changes in certification company's requirements may necessitate the College of Nursing having to alter the curriculum for students enrolled in the program. The college will make every attempt to minimize the effect on students, but may need to add courses, etc. to ensure the program remains in compliance with any new standards.
Clinical Hours (Back to Top)
There are 540 clinical hours within the curriculum. You will work with Clinical Nurse Specialist (CNS) preceptors to experience the five roles of the CNS and three spheres of influence. The roles of your clinical preceptor will reflect the objective of the clinical experience.
The five roles that you will be expected to focus clinical experiences around include:
• Clinical Expertise/Practice