A Specialized Look at the Role and the Position of the Clinical Nurse Specialist

A Specialized Look at the Role and the Position of the Clinical Nurse Specialist

Clinical Nurse Specialists (CNSs) are registered nurses (RNs) that have earned an advanced degree in nursing and are essential members of the healthcare team. CNS's are experts in a particular clinical practice and valuable learning resources that help increase quality of care to the health care system. CNSs use clinical expertise and knowledge in the delivery of evidence based nursing interventions in order to provide high quality of care to patients with particularly complicated or multifaceted problems. The following is a summary of CNS's roles, historical evolution, education and licensure requirements in differing states, as well as the future of the CNS in the healthcare system.

CNSs are skilled clinicians who work in dedicated areas of nursing within the healthcare system. They may practice in many different settings including hospitals, clinics, consultations, education, and in research laboratories. Improving patient care and practice standards according to evidence-based outcomes is a major role of the CNS at all healthcare levels. The CNS has a versatile role that includes providing direct patient care, improving patient outcomes, providing leadership to establish program improvements, and influencing health care delivery services (Hamric, Hanson, & Spross, 2009).

The physician shortage in the 1960's increased the need for cost effective care and consequently lead to the advanced degree of the CNS. According to the American Nurses Association, the CNS was formally accepted as an expert who required a master's degree in 1970. The role of the CNS was first developed by the National League for Nursing Education in the 1940's. Today, over 73,000 RN's are qualified to practice as a CNS (Chitty & Black, 2007).

2

Running head: CLINICAL NURSE SPECIALIST

With the sudden increase in technology and intricate patient problems facing the healthcare system, the specializations within the CNS role will become even more important.

States such as South Carolina and Mississippi vary in how they define the CNS role and the requirements for licensure. The South Carolina Nurse Practice Act (1976) recognizes CNSs as advanced practice nurses (APNs) who must be licensed RNs and certified in specialties. In South Carolina, CNSs hold at least a Master's degree. They may perform delegated medical acts with physician direction and prescribe medication (South Carolina Nurse Practice Act, 1976). In Mississippi, CNSs are licensed RNs who provide expert care; a Master's Degree or higher is required. However, Mississippi does not recognize the CNS as an APN (Mississippi Nursing Practice Law, 1972). To challenge state regulations, The National Association of Clinical Nurse Specialists (NACNS) argues that some state guidelines for this role should be modified. The NACNS does not support requirements for CNSs to hold a second license to practice, unless they desire prescriptive rights or perform duties that extend beyond that of an RN. They do not agree that the APNs should acquire certification in the form of an examination in specialty areas. The NACNS is concerned that certain state guidelines will alter the scope of practice for the CNS role and create obstacles (Lyon, 2003).

Hamric's early work for conceptual framework for advanced nursing greatly emphasized the CNS. Hamric, along with minor revisions from Spross and Hanson, proposed a framework that would apply to all APN specialties by combing three primary criteria with seven fundamental competencies. The first realm contains three primary criteria: Graduate education, certification in a specialty of choice, and practice that focuses highly on patient and family care. The second realm consists of the seven fundamental competencies: adequate research skills, clinical leadership, collaboration, decision-making skills, adept coaching, guidance and

3

Running head: CLINICAL NURSE SPECIALIST

consultation. Without conquering each realm, a CNS would be vulnerable to environmental elements that affect APNs (Hamric, et al., 2009).

Hamric's Integrative Model of Advanced Practice Nursing encompasses all the competencies needed to carry out each of the numerous roles of the CNS. These core competencies include expertise in direct clinical practice, consultation, collaboration, expert coaching skills including guidance, advanced research skills including utilization and evaluation, skills in ethical decision-making, clinical and professional leadership, and proficiency as a change agent (Spross & Lawson, 2009). These competencies are the fundamentals of all advanced nursing professions. CNSs can use Hamric's model to articulate the value of the profession. Clinical, professional, consultative, and collaborative leadership skills are all CNS competencies and attributes. The central competency in Hamric's model is the direct care of patients and families and appraises all